Genitourinary Radiology - Past Meetings

Transcription

Genitourinary Radiology
UR001-EB-X
A Guide to Penile Duplex Ultrasonography
All Day Location: GU/UR Community, Learning Center
Participants
Bipin Rajendran, MD, Richmond, VA (Presenter) Nothing to Disclose
Michael Maldonado, MD, Richmond, VA (Abstract Co-Author) Nothing to Disclose
John T. Roseman, MD, Richmond, VA (Abstract Co-Author) Nothing to Disclose
Uma R. Prasad, MD, Midlothian, VA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Penile duplex ultrasonography is a relatively safe, minimally invasive method for evaluation of a number of conditions, including but
not limited to Peyronie's disease as well as erectile dysfunction (ED) secondary to atherosclerotic or post-traumatic changes. Our
goals are to highlight our experience with this modality by sharing our institution's protocol and to demonstrate a few select cases
which highlight both normal sonographic findings as well as unique pathology.
TABLE OF CONTENTS/OUTLINE
1) Introduction to penile duplex ultrasonography2) Protocol3) Normal sonographic findings4) Sonographic findings associated with
Peyronie's disease5) Sonographic findings associated with erectile dysfunction secondary to atherosclerosis6) Unique sonographic
findings in a patient with erectile dysfunction secondary to prior pelvic trauma
UR003-EB-X
Renal Tumors with Low Signal Intensity on T2-weighted MR Image; Radiologic-pathologic Correlation
Participants
Youyeon Kim, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Deuk Jae Sung, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Na Yeon Han, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Ki Choon Sim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Beom Jin Park, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Min-Ju Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sung Bum Cho, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To review variable renal tumors which show low signal intensity on T2-weighted image.2. To explain the histopathologic features
that create the specific appearance on the MR image.3. To discuss the practicality of the MRI findings for the differential diagnosis
of the renal tumors.
Review of variable renal tumors with T2 low signal intensityImage findings of the tumors - AML - RCC Papillary RCC Clear cell RCC other rare tumors TCC Hemangioma Leiomyoma OncocytomaHistopathologic features associated low T2 signal intensity Smooth
muscle component Papillary structure High N/C ratio Hemorrhage Use of the MRI finding for the differential diagnosisSummary and
discussion
UR004-EB-X
Imaging of Renal Angiomyolipoma: It's Not All About Fat
Awards
Certificate of Merit
Participants
Haley R. Clark, MD, Dallas, TX (Presenter) Nothing to Disclose
Payal Kapur, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Ivan Pedrosa, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Technical considerations for US, CT, and MR when imaging renal angiomyolipoma (AML). 2. Correlation of histopatholgic subtypes
of renal AML with imaging characteristics. 3. Diagnostic pitfalls, including other renal malignancies which have overlapping MRI
imaging characteristics as renal AML.
Technical aspects: Ultrasound CT Non-contrast Contrast-enhanced Dual source MRI: 2D T1 IP/OP 3D T1 Dixon Spectral fat
suppression T2-weighted Contrast enhanced Diffusion-weighted Radiologic-Pathologic Correlation: WHO Classification of AML Classic
AML AML without visible fat AML with spontaneous hemorrhage AML status post embolization Enlarging AML Giant exophytic AML
Multiple AMLs in Tuberous Sclerosis AML in lymphangioleiomyomatosis AML with epithelial cyst (AMLEC) Epithelioid AML, pre and post
treatment with sirolimus Sclerosed epithelioid AML Diagnostic pitfalls: Fat containing clear cell renal cell carcinoma vs AML with
minimal but visible fat Papillary renal cell carcinoma vs AML without visible fat Retroperitoneal liposarcoma vs exophytic AML
Pseudo-angiomyolipoma after radiofrequency ablation Sclerosing extramedullary hematopoietic tumors
UR005-EB-X
Retroperitoneal Tumor and Retroperitoneal Fibrosis: CT and MR Characteristics and Pathological Correlative
Analysis
Participants
Keisuke Miyoshi, Ube, Japan (Presenter) Nothing to Disclose
Naofumi Matsunaga, MD, PhD, Ube, Japan (Abstract Co-Author) Nothing to Disclose
Masahiro Tanabe, MD, Ube, Japan (Abstract Co-Author) Nothing to Disclose
Takaaki Ueda, Ube, Japan (Abstract Co-Author) Nothing to Disclose
Sei Nakao, Ube, Japan (Abstract Co-Author) Nothing to Disclose
Yuko Harada, MD, Ube, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: 1. To review CT and MR imaging findings of various spectrum of retroperitoneal masses. 2. To
highlight key differential diagnostic points of imaging findings with pathologic correlation.
1. Introduction - anatomy, cellular origin, malignant potential. 2. Clinical features - epidemiology, clinical symptoms and prognosis.
3. Characteristic findings - neoplastic masses (mesodermal origin, neurogenic origin, germ cell origin, lymphoid or hematologic origin)
and nonneoplastic masses. 4. Key points for the correlation of radiologic and pathologic features.
UR007-EB-X
Ultrasonographic Appearance of Testicular Tumors: Ultrasonographic-Pathologic Correlation
FDA
Discussions may include off-label uses.
Participants
Yong-Soo Kim, MD, PhD, Guri City, Korea, Republic Of (Presenter) Nothing to Disclose
Sangjoon Lee, MD, Guri, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sanghyeok Lim, MD, Gyeonggi-do, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To understand the ultrasonographic features of testicular tumors on the pathologic basis. 2. To know ultrasonographic findings of
characteristic testicular tumors.
I. Germ cell neoplasm1. Seminoma2. Embryonal carcinoma3. Yolk sac tumor (adult, childhood type)4. Teratoma (Mature, Immature,
With an overtly malignant component)5. ChoriocarcinomaII. Mixed germ cell tumorsIII. Sex cord-stromal neoplasms1. Leydig cell
tumor2. Sertoli cell tumorIV. Mixed germ cell-sex cord-stromal neoplasmsV. Tumors of "passenger" and non-Leydig, interstitial
cells1. Lymphoma2. Leukemic infiltrates3. Miscellaneous others, including epidermoid cysts, mesenchymal tumors, and metastatic
tumors
UR008-EB-X
Cystogram "A Forgotten Study"
Awards
RSNA Country Presents Travel Award
Participants
Julian Ramirez Arango, MD, Mexico City, Mexico (Presenter) Nothing to Disclose
Mary C. Herrera-Zarza, MD, Mexico City, Mexico (Abstract Co-Author) Nothing to Disclose
Luis A. Ruiz Elizondo, MD, Mexico City, Mexico (Abstract Co-Author) Nothing to Disclose
Alin Marissa Becerril Ayala, MD, Mexico City, Mexico (Abstract Co-Author) Nothing to Disclose
Jose L. Criales, MD, Huixquilucan, Mexico (Abstract Co-Author) Nothing to Disclose
Kenji Kimura, MD, Mexico City, Mexico (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Even though there are great advances in urologyc imaging, the cystogram continues to be the imaging method of choice for some
pathologies, and its the radiologist duty to make a correct diagnostic impression through this method.Cystogram is highly efective,
has easy access, low cost and is minimally invasiveThe correct interpretation of the cystogram by the radiologist decrease false
positive results and increase our diagnostic ability.
Table of contents /OutlineIntroductionCorrect cystogram techniquesNormal anatomy and its anatomical variantsUses and utilities of
cystogramCommon pathologies diagnosed by this method
UR100-ED-X
Imaging of Gerota's Fascia
Participants
Jun Isogai, MD, Asahi, Japan (Presenter) Nothing to Disclose
Naoki Harata, Asahi, Japan (Abstract Co-Author) Nothing to Disclose
Katsuya Yoshida, MD, Asahi, Japan (Abstract Co-Author) Nothing to Disclose
Jun Kaneko, Hasuda, Japan (Abstract Co-Author) Nothing to Disclose
Tassei Nakagawa, MD, PhD, Asahi, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To understand interfascial spread of a wide variety of disorders in retroperitoneal Gerota's fascia.
Anatomy of retroperitoneal interfascial planes. CT or MRI findings of various interfascial disorders in Gerota's fascia.
Pneumoretroperitoneum Pancreatic fluid / Bile / Urine collection Retroperitoneal hematoma Retroperitoneal abscess Tumor and
inflammatory extension of renal, pancreatic and colon diseases Malignant lymphoma Retroperitoneal dissemination of thoracic tumor
Primary retroperitoneal tumor
UR101-ED-X
Genitourinary Applications of Spectral CT
Participants
Nicholas L. Fulton, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Luis A. Landeras, MD, Cleveland, OH (Abstract Co-Author) Institutional Grant support, Koninklijke Philips NV
Jason DiPoce, MD, Jerusalem, Israel (Abstract Co-Author) Nothing to Disclose
Jacob Sosna, MD, Jerusalem, Israel (Abstract Co-Author) Consultant, ActiViews Ltd Research Grant, Koninklijke Philips NV
Prabhakar Rajiah, MD, FRCR, Cleveland, OH (Presenter) Institutional Research Grant, Koninklijke Philips NV
TEACHING POINTS
Dual energy/spectral CT scanners provide material characterization capabilities which improve diagnostic accuracy, without
increasing radiation. There are several techniques of dual energy CT, including a dual layer technology Spectral detector CT
enables retrospective generation of spectral images
-Spectral CT- Physics-Techniques of spectral CT-Phantom studies-Advantages and disadvantages of various implementationsGenitourinary applications of spectral CT with illustrations Stone characterization- Uric acid vs non uric acid Renal mass
characterization- virtual non contrast, iodine person, effective atomic number based images Adrenal mass characterization
Improved lesion detection and characterization Tumor perfusion and response to therapy Urinary stone in iodinated solution Virtual
non contrast in multiphasic studies- Radiation dose savings Urothelial tumor detection Artifact reduction
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Prabhakar Rajiah, MD, FRCR - 2014 Honored Educator
Jacob Sosna, MD - 2012 Honored Educator
Jason DiPoce, MD - 2013 Honored Educator
UR102-ED-X
Eponyms in Urogenital Radiology: Old Names, But Still Golden Nuggets
Participants
Daniel M. Figueira, Niteroi, Brazil (Presenter) Nothing to Disclose
Emanuela T. Freitas, MD, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Felipe B. Afonso, MD, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Joao A. Vianna, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Daniel G. Neves, MD, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Leonardo K. Bittencourt, MD, PhD, Rio De Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
- Eponyms were historically used in medicine for honorary and educational purposes, but their importance has been questioned in
the present, in favor of a more anatomical description of findings and diseases. However, a number of eponyms and 'auntminnies'
still constitute useful educational tools and mnemonics in radiology practice.- The urogenital system is rich in eponyms and
'auntminnies', which translate a variable sort of anatomical structures and conditions, such as: Gerota´s fascia, Zuckerckandl´s
fascia, Denonvillier´s fascia, Bertin´s column, Malpighi´s pyramid, Weigert-Meyer rule, Bricker surgery, Peyronie disease, etc.- The
objective of this work is to review the most well-known and relevant eponyms in urogenital radiology, along with a didatic and
illustrative approach, based on mnemonics and pattern recognition.
1 - What is an eponym? What is an 'auntminnie'?2 - The use of eponyms throughout medical history. Is there any role for them
today?3 - Eponyms and 'auntminnies' in the urogenital system: an illustrative and mnemonical approach- Anatomy: Gerota´s fascia,
Zuckerckandl´s fascia, Denonvillier´s fascia, Bertin´s column, Malpighi´s pyramid, Retzius´s space.- Malformations: Weigert - Meyer
rule.- Diseases: Conn´s disease, Wilms tumor, Peyronie disease.- Syndrome: Zinner´s syndrome, Bourneville syndrome.- Surgery:
Bricker Surgery.
UR103-ED-X
PIRADS v2: A Case-based Review of the New Categorization with Emphasis on Its Impact on MR Guided
Biopsy, Its Limitations and Pitfalls
Participants
Varaha Tammisetti, MD, Houston, TX (Presenter) Nothing to Disclose
Bijan Bijan, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Sadhna Verma, MD, Cincinnati, OH (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Review the new version of PIRADS with emphasis on changes from prior version and comparsion to similar other criteria. 2.
Illustrate case based examples of each of the PIRADS categories and pitfalls in categorization and interpretation. This will be in a
Prostate MR Rad-Path correlation format. 3. Limitations of current PIRADS version. 4. Illustration and review of literature on
utilization of PIRADS in each of the clinical settings with emphasis on its role in MR guided (direct or indirect by fusion) targeted
biopsy.
1. Clinical and technical considerations including 'clinically significant cancer', clinical scenarios and technical parameters2. Review
of relevant normal anatomy with illustration of each of the lexicon of normal and pathological terms.3. Overview of PIRADS v.2 with
review of changes and comparison to other criteria.4. Case based examples of each of PIRADS categories in Peripheral and
Transitional zones including benign findings such as prostatitis, asymmetric focal atrophy, periprostatic vessel, calcification, normal
central zone. Presented in a quiz format with Rad-Path correlation.5. Limitations of current PIRADS and also pitfalls. Current
utility/status of DCE.6. Case based examples on utilization of PIRADS in each of the clinical settings with emphasis on its role in MR
guided targeted biopsy.
Honored Educators
Sadhna Verma, MD - 2013 Honored Educator
UR104-ED-X
Prostate Cancer in the Transition Zone and the Anterior Fibromuscular Stroma: Clues to the Diagnosis in
Multiparametric MRI with Emphasis on Intraprostatic Patterns of Spread and the Relative Frequency of the
Locations
Awards
Magna Cum Laude
Participants
Hiroshi Shinmoto, MD, Tokorozawa, Japan (Presenter) Nothing to Disclose
Shigeyoshi Soga, MD, Tokorozawa, Japan (Abstract Co-Author) Nothing to Disclose
Chiharu Tamura, Tokorozawa, Japan (Abstract Co-Author) Nothing to Disclose
Kentaro Yamada, MD, Tokorozawa, Japan (Abstract Co-Author) Nothing to Disclose
Teppei Okamura, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Hiroko Tomita, Tokorozawa, Japan (Abstract Co-Author) Nothing to Disclose
Tatsumi Kaji, MD, Tokorozawa, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Although the diagnostic performance of multiparametric MRI in peripheral zone (PZ) prostate cancer has been improved up to
approximately 80 to 90% sensitivity and specificity, the diagnosis of transition zone (TZ) prostate cancer is still challenging. Thus,
the purpose of this exhibit is to present the patterns of intraprostatic spread and the relative frequency of the locations of
prostate cancer in the TZ and the anterior fibromuscular stroma (AFMS) based on 155 prostatectomy specimens with
multiparametric MRI data, and to provide diagnostic clues as to interpreting multiparametric MRI in TZ and AFMS prostate cancer.
Anatomy of the TZ and AFMS What is anterior prostate cancer (APC)? Clinical importance of APC Morphological features of TZ and
AFMS prostate cancer The relative frequency of the locations of TZ and AFMS prostate cancer Atypical locations of TZ prostate
cancer The non-cancerous AFMS and BPH mimicking TZ prostate cancer
UR106-ED-X
Multimodalityimaging Features of Sarcomas of the Abdomen and Pelvis with Radiologic-pathologic Correlation
Participants
Kara D. Gaetke-Udager, MD, Ann Arbor, MI (Presenter) Nothing to Disclose
Aaron M. Udager, MD, PhD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Katherine E. Maturen, MD, Ann Arbor, MI (Abstract Co-Author) Consultant, GlaxoSmithKline plc; Medical Advisory Board,
GlaxoSmithKline plc
Corrie M. Yablon, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
After review of this exhibit, the viewer will be able to: List the types of sarcoma that can occur in the abdomen and pelvis Describe
unique and shared imaging features of abdominal and pelvic sarcomas Identify imaging characteristics that aid biopsy planning
Explain how the pathologic appearance correlates with the imaging findings Understand the surgical considerations for abdominal
and pelvic sarcomas
Background Embryologic origin of soft tissue tumors Nomenclature of soft tissue tumors Surgical considerations Sarcomas of the
abdomen and pelvis For each tumor below, we will discuss: Demographics Clinical presentation Pathologic features Multimodality
imaging features Treatment options Types of sarcomas Well-differentiated liposarcoma De-differentiated liposarcoma Pleomorphic
liposarcoma Myxoid liposarcoma Undifferentiated high-grade pleomorphic sarcoma Leiomyosarcoma Extraskeletal osteosarcoma
Chondrosarcoma Ewing sarcoma Synovial sarcoma Alveolar soft part sarcoma Conclusions Challenge of overlapping imaging features
Pathologic features can be used to understand imaging and direct clinical management Imaging characteristics guide biopsy
decisions Importance of surgical considerations in radiology report
Honored Educators
Katherine E. Maturen, MD - 2014 Honored Educator
UR107-ED-X
Sonographic Assessment of Tumour Margins at Partial Nephrectomy (PN) - Intraoperative and Ex-Vivo.
Review of Technique
Participants
Naveed Altaf, MBBS, MRCS, Middlesbrough, United Kingdom (Presenter) Nothing to Disclose
Geoffrey P. Naisby, MBBS, Yarm, United Kingdom (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To review the technique of ultrasound control of resection margins in Patients undergoing PN - Both Intraoperative and ex-vivo.
2. To discuss the efficacy of this approach and its potential to demonstrate additional findings not seen on the preoperative
imaging which can modify surgery.
BackgroundIntraoperative ultrasound is a well-established technique routinely used to facilitate surgical resection during partial
nephrectomy.Technique: Ultrasound was performed using a 12MHz probe after mobilisation of kidney and for laparoscopic cases, a
laparoscopic USS probe was used. Tumour size and depth was mapped and area of excision marked with diathermy.Following
resection, the sample was evaluated in 3 dimensions, recording the closest margin between tumour and outer parenchymal edge.
Margins were considered free of tumour when a rim of healthy renal parenchyma was seen completely without a gap or tumour was
contained within the pseudocapsule.Discussion:In line with a previous reports of surgical specimen (ex-vivo) ultrasound in assessing
margin status for PN, we confirm the safety and efficacy of this approach in our single institution series. Patient characteristics,
operative indications, tumour and margin size were comparable to previous series.
UR109-ED-X
Multimodality Evaluation of Renal Transplant Vascular Complications
FDA
Participants
Behrad Golshani, MD, Sacramento, CA (Presenter) Nothing to Disclose
Wonsuk Kim, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Danny Cheng, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Catherine T. Vu, MD, Denver, CO (Abstract Co-Author) Nothing to Disclose
Ghaneh Fananapazir, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: To review common and uncommon renal transplant vascular complications across multiple imaging
modalities including ultrasound, MRI, CT, and conventional angiography. To discuss pearls and pitfalls related to uncommon renal
transplant vascular complications.
Background Renal transplant vascular anatomy Incidence of common and uncommon rental transplant vascular complications
Representative ultrasound, CT, MRA and/or digital subtraction angiography images of the following entities will be presented:
Tandem renal artery stenosis Renal vein stenosis Pseudo-renal artery stenosis External iliac artery stenosis External iliac vein
stenosis Renal artery thrombosis Renal vein thrombosis Extrarenal pseudoaneurysm Intrarenal pseudoaneurysm Arteriovenous fistula
Subcapsular hematoma
UR110-ED-X
Staging of Prostate Cancer: Tips Not to Miss an Extracapsular Extension Reported Posteriorly by the
Pathologist
Participants
Marta Drake Perez, MD, Santander, Spain (Presenter) Nothing to Disclose
Pedro Lastra Garcia-Baron, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Alejandro Fernandez Florez, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Ainara Azueta Etxebarria, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Elena Yllera Contreras, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Elena Lopez Uzquiza, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Gerardo Lopez Rasines, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To summarize the MRI signs of prostate cancer with extracapsular extension, with the histopathologic outcomes as the reference
standard. To emphasize the correlation between the imaging findings and the histopathological results. To review the cases where
the radiologic pathology correlation failed, giving a second look to the MRI and trying to figure out where the typical mistakes are.
- Importance of an accurate preoperative staging in prostate cancer.- MRI imaging protocol for prostate cancer in 3T magnet
without endorectal coil.- MRI criteria to determine extracapsular extension, using radical prostatectomy histopathology as the
reference standard. Irregular bulge in the prostatic capsule Broad capsular tumour contact (>12mm) Obliteration of the
rectoprostatic angle Obliteration of the vesiculoprostatic angle Asymmetry of the neurovascular bundle Evidence of direct tumor
extension- Common mistakes from our daily practice
UR111-ED-X
Retrograde Urethrogram: Anatomy, Pathology, and Repair
Participants
Franco Verde, MD, Baltimore, MD (Presenter) Nothing to Disclose
Lynda Mettee, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Edward J. Wright, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Martin Auster, MD, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Knowing anatomy of male urethra is critical for operative repair Know the appearance of stricturesKnow the surgical approach to
urethral disease and post-operative appearance on retrograde urethrograms
A. Technique a. Patient prep b. Equipment used c. Positioning and fluoro tipsB. Normal anatomyC. Pathology a. Stricture b.
TraumaD. Surgical approachE. Post-operative appearance a. Normal postop retrograde ureterogram b. Leakage c. Followup d.
Recurrent stricture
UR112-ED-X
Magnetic Resonance Imaging Evaluation of Urothelial Cell Carcinoma: Staging and Treatment Planning with
Histopathological Correlation
Participants
Peter A. Harri, MD, Atlanta, GA (Presenter) Nothing to Disclose
Courtney A. Coursey Moreno, MD, Suwanee, GA (Abstract Co-Author) Nothing to Disclose
Juan C. Camacho, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Pardeep K. Mittal, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is: Review basic principles of urothelial cell carcinoma (UCC). Describe the use of magnetic resonance
imaging (MRI) to differentiate UCC in the urinary system from other malignant and benign lesions. Demonstrate the use of MRI to
adequately stage UCC within the urinary tract and locate distant disease. Discuss the impact of MRI for accurate pre-surgical
evaluation and staging on management and treatment options.
Review common presentations of UCC, including key characteristics that define malignancy with histopathological correlations.
Review of UCC staging with MRI imaging findings. Discuss the impact of MRI for accurate pre-surgical evaluation and staging on
management and treatment options. Important concepts are illustrated with schematic diagrams. Emphasis is placed on practical
approaches and image pattern recognition. Conclusions: MRI plays a key role for noninvasive diagnosis of UCC and staging of the
tumor, especially for smaller lesions where surgical management can differ depending on the extant of invasion. Adequate
knowledge of UCC imaging features on MRI is crucial for appropriate and prompt patient intervention.
UR113-ED-X
Multiple Renal Masses: A Review of Causes with Emphasis on Differential Diagnosis
Participants
Mariano Volpacchio, MD, Buenos Aires, Argentina (Presenter) Nothing to Disclose
Christine O. Menias, MD, Scottsdale, AZ (Abstract Co-Author) Nothing to Disclose
Mario G. Santamarina, MD, Valparaiso, Chile (Abstract Co-Author) Nothing to Disclose
Joaquina Paz Lopez Moras, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Veronica Rubio, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Antonio Luna, MD, Jaen, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The goals of this presentation are: To review causes of multiple renal masses To discuss imaging findings of the different entities
To provide imaging-based clues useful to guide to the correct diagnosis
- Introduction- Etiology of multiple renal masses Hereditary Inflammatory and infectious Immunologic Vascular Neoplastic benign,
primary malignant, secondary malignant- Imaging findings specific to the kidney and associated findings of each entity - Differential
diagnosis cluesSummaryThe presence of multiple renal masses may be an isolated or dominant imaging finding as well as an
additional abnormality in the setting of multiorgan involvement.An imaging-based, multimodality approach may be crucial in the
differential diagnosis process as well as in patient management.Awareness of the imaging appearance of the various causes in
different imaging modalities and integration with other findings may result in a correct diagnosis in most cases as well as in assisting
in proper patient work-up and management.
Honored Educators
Christine O. Menias, MD - 2013 Honored Educator
UR115-ED-X
Pharmakinetic, Gadolinium and Technical Parameters Affecting Bolus Geometry during Contrast Enhanced
Renal MR Angiography: An Overview
Participants
Charbel Saade, PhD, Beirut, Lebanon (Presenter) Nothing to Disclose
Ghina Al Fout, Beirut, Lebanon (Abstract Co-Author) Nothing to Disclose
Batoul Dorkmark, Beirut, Lebanon (Abstract Co-Author) Nothing to Disclose
Fadi M. El-Merhi, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Hussain M. Almohiy, PhD, Abha, Saudi Arabia (Abstract Co-Author) Nothing to Disclose
Rayan Bou Fakhredin, Beirut, Lebanon (Abstract Co-Author) Nothing to Disclose
Bassam El-Achkar, MD, Beirut, Lebanon (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Optimal arterial hyperintensity is essential during MRA Matching scanning parameters such as TR, TE, Flip angle and parallel imaging
with with vessel dynamics significantly improves vessel hyperintensity This leads to increased arterial hyperintensity and reduced
venous hypointensity This can also lead to a reduced volume of Gadolinium based contrast agents. Reduced gadolinium-based
contrast volume can reduce tissue, technique and motion related artefacts This can also lead to reduced specific absorption rate
A. Renal Vascular Anatomy and flow dynamics B. Scanning parameters C. Contrast media parametersD. Linear vs. Macrocyclic
GadoliniumE. Parameters affecting bolus geomteryF. Transverse and Longitudinal relaxation ratio and its effect on signal intensityH.
Comparison between 1.5T and 3.0T scanning parameters
UR116-ED-X
What's Going On With My Kidneys? When Diagnosis is Challenging: Multimodality Imaging in Atypical Nephritis
Awards
Participants
Virginia Gomez, San Sebastian, Spain (Presenter) Nothing to Disclose
Juan Vega Eraso, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
Maria Carmen Biurrun Mancisidor, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
Gorka Arenaza Choperena, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
Gonzalo Vega-Hazas, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
Diana Garcia Asensio, Donostia, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To demonstrate the spectrum of imaging findings of upper urinary tract infections, with emphasis on certain rare entities where
little literature has been written about.To discuss the role of the different imaging techniques.To summarize the different risk
factors for developing UTI, describing some anatomical conditions mostly involved in recurrent nephritis.
While majority of UTIs are uncomplicated and can be diagnosed and treated based on clinical and laboratory data alone, imaging is
required in some clinical scenarios.Different imaging modalities include US, IVU, CT, MRI and we have to be aware of their potential
benefits and limitations.We will discuss some diagnostic classic signs and extrarrenal findings in typical scenarios. Thus, we will
emphasize and illustrate with cases in which there is no or little literature written about. Such conditions include renal tumors with
superimposed infection, atypical infection in kidney´s grafts, anaerobic germ infection associated to urinary stone, atypical form of
xantogranulomatous poyelonephritis, subcapsular abscesses...Finally, we will summarize the predisposing factors for developing UTI
and recurrent infections with different cases: anomalies on the collecting system and ureter, and anomalies on the position and
rotation of the kidney.
UR118-ED-X
The Added Value of Functional and Molecular Imaging of the Scrotum
Awards
Cum Laude
Participants
Sandra Baleato Gonzalez, MD, PhD, Santiago, Spain (Presenter) Nothing to Disclose
Roberto Garcia Figueiras, MD, Santiago de Compostela, Spain (Abstract Co-Author) Nothing to Disclose
Joan C. Vilanova, MD, PhD, Girona, Spain (Abstract Co-Author) Nothing to Disclose
Gabriel C. Fernandez-Perez, PhD, MD, Avila, Spain (Abstract Co-Author) Nothing to Disclose
Nuria Escudero-Garcia, Santiago de Compostela, Spain (Abstract Co-Author) Nothing to Disclose
Anxo Martinez De Alegria, MD, Santiago de Compostela, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The evaluation of scrotum has traditionally been made based on morphologic imaging. Recent developments in imaging techniques
have improved the ability to evaluate scrotal entities. Beside this, multiparametric magnetic resonance imaging (MRI) may combine
the information from different anatomical, functional and molecular imaging techniques, thus allowing an improved understanding of
scrotal pathologies. The aim of this exhibit is: To emphasis the added information of functional and molecular imaging for evaluating
the scrotum. To learn about the imaging findings of the scrotum based on different imaging techniques:dynamic contrast-enhanced
MRI (DCE-MRI), dynamic contrast-enhanced ultrasound (DCE-US), diffusion-weighted MRI (DWI-MRI), MR spectroscopy imaging
(MRSI),CT, PET, and US-elastography.
1.Clinical setting:1.1. Cryptorchidism1.2. Acute scrotum1.3. Non acute scrotum 1.3.1. Extratesticular lesion 1.3.2. Intratesticular
lesions 2. Ultrasound utilities2.1. DCE-ultrasound: evaluate acute scrotum.2.2. Elastography: characterization of lesions 3. MRI
utilities3.1. DCE-MRI: characterization of leisons3.2. DWI-W-BODY: staging and monitoring3.3 Spectroscopy: evaluate
spermatogenesis
UR119-ED-X
The Nuts and Bolts of the Acute Scrotum: A Multiple Choice Question Case-Based Review of Acute Scrotal
Pathology
Awards
Participants
Christina Ma, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Anokh Pahwa, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Michael J. Nguyen, MD, Santa Barbara, CA (Abstract Co-Author) Nothing to Disclose
Michael L. Douek, MD, MBA, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Steven S. Raman, MD, Santa Monica, CA (Abstract Co-Author) Nothing to Disclose
Maitraya K. Patel, MD, Sylmar, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Acute scrotal abnormalities commonly present to the Emergency Department; several conditions require emergent surgical
exploration by the urologist. With the help of the clinical history and physical examination, the radiologist can offer a specific
diagnosis and guide decision-making particularly regarding surgical intervention. This multiple choice question case-based review will
assist the radiologist at all levels of training better identify and diagnose these abnormalities and make appropriate
recommendations to the referring clinician.
Comprehensive multimodality imaging review of acute scrotal pathology in a multiple choice question format with pertinent
discussion of clinical presentation, management, and differential diagnosis. Cases will include a spectrum of acute scrotal
pathology: 1. Ischemia (testicular torsion, torsion of the appendix testis, testicular infarction); 2. Trauma (testicular rupture,
intratesticular hematoma, testicular contusion, hematocele); 3. Infection (acute epididymitis including tuberculous epididymitis,
abscess, Fournier's gangrene); 4. Testicular and extratesticular neoplasms (germ cell neoplasm, burned out germ cell tumor,
lymphoma, metastasis, liposarcoma of the spermatic cord); 5. Enlarged scrotum (scrotal wall edema, hydrocele, spermatic cord
hydrocele).
UR121-ED-X
Evaluation and Follow-up of the Complications of Urinary Tract Surgical Procedures: CT-urographic Patterns
Participants
Gianpiero Cardone, MD, Milano, Italy (Presenter) Nothing to Disclose
Maurizio Papa, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Paola Mangili, PhD, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Giuseppe Balconi, Ornago, Italy (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To review the most frequent urinary tract postoperative complications.To illustrate CT-Urographic patterns of urinary tract
postoperative complications.To describe the usefulness of CT-Urography in the diagnosis and follow-up of urinary tract
postoperative complications.
1) Most frequent urinary tract postoperative complications: Urinary leaks Uretero-vesical anastomosis dehiscence Ureterocutaneous
fistulas Bleeding / hematomas Peritoneal and retroperitoneal fluid collections Urinary tract stenosis 2) Best CT techniques in the
evaluation of urinary tract postoperative complications3) Conventional and urographic CT patterns of urinary tract postoperative
complications4) CT imaging follow-up of urinary tract postoperative complications CONCLUSIONS1) Ureteral lesions, retroperitoneal
hematomas and/or bleeding and fluid collections are the most frequent urinary tract postoperative complications2) Urographic
images combined with conventional CT imaging allow an accurate diagnosis and follow-up of urinary tract postoperative
complications3) Source axial images and MPR of the urographic acquisition show a better identification of urinary tract lesions4) 3D
MIP reconstructions are useful in summarising urographic axial images
UR122-ED-X
Infiltrative Renal Lesions in Adults - Spectrum of Disease
Awards
Identified for RadioGraphics
Participants
Lori M. Gettle, MD, MBA, Hummelstown, PA (Presenter) Nothing to Disclose
Uzma A. Rana, MD, MPH, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Nabeel I. Sarwani, MD, Hummelstown, PA (Abstract Co-Author) Nothing to Disclose
Cary L. Siegel, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Brent J. Wagner, MD, Reading, PA (Abstract Co-Author) Nothing to Disclose
Perry J. Pickhardt, MD, Madison, WI (Abstract Co-Author) Co-founder, VirtuoCTC, LLC; Stockholder, Cellectar Biosciences, Inc;
Research Consultant, Bracco Group; Research Consultant, KIT ; Research Grant, Koninklijke Philips NV
Thomas M. Dykes, MD, Hershey, PA (Abstract Co-Author) Researcher, Bayer AG
TEACHING POINTS
Review the differential diagnosis of infiltrative renal lesions in adults. Review imaging modalities and protocols used to evaluate
infiltrative renal lesions. Demonstrate the imaging features of benign and malignant infiltrative renal lesions.
Differential diagnosis of benign and malignant infiltrative renal lesions in adults. Imaging modalities and protocols to evaluate
infiltrative renal lesions. Ultrasound CT MRI PET-CT Imaging features of infiltrative renal lesions. Benign Pyelonephritis
Angiomyolipoma Infarct Contusion Malignant Urothelial carcinoma Lymphoma Less common renal carcinomas Metastases Renal
sarcoma
Honored Educators
Perry J. Pickhardt, MD - 2014 Honored Educator
UR123-ED-X
Imaging Features of Paratesticular Masses
Participants
Mustafa Secil, MD, Izmir, Turkey (Presenter) Nothing to Disclose
Michele Bertolotto, MD, Trieste, Italy (Abstract Co-Author) Nothing to Disclose
Laurence M. Rocher, MD, Kremlin Bicetre, France (Abstract Co-Author) Nothing to Disclose
Gokhan Pekindil, MD, Manisa, Turkey (Abstract Co-Author) Nothing to Disclose
Jonathan Richenberg, MRCP, FRCR, Brighton, United Kingdom (Abstract Co-Author) Nothing to Disclose
Lorenzo E. Derchi, MD, Genova, Italy (Abstract Co-Author) Nothing to Disclose
Parvati Ramchandani, MD, Merion Station, PA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To demonstrate the imaging findings of paratesticular masses 2. To illustrate the radiological features in correlation with the
pathological findings
Paratesticular masses are relatively rare lesions which include the non-neoplastic lesions, and benign or malignant neoplasms. Nonneoplastic lesions of paratesticular area include the tunical cyst, epididymal cyst, spermatocele, fibrous pseudotumor, spermatic
cord cyst, lipomatosis, and polyorchidism. Neoplastic lesions may either be benign or malignant. Benign neoplasms are lipoma,
adenomatoid tumor, leiomyoma, angioleiomyoma, angiomyofibroblastoma-like tumor, hemangioma and papillary cystadenoma.
Malignant neoplasms are mostly mesenchymal in origin, namely the rhabdomyosarcoma, liposarcoma, leiomyosarcoma, and
undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). Malignant mesothelioma, metastases due to various
primaries, lymphoma/leukemia and plasmocytoma. Imaging findings of these lesions are going to be be presented.
UR125-ED-X
MRI of the Scrotum : A Complimentary Tool or A Necessary Diagnostic Step?
Participants
Ahmed S. Soliman, MBBS, Doha, Qatar (Presenter) Nothing to Disclose
Maneesh Khanna, MBBS, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
Sushila Ladumor, MBBS, MD, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
Ahmed M. Sherif, MBBCh, FRCR, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To understand the: Scrotal anatomy on MRI and its imaging protocol.A review of MRI appearnce of a wide spectrum of scrotal
disease . To understand the importance of MRI in problem solving situations such as: -Differentiating stromal from non stromal
tumor. -Assessing tunica or epididymal involvement by the neoplastic lesion and evaluating retroperitoneum at the same time Understand the difference of imaging caracteristics between different types of testicular neoplasm in dynamic post contrast studies
and diffusion WI.
A. MRI anatomy of the scrotum . B.Technique of MRI of the scrotum : sequences and aim of each. C. Scrotal pathologies : 1.
Benign extratesticular lesions : Hematoma, Infection :TB epidydmoorchitis, Adenomatoid tumor, Dilatation of cowper gland etc. 2
.Malignant extratesticular: Sclerosing Liposarcoma of epidydmis . 3. Benign testicular -Chronic infarction,Testicular
abscess,Testicular contusion, tubular ectasia of rete testis, Stromal tumours such as Sertoli cell, Leydig cell and granulosa cell
tumour . Microlithiasis of the testis. 4. Malignant testicular : Seminomatous and non seminomatous germ cell tumour, lymphoma. D.
Role of enhancement characterictics (DCE curves) and DWI in differentiating testicular neoplasms- review of data of a series of
more than 10 intratesticular neoplasms .
UR126-ED-X
Ductal Adenocarcinoma of the Prostate: Imaging and Histopathological Features of this Unusual Suspect
FDA
Participants
Adam W. Jaster, MD, Dallas, TX (Presenter) Nothing to Disclose
Daniel N. Costa, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Ronaldo H. Baroni, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Franto Francis, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Neil M. Rofsky, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
Thais Mussi, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Ivan Pedrosa, MD, Dallas, TX (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this presentation is:1. To review the epidemiology, clinical findings and disease course of the ductal
adenocarcinoma of the prostate (DAP) in comparison with the more common acinar adenocarcinoma of the prostate (AAP);2. To
compare the unique and overlapping radiological (particularly MR imaging) features of DAP versus AAP with histopathological
correlation.
1. Ductal Adenocarcinoma of the Prostate (DAP) Epidemiology Clinical Features Diagnosis and Staging Clinical Management and
Outcomes2. MR Imaging of DAP and Histopathological Correlation Predominantly solid presentation Solid-cystic presentation
Predominantly cystic presentation3. Differentiating DAP from AAP and Mixed Tumors Table and illustrations summarizing the imaging
and histopathologic features common to both AAP and DAP and the findings favoring one subtype over the other4. Clinical
Implications Comparison of staging, clinical management, and outcomes of DAP and AAP (Table)5. Conclusions
UR127-ED-X
Calling All Kidneys! Sonographic Findings of Renal Pathology Beyond Hydronephrosis with CT and MR
Correlation
Participants
Dana E. Amiraian, MD, Jacksonville, FL (Presenter) Nothing to Disclose
Melanie P. Caserta, MD, Jacksonville, FL (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Ultrasound is an important imaging modality for evaluating the kidneys, and knowledge of sonographic abnormalities can help in
identifying and differentiating renal pathology. While not required for most uncomplicated cases of pyelonephritis, ultrasound can
help identify complications of renal infection, some of which require emergent intervention. There are various types of renal masses,
as well as many mass mimickers, and ultrasound is helpful in detecting and differentiating these entities. Ultrasound is useful for
identifying and localizing abnormal echogenic renal structures, which can usually be correlated on CT.
Review of renal ultrasound indications and normal anatomy on ultrasoundSonographic features of renal infection Pyelonephritis
Emphysematous pyelonephritis Pyonephrosis Xanthogranulomatous pyelonephritis Tuberculosis HIV nephropathy FungalApproach to
renal masses Mimickers Renal cell carcinoma Transitional cell carcinoma Lymphoma AngiomyolipomaEvaluation of echogenic
structures Nephrolithiasis Medullary nephrocalcinosis Cortical nephrocalcinosis Papillary necrosisTake-home points
UR128-ED-X
Retroperitoneal Tumors: MR Imaging Characteristics, Diagnostic Clues, Differential Diagnosis and
Histopathological Correlation
Participants
Pardeep K. Mittal, MD, Atlanta, GA (Presenter) Nothing to Disclose
Peter A. Harri, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Lauren F. Alexander, MD, Atlanta, GA (Abstract Co-Author) Spouse, Stockholder, Abbott Laboratories; Spouse, Stockholder, AbbVie
Inc; Spouse, Stockholder, General Electric Company
William C. Small, MD, PhD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Courtney A. Coursey Moreno, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To describe diagnostic challenges including localization of the retroperitoneal tumors, extent of invasion and characterization of
specific pathology such as liposarcoma, leiomyosarcoma.,extragonadal germ cell, paragangliomas and sarcoma etc. 2. To illustrate
patterns of spread, tumor components, tumor vascularity helping in narrowing the differential diagnosis.
Presentation will includes MRI characterization of retroperitoneal tumors using a dedicated less than 30 minute protocol of
abdominopelvic MRI without and with contrast.Primary retroperitoneal (RP) tumors originating in the retroperitoneum but outside the
major RP organs are uncommon. One of the challenges to radiologist is correct localization of the RP lesions, characterization as
well extent of the disease, involvement of adjacent structures, identifying the organ of origin.Hence MR imaging is valuable in
evaluating RP tumors particularly in staging, assessment of vascular invasion and fat content due its excellent soft tissue contrast.
Specific diagnosis might be difficult to achieve due to overlapping features but certain clues will help in narrowing the differential
diagnosis such as liposarcoma,leiomysarcoma,solitary fibrous tumor, paraganglioma and lymphoma etc.
UR129-ED-X
Cysts of the Lower Male Genitourinary Tract, From the Prostate to the Penis
Awards
Participants
Elena Lopez Uzquiza, Santander, Spain (Presenter) Nothing to Disclose
Elena Yllera Contreras, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Alejandro Fernandez Florez, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Pedro Lastra Garcia-Baron, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Marta Drake Perez, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
Gerardo Lopez Rasines, MD, Santander, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To review the embryologic development of the male genital tract (GT).2. To expose the normal anatomy and appearance of the
male GT with different imaging techniques.3. To summarize the cystic lesions founded along the male GT, explaining the key findings
in order to elaborate an easy differential diagnose.
1. Embryologic development- Mesonephric (wolffran) ducts.- Paramesonephric (mullerian) ducts.2. Normal appearance- Ultrasound
(transrectal, transperineal, testicular, transabdominal)- MRI3. Sample cases and mimics- Intraprostatic cysts (retention cyst, cystic
degeneration of BPH and tumours, abscess)- Extraprostatic cysts (seminal vesicle cyst, Cowper duct cyst)- Mimics of prostatic and
extraprostatic cysts (urethral diverticulum)- Scrotal and testicular cysts- Mimics of scrotal and testicular cysts (hydrocele,
hematocele, pyocele, varicocele)- Perineal cysts (epidermoid cyst of the median raphe)- Penis cysts
UR130-ED-X
Review of Retroperitoneal Fat-containing Tumors: Etiologies, Radiological Findings and Clinical Management
Awards
Participants
Qiushi Wang, MD, Indianapolis, IN (Presenter) Nothing to Disclose
Fatih Akisik, MD, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
Temel Tirkes, MD, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
Mark Tann, MD, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
Kumaresan Sandrasegaran, MD, Carmel, IN (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) To learn the differential diagnosis of retroperitoneal fat-containing tumors.2) To learn how to differentiate retroperitoneal fatcontaining tumors using radiologic signs.3) To learn clinical management.
1) Contrast-enhanced CT and MRIs will be reviewed. 2) Brief discussion of how to detect macroscopic and microscopic fat on MR
imaging.3) Review the spectrum of retroperitoneal fat-containing tumors.4) The classic and atypical appearances of a spectrum of
fat-containing tumors, including myelolipoma, angiomyolipoma, lipoma, liposarcoma, extramedullary hematopoiesis,
neurofibromatosis, primary retroperitoneal teratoma, lipoblastomatosis, and hibernoma are discussed. 5) To discuss clinical
management of different fat-containing tumors.
Honored Educators
Fatih Akisik, MD - 2014 Honored Educator
Temel Tirkes, MD - 2013 Honored Educator
Kumaresan Sandrasegaran, MD - 2013 Honored Educator
UR134-ED-X
Peripheral Zone Prostate Lesions: Differentiating Lesions with Prostate Magnetic Resonance Imaging Using
PI-RADS Version 2
Participants
David C. Gimarc, MD, Aurora, CO (Presenter) Nothing to Disclose
Toshimasa J. Clark, MD, Denver, CO (Abstract Co-Author) Nothing to Disclose
Jeffrey Meier, MD, Aurora, CO (Abstract Co-Author) Nothing to Disclose
Nayana U. Patel, MD, Aurora, CO (Abstract Co-Author) Nothing to Disclose
Sajal S. Pokharel, MD, PhD, Aurora, CO (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
After viewing the presentation, participants will be able to better understand the differentiation of prostate zonal anatomy,
specifically the peripheral zone, and describe the different pathological diagnoses that occur within these zones. They will then be
able to explain the utilization and categorization of PI-RADS version 2 with respect to peripheral zone lesions to distinguish benign
and malignant etiologies based on findings in various sequences and technical factors.
Prostate Cancer Overview MR and Prostate Imaging: Pictorial Overview Basic Anatomy (Peripheral Zone - PZ) Essential Sequences
and Technical Aspects Multiparametric Imaging PI-RADS (version 2) Findings Differentiation of PZ lesions using PI-RADS v. 2 Benign
Etiologies Malignant Etiologies Overall assessment (PI-RADS 1-5) Overall Limitations Recurrent Lesions or surveillance
Examples/Cases of PZ lesions (benign and malignant)
UR135-ED-X
Pitfalls and Mimickers on MDCTof the Kidney and Retroperitoneum
Participants
Takehiko Gokan, MD, Tokyo, Japan (Presenter) Nothing to Disclose
Yoshimitsu Ohgiya, MD, Shinagawa-ku, Japan (Abstract Co-Author) Nothing to Disclose
Masanori Hirose, MD, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Noritaka Seino, Tokyo, Japan (Abstract Co-Author) Nothing to Disclose
Nobuyuki Takeyama, MD, Yokohama, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
In diagnosing MDCT of the kidney and the retroperitoneum, there are many pitfalls and mimickers, which may lead to misdiagnosis
and erroneous patient management. In this exhibit, we show diagnostic pitfalls on MDCT of the kidney and the retroperitoneum as
well as show how to avoid these diagnostic pitfalls and differentiate the mimickers.
The cases will be presented in a quiz format. Key differential diagnostic points, pitfalls, and therapeutic management will be
highlighted in the discussion of each case. Diagnostic PitfallsAdrenal pseudotumor due to surrounding normal anatomical structures
orextra-adrenal pathological conditionsMissed renal lesion due to evaluation with inappropriate phase after iv
contrast.ScanArtifacts: motion artifacts, partial volume artifacts, beam hardening artifacts.Miscellaneous: Diagnostic
mimickersPapillary renal cell carcinoma vs. angiomyolipoma with minimal fatRetroperitoneal liposarcoma vs. exophytic growing
angiomyolipomaIgG related disease vs. lymphomaTuberculous-like granuloma vs. renal cell carcinomaetc.
UR136-ED-X
The ABCs of BHD: An In-depth Review of Birt-Hogg-Dubé Syndrome
Participants
Shiva Gupta, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Hyunseon C. Kang, MD, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Dhakshina M. Ganeshan, MBBS, FRCR, Houston, TX (Abstract Co-Author) Nothing to Disclose
Ajaykumar C. Morani, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Vikas Kundra, MD, PhD, Houston, TX (Presenter) License agreement, Introgen Therapeutics, Inc
TEACHING POINTS
Develop an understanding of: Molecular genetics of Birt-Hogg-Dubé Syndrome Histopathology of renal tumors in Birt-Hogg-Dubé
Syndrome Pertinent imaging findings and renal tumor subtypes of Birt-Hogg-Dubé Syndrome Treatment options for renal tumors in
Birt-Hogg-Dubé Syndrome
I. Introduction to Hereditary Renal Cell Carcinomas (HRCCs) and Birt-Hogg-Dubé SyndromeII. Molecular Genetics of Birt-Hogg-Dubé
SyndromeIII. Histopathology of Renal Tumors in Birt-Hogg-Dubé SyndromeIV. Imaging of Birt-Hogg-Dubé Syndrome Renal Tumors:
Hybrid Chromophobe Renal Cell Carcinoma (RCC)-Oncocytoma, Chromophobe RCC, Oncocytoma, Clear Cell RCC, Papillary RCC
Extrarenal Abdominal Features Pulmonary Features: Pulmonary Cysts, Pneumothoraces Other Findings (e.g. skin lesions)V. Summary
Radiologists may be the first to suspect a HRCC syndrome. In-depth knowledge of Birt-Hogg-Dubé syndrome provides a framework
for differentiating it from other hereditary RCC syndromes, and understanding the precision therapies for treating RCCs.
UR137-ED-X
It's Not All About the Prostate! Incidental Extraprostatic Neoplasms and Clinically Significant Findings on
Multiparametric Prostate MRI
Participants
Ross L. Eppelheimer, MD, Mineola, NY (Presenter) Nothing to Disclose
Corinne C. Liu, MD, Mineola, NY (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Multiparametric prostate MRI plays a major role in the assessment and staging of prostate cancer. However, extraprostatic
neoplasms and clinically significant incidental findings can be found on MRI. This exhibit will show specific examples of these findings
to demonstrate the importance of reviewing the extraprostatic regions of a prostate MRI in order to avoid missing potentially
significant findings.
The cases will be presented in an interactive quiz format. Specific cases will be presented to individuals viewing the exhibit. Correct
answers will be revealed and the rationale explained. Key differential diagnostic considerations will also be included, if applicable.
The list of cases include: Schwannoma arising adjacent to seminal vesicleColon cancer in the setting of ulcerative colitisRight
common iliac artery aneurysm with focal dissectionScrotal lipomaHorseshoe kidneyAvascular necrosis of the femoral heads
UR138-ED-X
The Treated Prostate on 3T Multiparametric Prostate MRI: An Interactive Quiz
Participants
Ross L. Eppelheimer, MD, Mineola, NY (Presenter) Nothing to Disclose
John Mattimore, Stony Brook, NY (Abstract Co-Author) Nothing to Disclose
Corinne C. Liu, MD, Mineola, NY (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Multiparametric prostate MRI plays a major role in evaluating for recurrent disease in patients with biochemical relapse after radical
prostatectomy, radiation therapy and cryoablation. Anatomy of the pelvis is distorted after radical prostatectomy while radiation
and cryoablation distorts the zonal anatomy. This exhibit will review the postsurgical and post-treatment changes of the prostate
after radical prostatectomy, radiation therapy and cryoablation. Participants will understand the pitfalls of the treated prostate that
can be mistaken for recurrent disease. We also describe the limitations and strengths of certain sequences of multiparametric
prostate MRI in the treated prostate.
The cases will be presented in an interactive quiz format. Specific cases post radical prostatectomy, radiation and cryoablation will
be presented to individuals viewing the exhibit. Correct answers will be revealed and the rationale explained.List of cases:Normal
periureteral enhancement versus recurrent disease after prostatectomy on prostate MRIImaging characteristics of the prostate and
recurrent prostate cancer post cryoablationImaging characteristics of the prostate and recurrent prostate cancer post
Brachytherapy and Cyberknife therapy
UR139-ED-X
Non-invasive Radiological Manifestations of Obstructive Azospermia
Awards
Participants
Wonsuk Kim, MD, Sacramento, CA (Presenter) Nothing to Disclose
Arian Nikpour, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Behrad Golshani, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Eugenio O. Gerscovich, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Review the pertinent anatomy and embryogenesis of the male reproductive system with respect to obstructive azospermia. Review
various acquired and congenital causes of obstructive azospermia. Review CT, ultrasound, and MR examples related to obstructive
azospermia.
Anatomy/Embrogenesis of the male ejaculatory system Clinical relevance Epidemiology Presentation Diagnosis Management
Pathophysiology of ejaculatory duct obstruction Acquired Epididymal obstruction Vas deferens obstruction Ejaculatory duct
obstruction Congenital Epididymal obstruction Vas deferens obstruction Ejaculatory duct obstruction Review of imaging examples Scrotal ultrasound Transrectal ultrasound CT MRI Summary
UR140-ED-X
Biochemical Recurrence of Prostate Carcinoma: A Multimodality Approach
Participants
Mariano Volpacchio, MD, Buenos Aires, Argentina (Presenter) Nothing to Disclose
Diego M. Haberman, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Victor Llanquipacha, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Veronica Rubio, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Mario G. Santamarina, MD, Valparaiso, Chile (Abstract Co-Author) Nothing to Disclose
Victoria Franco, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The goals of this presentation are To review the concept of prostate carcinoma biochemical recurrence To review the diagnostic
work-up in patients with biochemical recurrence To discuss the merits and limitations of different imaging modalities in the approach
to prostate biochemical recurrence To illustrate typical and atypical findings and patterns of recurrence on different imaging
modalities
IntroductionTreatment of prostate cancer and derived imaging findingsBiochemical recurrence concepts and work-upImaging
modalities: merits and limitations MDCT MRI Whole Body MRI SPECT PET/CTDiagnostic algorithm and therapeutic options after
recurrenceSummaryBiochemical recurrence is a common clinical scenario after both local and systemic treatment.The treating
physician is often faced with the challenge represented by a timely and proper diagnosis and localization of the site of recurrence
and the ensuing managment.A variety of morphologic, functional and metabolic imaging modalities are currently available and a
proper, patient-adjusted and cost-effective approach is crucial in order to achieve adequate management.A rational use of the
array of diagnostic tools based on knowledge of their respective strengh and limitations is of paramount importance.
UR141-ED-X
Dynamic Voiding UrethroMR: A New Diagnostic Approach to Urethral Lesions
Participants
Carlos M. Araujo Junior, MD, Rio De Janeiro, Brazil (Presenter) Nothing to Disclose
Jose Pedro R. Ravani, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Romulo Varella, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Nara S. Astacio, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
In this article, we describe the protocol and the main findings of dynamic UrethroMR, while reviewing the appearance of urethral
strictures secondary to changes related to surgical procedures and STDs, demonstrating its importance in characterizing
espongiofibrosis.
MATERIALS AND METHODSImages were acquired in a Siemens Aera 1.5-T Scanner, with multiplanar T1 and T2-weighted sequences,
T2 with urographic effect by technical MIP obtained at rest and during voiding effort, SPACE, T1 fat-sat before and after
administration of gadolinium.DISCUSSIONMR is a noninvasive imaging method with high spatial resolution, which allows multiplanar
evaluation and good tissue characterization. Furthermore, it is highly accurate in the diagnosis of urethral strictures, enabling the
identification of lesions that are often underestimated in voiding uretrocistography, and allowing the physician a more accurate
surgical plan. MRI also allows complete assessment of the peri-urethral compartments, identifying risk factors and the presence of
associated complications.CONCLUSIONUrethroMRI is a new imaging modality that shows potential to identify and quantify urethral
strictures, for which surgery remains the best treatment option, and the preoperative evaluation is crucial for success therapy in
these patients.
UR142-ED-X
Magnetic Resonance Imaging of Penile Diseases
Participants
Van Lai Nguyen, MD, Rotterdam, Netherlands (Presenter) Nothing to Disclose
Mariska Rossius, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Piotr Wielopolsky, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Gert Dohle, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
Gabriel P. Krestin, MD, PhD, Rotterdam, Netherlands (Abstract Co-Author) Consultant, General Electric Company; Research Grant,
General Electric Company; Research Grant, Bayer AG; Research Grant, Siemens AG; Speakers Bureau, Siemens AG
Roy S. Dwarkasing, MD, Rotterdam, Netherlands (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
MRI of the penis is challenging, mainly because of motion issues. In this exhibit we present our experience with dedicated MRI
penis, focus on the added value of MRI for penile diseases and conditions and propose recommendations for proper imaging.
Teaching points: To describe technical challenges of state of the art MRI of the penis. To presents methods of MRI penis, including
application of pelvic phased array and other dedicated external surface receiver coils. To illustrate and describe the added value of
MRI for different penile disorders. To propose a practical MRI protocol, including scan parameters, for routine use with a pelvic
phased array coil for both 1.5 and 3.0 T MR systems.
1. Introduction 2. Technical challenges for MRI penis 3. Clinical cases: Added values of MRI penis to clinical assessment and other
imaging modalities. 4. Limitations and pitfalls 5. Recommended imaging protocol (1.5 and 3.0T) 6. References.
UR143-ED-X
A Multimodality Review of Native Renal Vascular Pathology
Participants
Sayf A. Al-Katib, MD, Royal Oak, MI (Presenter) Nothing to Disclose
Monisha Shetty, MD, Royal Oak, MI (Abstract Co-Author) Nothing to Disclose
Marco A. Amendola, MD, Coral Gables, FL (Abstract Co-Author) Nothing to Disclose
Beatrice L. Madrazo, MD, Miami, FL (Abstract Co-Author) Nothing to Disclose
Syed Zafar H. Jafri, MD, Royal Oak, MI (Abstract Co-Author) Nothing to Disclose
Emily Nghiem, Royal Oak, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To review the imaging features of common and uncommon pathology affecting the renal artery, renal vein and intraparenchymal
vessels by multiple modalities including CT, US, MRI and angiography. To highlight the presentation and management of this
spectrum of native renal vascular pathology. To provide a framework to evaluate the native kidney for vascular pathology.
Renal Artery Pathology Renal artery aneurysm Renal arteriovenous fistula Renal arteriovenous malformation Fibromuscular dysplasia
affecting the renal artery Spontaneous isolated renal artery dissection Renal artery stenosis Renal vascular pedicle injury in trauma
Renal Vein Pathology Bland renal vein thrombosis Tumor thrombus secondary to renal cell carcinoma and adrenal cortical carcinoma
Renal vein leiomyosarcoma Nutcracker phenomenon Renal Parenchymal Vascular Pathology Iatrogenic pseudoaneurysm Subcapsular
hematoma after lithotripsy Page kidney Spontaneous parenchymal bleeds Renal cortical necrosis Renal infarction Renal laceration
Polyarteritis nodosa
UR144-ED-X
Computer-Aided Diagnosis of Prostate Cancer on Multi-parametric MRI: How I Do It
Participants
Ge Gao, MD, Beijing, China (Presenter) Nothing to Disclose
Xiaoying Wang, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Jue Zhang, Beijing, China (Abstract Co-Author) Nothing to Disclose
Chengyan Wang, PhD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Juan Hu, Kunming, China (Abstract Co-Author) Nothing to Disclose
Xuedong Yang, Beijing, China (Abstract Co-Author) Nothing to Disclose
He Wang, MD, Beijing, China (Abstract Co-Author) Research Grant, General Electric Company
TEACHING POINTS
1. To review the popular computer-aided diagnosis (CAD) system for identification and classification of prostate cancer(PCa) in
clinical work. 2. To explain the workflow of CAD for localization of PCa that combines features derived from multi-parametric MRI
(mp-MRI), and evaluate the performance of this system.
1. Clinical application of CAD for prostate cancer diagnosis2. Clinical promotion of mp-MRI for prostate cancer diagnosis is in a
dilemma3. Application and workflow of PCa CAD system for cancer localization Mp-MRI preprocessing Prostate segmentation Sample
collection Imaging features extraction Classification: system training and testing Outcome of the CAD system 4. Performance of the
lesion localization by CAD system
UR145-ED-X
Abnormal Descent of the Testes
Participants
Pankaj Nepal, MD, Doha, Qatar (Presenter) Nothing to Disclose
Devendra Kumar, MBBS, MD, Hamilton, ON (Abstract Co-Author) Nothing to Disclose
Subramaniyan Ramanathan, MD, MBBS, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
Habeeba Hena, MD, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
Mahmoud Al Raheem Heidous, MD, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
Atif Wasim Haneef Mohamad, MD, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) Undescended testes is the testes that fails to reach bottom of scrotum in expected location. 2) True undescended testes
includes intraabdominal testes or canalicular testes found in inguinal canal or superficial ring . 3) However ectopic testes is the one
which has wandered from usual path due to abnormal gubernacular insertion and found in uncommon location. 4) Ultrasound is first
line of investigation to identify inguinal and superficial undescended testes. 5) MRI is reserved for the intraabdominal and
undescended testes not visualized by ultrasound.
1) Pathway of testes descent in usual as well as unusual locations.2) Brief discussion on complications and clinical features.3)
Judicious use of imaging modalities including ultrasound, MRI or laparoscopy for tracing intraabdominal testes and identifiying
testicular vessels In imaging.4)Spectrum of demonstration:a) Ultrasound images of testes : in inguinal canal, superficial ring, left
iliac fossab) MRI images of testes: in left iliac fossa, superficial to rectus sheath ( ectopic), root of scrotum, inguinal canal,
superficial ring and root of penis.c) CT image of testes: Calcified and high mesenteric (ectopic) with germ cell tumor.
UR146-ED-X
Pathways, Pearls and Pitfalls: An MR Feature-based Algorithm for Renal Mass Characterization
Awards
Cum Laude
Participants
Kristy Lee, MD, Boston , MA (Presenter) Nothing to Disclose
Katherine M. Troy, MD, Brookline, MA (Abstract Co-Author) Nothing to Disclose
Leo L. Tsai, MD, PhD, Boston, MA (Abstract Co-Author) Co-founder, Agile Devices Inc; Stockholder, Agile Devices Inc; Research
Consultant, Agile Devices Inc;
Karen S. Lee, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Maryellen R. Sun, MD, Boston, MA (Abstract Co-Author) Research Grant, Glaxo SmithKline plc
TEACHING POINTS
1.Incidental renal masses are being discovered with increasing frequency due to the rising number of cross-sectional studies being
performed. Although the vast majority of masses are incidental, many are incompletely characterized and indeterminate. MRI allows
for accurate characterization which is essential to ensure appropriate medical versus surgical case management 2.Biopsy can play a
role in many cases in which diagnosis is in question
Intro: MR imaging protocol; Algorithm: Utilizing characteristic lesion features at each pulse sequence, a stepwise approach to
diagnosis of solid and cystic renal masses is presented. The algorithm incorporates factors such as the presence of cystic versus
solid components, signal intensity at T2WI and T1WI, microscopic and macroscopic fat, hemorrhage, hemosiderin, restricted
diffusion and pattern of enhancement. We demonstrate the utility of this algorithm through a case-based approach and highlight
potential pitfalls and pearls. Cases include benign and malignant neoplasms (clear cell, papillary and chromophobe renal cell and
urothelial carcinoma, metastases, lymphoma, typical and fat poor angiomyolipoma, oncocytoma, reninoma, and solitary fibrous
tumors, and non-neoplastic etiologies such as infectious and inflammatory lesions, infarct, hematoma, and xanthogranulomatous
pyelonephritis.
UR147-ED-X
MR Imaging Spectrum of Penile Prosthesis and Its Complications
Participants
Subramaniyan Ramanathan, MD, MBBS, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
Pankaj Nepal, MD, Doha, Qatar (Presenter) Nothing to Disclose
Devendra Kumar, MBBS, MD, Hamilton, ON (Abstract Co-Author) Nothing to Disclose
Nicola Schieda, MD, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Ahmad Shamsodini, MS, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
Mahmoud Al Raheem Heidous, MD, Doha, Qatar (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) Penile prosthesis is ideal for patients with organic erectile dysfunction which is not responding to medications and non surgical
treatments. 2) Types of prosthesis : malleable and inflatable penile prosthesis (IPP). 3) Various complications of prosthesis are
persistent pain, bending or deformity, mechanical malfunction, cross over and crural perforations. Complications of the reservoir
include rupture, herniation and malfunction. 4) MR evaluation of penile prosthesis is superior due to its high soft tissue
contrast.Ultrasound can be used for initial evaluation and reservoir related complications.
1) Detailed MRI anatomy of normal penis, malleable and inflatable penile prosthesis. 2) Our institutional MRI protocol, common
indications. 3) Types of penile implants; malleable or semi rigid and inflatable penile prosthesis. 4) USG and MRI appearance of 3
part IPP including penile cylinders, pump and reservoir. 5)Spectrum of complications for demonstration ( Images for exibits) : - MR
images of Buckling or S shaped deformity, displacement of the malleable rod - Cross-over of cylinders, - Reservoir leak, - Reservoir
herniation into inguinal canal, - Prosthesis infection and erosion, - Ultrasound images of penile anatomy.
UR148-ED-X
Multiparametric MR Imaging of the Prostate and Prostatic Bed in the Evaluation of Cancer Recurrence
Participants
Dafne D. Melquiades, Rio de Janeiro, Brazil (Presenter) Nothing to Disclose
Erick S. Hollanda, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Natalia Sabaneeff, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Bruno R. Falcone, MD, Rio Dejjaneiro, Brazil (Abstract Co-Author) Nothing to Disclose
Carolina L. Vaz, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Guilherme M. Cunha, MD, San Diego, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1- Demonstrate that multiparametric pelvic MR imaging is a valuable tool in the diagnosis of the prostate cancer recurrence.2Review the normal findings post-prostatectomy and post-radiation, as well as the findings suspicious for local and distant tumor
recurrence.3- Discuss the practical applications and decision algorithms for the management of prostate cancer recurrence, based
on the combination of imaging findings and clinical information.
1- Risk assessment, staging and treatment options for prostate cancer2- Multiparametric MR imaging protocol and postprocessing3- Normal findings after radiotherapy and brachytherapy4- Normal findings after prostatectomy5- What is the available
clinical evidence on the performance of multiparametric MR imaging for detection of tumor recurrence?6- MR findings of tumor
recurrence:- Post-radiation;- Post-prostatectomy;- Nodal recurrence;- Distant metastases;7- How to use MR imaging information
when suspecting of prostate cancer recurrence?
UR149-ED-X
Staging of Prostate Cancer Using Multiparametric MR Imaging: A Practical Approach
Participants
Dafne D. Melquiades, Rio de Janeiro, Brazil (Presenter) Nothing to Disclose
Erick S. Hollanda, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Guilherme M. Cunha, MD, San Diego, CA (Abstract Co-Author) Nothing to Disclose
Bruno R. Falcone, MD, Rio Dejjaneiro, Brazil (Abstract Co-Author) Nothing to Disclose
Carolina L. Vaz, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Sabrina O. Bernal, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
• Demonstrate through a pictorial essay that multiparametric prostate MR can assist in a relevant way in the preoperative local
staging of PCa.• Review the main findings related to the PCa staging. We will briefly discuss the role of PI-RADS criteria in detection
and also recent evidence in disease staging.• Discuss about the performance and imaging criteria for the detection of extracapsular
extension and seminal vesicle invasion, based on multiparametric MR imaging.• The main clinical signs described for extracapsular
extension in T2WI are: nerurovascular bundle asymmetry or tumor involvement, focal bulging or irregularity in prostate contour,
obliteration of the rectoprostatic angle, capsular retraction, contact of the tumor with the prostatic capsule and signs of capsule
rupture with direct tumor extension to the periprostatic fat.
- Anatomy of the prostate gland and seminal vesicles.- Clinical staging of prostate cancer.- How does staging affect the treatment
options?- Multiparametric MR imaging protocol.- Typical MR imaging appearance of prostate cancer.- MR imaging findings for
extracapsular extension.- MR imaging findings for seminal vesicle involvement.- MR imaging findings for bladder neck invasion.Imaging pitfalls that may affect staging.
UR150-ED-X
MRI for the Diagnosis of Prostate Cancer: Basic Knowledge, Optimal Scan Protocols, Interpretations, and New
Applications
Participants
Ryuji Akita, RT, MS, Hiroshima, Japan (Presenter) Nothing to Disclose
Yukiko Honda, MD, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Kazushi Yokomachi, RT, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Yuji Akiyama, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Makoto Iida, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Kazuo Awai, MD, Hiroshima, Japan (Abstract Co-Author) Research Grant, Toshiba Corporation; Research Grant, Hitachi, Ltd;
Research Grant, Bayer AG; Reseach Grant, DAIICHI SANKYO Group; Medical Advisor, DAIICHI SANKYO Group; Research Grant, Eisai
Co, Ltd; Research Grant, Nemoto-Kyourindo; ; ; ; ;
TEACHING POINTS
We present optimal MR protocols for the diagnosis of prostate cancer.Furtheremore, we demonstrate clinical utility of new
applications such as computed diffusion weighted imaging (cDWI) and high resolution 3D TSE T2-weighted imaging.The cDWI may
improve sensitivity of prostate cancer and high resolution 3D TSE T2-weighted imaging may improve assessment of local invasion
(extracapsular extension and seminal vesicle invasion).
1. Current diagnostic process 2. Optimal MRI protocol for diagnosing prostate cancer 3. Detectability of prostate cancer by MRI 4.
Correlation between MR findings and the clinical T stage or Gleason score 5. Pitfalls of MRI interpretation: Artifacts and changes
after biopsy or treatment 6. New applications for MRI 6.1. cDWI 6.2. High resolution 3D TSE T2-weighted imaging
UR151-ED-X
New Concepts in Kidney Stone Characterization with CT
Participants
Blanca Pano Brufau, MD, Barcelona, Spain (Presenter) Nothing to Disclose
Rafael Salvador Izquierdo, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Javier L. Moreno Negrete, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Carmen Sebastia Cerqueda, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Laura Bunesch Villalba, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Carlos Nicolau, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
-To review relevant clinical concepts for radiologists regarding kidney stones, focusing in the fragility and stone burden concepts.To discuss the CT and dual energy CT (DECT) findings to bear in mind when planning treatment .-To analyze current literature
regarding CT dose reduction and further classification based on calculi composition.
1. Introduction: clinical concepts of radiological interest-Composition-Treatment options and how radiological information can help
guide the appropriate treatment strategy: expectant attitude, active extraction and medical treatment 2. Contribution of CT in
treatment planning2.1. Simple energy MDCT-Detection and localization: the halo and comet tail signs. The HIV PatientCharacterization -Size: Windowing, image magnification and stone burden -Composition (Stone Fragility): homogeneity, shape and
density -Limitations in simple energy characterization2.2 DECT-Technique-Parameters for allow differentiation between uric and
non-uric acid composition-Post-processing Software3. Future Directions-Further classifications based on stones compositionDecreased radiation dose4. Structured radiological report. Summary of relevant data that CT and DECT can provide to guide the
appropriate therapeutic management
UR152-ED-X
PI-RADS v2: MRI Imaging Features of Prostate Cancer and the Experience of an Active MRI Surveillance
Program
Participants
Robert M. Marks, MD, San Diego, CA (Presenter) Nothing to Disclose
John R. Dryden, MD, SAN DIEGO, CA (Abstract Co-Author) Nothing to Disclose
Jonathan Berger, MD, San Diego, CA (Abstract Co-Author) Nothing to Disclose
Sean Stroup, MD, San Diego, CA (Abstract Co-Author) Nothing to Disclose
Richard S. Montgomery, MD, San Antonio, TX (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
This educational exhibit will 1) Discuss the role of MRI in Prostate Cancer 2) Discuss the MRI imaging technique at our institution 3)
Review the categories of PI-RADS v2 with pathologically proven MRI cases 4) Discuss the role and clinical experience of an active
MRI surveillance program at a tertiary care hospital.
Overview of the indications for Prostate MRI in the diagnosis or surveillance of Prostate Cancer Discuss the imaging technique for
Prostate MRI at our institution Include table of MRI parameters Discuss the categories of both T2 and ADC findings of PI-RADS v2
Chart of PI-RADS v2 categories Discuss lesion measurement guidelines for peripheral zone vs. transitional zone Discuss the role of
contrast enhancement in PI-RADS v2 Pathologically proven MRI cases for each PI-RADS v2 category Discuss extracapsular
extension with representative cases Discuss seminal vesicle invasion with representative cases Discuss the experience of an active
MRI surveillance program at a tertiary care medical center Discuss the role of an active MRI surveillance program Benefits of
observing a lesion vs. prostatectomy Indication for MRI surveillance Discuss upstaging of tumors based on Prostate MRI after initial
biopsy
UR153-ED-X
Imagenological Review of the Key Findings in Retroperitoneal Fibrosis and its Complications
Participants
Karin Daniela Muller Campos, Santiago, Chile (Presenter) Nothing to Disclose
Roberto Correa Soto, Salamanca, Spain (Abstract Co-Author) Nothing to Disclose
Jorge Ortiz Vega, MD, Santiago, Chile (Abstract Co-Author) Nothing to Disclose
Ignacio Maldonado, MD, Santiago, Chile (Abstract Co-Author) Nothing to Disclose
Rodrigo Bazaes, MD, PhD, Santiago, Chile (Abstract Co-Author) Nothing to Disclose
Cristian Varela, MD, Santiago, Chile (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is:1. To understand the pathophysiology of retroperitoneal fibrosis and to know the typical clinical
manifestation2. To characterize the typical imaging findings of the disease, with an emphasis on differential diagnosis with
retroperitoneal malignancies3. To describe the most useful radiologic technique in this disease
- Introduction- Clinical presentation and pathophysiology of retroperitoneal fibrosis.- Imaging techniques and findings:1.
Multidetector computed tomography and magnetic resonance2. Applications of Positron emission tomography 3. Radiological findings
indicating good prognosis4. Imaging findings of complications and markers of poor prognosis- Common diagnostic pitfalls and
differential diagnoses.- Cases to illustrate the radiologic features.
UR154-ED-X
New Staging and Scoring Systems of Renal Cell Carcinomas: What the Radiologist Needs to Report
Participants
Manjiri K. Dighe, MD, Seattle, WA (Presenter) Research Grant, General Electric Company
Jean H. Lee, MD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Funda Vakar-Lopez, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Ryan O'Malley, MD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Sandeep Vaidya, MD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. It is important for radiologists to be acquainted not only with the well widespread TNM staging system, but also with the new
RCC scoring systems, since their conjoint use is crucial to manage the best treatment approach of renal masses. Since the advent
of R.E.N.A.L., 3 more systems appeared and, although they have demonstrated to be reproducible inter-observer, they all have
inherent strengths and weaknesses. Because some difficulties have been detected when applying the renal scores, new scoring
systems are being developed in order to overcome those problems and to create more practical and simpler scores. 2. The aim of
this educational poster is to review the imaging characteristics of various sub-types of renal cell carcinoma and to review the
various imaging systems/algorithms used in deciding the appropriate method of treatment of RCC.
1. To understand the subtypes of renal cell carcinomas (RCCs) and their imaging characteristics 2. To review the new staging and
scoring methods available including R.E.N.A.L, P.A.D.U.A, C-index scoring and A.B.L.A.T.E. algorithm. 3. To illustrate various renal
tumors using the new scoring systems by means of pictorial examples. 4. To provide reporting macros that can be used for the
various staging/scoring systems
UR155-ED-X
Crystal Clear or Somewhat Murky: A Pictorial Review of Imaging Biomarkers that are Predictive of Cytogenetic
Abnormalities in Clear Cell Renal Cell Carcinoma
Participants
Jonathan R. Young, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Jocelyn A. Young, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Jiaoti Huang, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Cytogenetics is becoming increasingly important in predicting patient prognosis in RCC because it can more accurately reflect
cancer physiology in an individual patient. However, cytogenetic analyses require invasive procedures to obtain tissue samples. 2.
Imaging features on multiphasic MDCT may potentially provide a non-invasive means of predicting cytogenetic information and thus
influence how cytogenetic information is obtained and utilized to predict patient outcome. 3. For instance, enhancement on 4phase MDCT can help predict the loss of chromosome 8p and the gain of chromosome 20, abnormalities that are associated with a
higher tumor grade and greater risk of recurrence.
1. Epidemiology of Renal Cell Carcinoma2. The Importance and Expanding Role of Cytogenetics in the Management of RCC3. Common
Cytogenetic Abnormalities in Clear Cell RCC4. Cytogenetic Abnormalities in Clear Cell RCC with Prognostic Implications5. Multiphasic
MDCT Imaging Biomarkers to Predict Cytogenetic Abnormalities with Prognostic Implications
UR158-ED-X
Multimodality Imaging of Non-Malignant Penile Disorders: A One-Stop Shop for Radiologists
Participants
Stephanie A. Lee-Felker, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Ely R. Felker, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Maurice M. Garcia, MD, MS, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Valdair F. Muglia, MD, PhD, Ribeirao Preto, Brazil (Abstract Co-Author) Nothing to Disclose
Antonio C. Westphalen, MD, Mill Valley, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is to:1. Review normal penile anatomy and physiology of erection2. Present the multimodality imaging
appearances of an array of common, non-malignant penile disorders on ultrasound, cavernosagram, computed tomography,
magnetic resonance imaging, and angiography3. Discuss which penile disorders require urgent urological intervention
1. Normal penile anatomy: structural, arterial, and venous anatomy2. Normal physiology of erection a. Normal color and spectral
Doppler ultrasound of erection3. Multimodality imaging of erectile dysfunction a. Arterial insufficiency b. Venous incompetence,
dorsal vein thrombosis c. Priapism i. Low flow priapism ii. High flow priapism: cavernosal artery pseudoaneurysm, cavernosoarterial
fistula d. Color and spectral Doppler ultrasound, fluoroscopic cavernosagram, and CT cavernosagram evaluation4. Multimodality
imaging of common penile implants and devices, including related complications a. Device malposition b. Infection5. Infectious
conditions: abscess6. Inflammatory conditions: Peyronie's disease7. Trauma: penile hematoma, penile fracture
UR159-ED-X
Beyond Urothelial Bladder Cancers: Uncommon Players
Participants
TEACHING POINTS
1. To identify and illustrate the spectrum of primary bladder tumors other than urothelial carcinoma.2. To present typical and
atypical radiologic findings of these tumors.3. To correlate radiologic findings with pathology.
1.The imaging findings on US, CT, MRI and PET of uncommon primary bladder tumors beyond urothelial bladder cancers are
presented, with particular attention to what the radiologist may add to diagnosis and help management.2.The tumors discussed
include squamous carcinoma, adenocarcinoma, neuroendocrine carcinoma, carcinoid, melanoma, leiomyoma, fibroma, urachal
carcinoma, paraganglioma, hemangioma, pheochromocytoma, plasmacytoma, rhabdomyosarcoma, leiomyosarcoma, lymphoma,
chloroma, neurofibroma, inflammatory myofibroblastic tumor, nephrogenic adenoma, and solitary fibrous tumor.
Honored Educators
UR160-ED-X
Adrenal Gland Abnormalities Associated with Systemic Conditions: A Pictorial Review of Clinical and
Radiological Findings
Participants
TEACHING POINTS
1.Learn systemic conditions and associated imaging findings that can involve the adrenal glands.2.Abdominal radiologists need to
suspect the systemic conditions that can involve adrenal glands.
Honored Educators
UR161-ED-X
Multiparametric Ultrasonography of Scrotal Pathology: A Pictorial Review
FDA
Awards
Participants
Dean Y. Huang, FRCR, London, United Kingdom (Presenter) Nothing to Disclose
Eleni Konstantatou, MD, MSc, london, United Kingdom (Abstract Co-Author) Nothing to Disclose
Robert J. Eckersley, PhD, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Maria E. Sellars, MD, FRCR, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Paul S. Sidhu, MRCP, FRCR, London, United Kingdom (Abstract Co-Author) Speaker, Bracco Group; Speaker, General Electric
Company
TEACHING POINTS
Innovative ultrasonography techniques, such as contrast-enhanced ultrasonography (CEUS), and strain elastography (SE), have
allowed advanced imaging of scrotal pathology. When added to conventional grey-scale US and Doppler US as part of a
multiparametric ultrasonography (MP-US) examination, each of these techniques provide information that could be useful when
diagnosing disorders within the scrotum. This exhibit aims to increase learners' familiarity with the appearances seen with these
techniques, and to illustrate the usefulness of MP-US in imaging intra- and extratesticular pathology, particularly in the context of
confirming benignity, for improved diagnostic confidence.
This exhibit aims to illustrate MP-US appearances of a spectrum of intra- and extratesticular pathology, including tumors such as
seminoma, non-seminomatous germ cell tumors, sex-cord stromal tumors, lymphoma, metastasis, and sarcomas, as well as benign
processes such as epidermoid cysts, venous infarction, intra-testicular hematoma, abscesses, segmental infarction, sarcoidosis,
post-biopsy scar, testicular cysts, orchitis, adenomatoid lesions, and testicular torsion. The role of the newer techniques such as
CEUS and SE in offering the means of better characterizing vascularity and inherent stiffness of lesions is also discussed.
UR162-ED-X
'The Ureter...Where Did You Come From? Where Did You Go?' An Interactive Teaching File
Participants
Megan T. Elgethun, MD, Pittsburgh, PA (Presenter) Nothing to Disclose
Matthew S. Hartman, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
Paul R. Klepchick, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
Matthew T. Heller, MD, Pittsburgh, PA (Abstract Co-Author) Consultant, Reed Elsevier; Author, Reedl Elsevier
David C. Reisner, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is:1. To review the normal course, embryology and anatomy of the ureter. 2. Discuss the different
imaging modalities utilized for evaluation of the ureter.3. Demonstrate and review examples of pathology and surgical procedures
affecting the course and appearance of the ureter. 4. To highlight the normal appearance, potential complications and imaging
pitfalls of the ureter through the use of an interactive teaching file
This presentation will cover the following sections:1. Normal anatomy, embryology and course of the ureter.2. Review the common
imaging modalities used to evaluate the ureter.3. Demonstrate pathologic conditions that affects the normal course and appearance
of the ureter.4. Review common surgical procedures, interventions and post operative appearances of the ureter.5. Interactive
Teaching File6. Summary
UR163-ED-X
CT Findings in Long Term Peritoneal Dialysis
Participants
Joe Peltz, MD, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Shaza Alsharif, MD, Jeddah, Saudi Arabia (Presenter) Nothing to Disclose
Catherine Milne, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Armen H. Attarian, MD, Mont-Royal, QC (Abstract Co-Author) Nothing to Disclose
Benoit D. Mesurolle, MD, Montreal, QC (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The goals of this exhibit are:1. To present and discuss the complications of peritoneal dialysis (PD) catheters encountered in series
of 133 patients during CT scan of the abdomen.2. To describe the associated abdominal finings during peritoneal dialysis and after
peritoneal dialysis catheter removal.
• Demographics of renal failure and types of dialysis.• Indications of abdominal CT in patients with PD catheters.• Factors
contributing to the development of PD related complications.• Review the imaging of complications expected in the long term of
peritoneal dialysis catheter, including those that develop after catheter removal based on two institutions experience.
UR165-ED-X
Role of MRI in Evaluation of Penile Carcinomas: Impact on Staging, Prognosis and Management Decisions
Awards
Participants
Priya Ghosh, MD, MBBS, Kolkata, India (Presenter) Nothing to Disclose
Saugata Sen, MBBS, MD, Kolkata, India (Abstract Co-Author) Nothing to Disclose
Sumit Mukhopadhyay, MD, Kolkata, India (Abstract Co-Author) Nothing to Disclose
Aditi Chandra, Kolkata, India (Abstract Co-Author) Nothing to Disclose
Dayananda Lingegowda, MBBS, Kolkata, India (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
MRI can accurately delineate the anatomy of penis High contrast of a neoplastic lesion with normal tissue is obtained on T2weighted images (T2WI) and post-gadolinium T1-weighted images (T1WI) Multiplanar imaging with MRI can provide adequate
information required for loco-regional staging and prognostication of penile carcinomas as well as diagnose post-operative
recurrences
Background: Prognosis and treatment of penile carcinomas depend on local extent and regional nodal staging. Clinical examination
can provide preliminary staging of penile neoplasms, but MRI is more accurate in loco-regional staging of penile cancer and has a
good correlation with histologic staging Normal imaging anatomy: Corpora cavernosa, crura, corpus spongiosum, urethra, covering
layers Technique and sequences Imaging appearance of carcinoma: Hypointense to corpora in T2WI and T1WI, enhances in postgadolinium T1WI, but lesser than corpora Method of staging using MRI: TNM, Jackson staging T1: limited to the subcutaneous
tissue T2: involvement of corpora T3: involvement of urethra or prostate T4: invasion of other adjacent structures Nodal
assessment: superficial and deep inguinal, pelvic MRI evaluation: Impact on prognosis and management Other penile neoplasms
Summary and conclusion
UR166-ED-X
Array of Imaging Features in Tuberous Sclerosis Renal Disease with Histopathologic Correlation
Participants
Jignesh N. Shah, MD, Memphis, TN (Presenter) Nothing to Disclose
Harris L. Cohen, MD, Memphis, TN (Abstract Co-Author) Nothing to Disclose
John Bissler, Memphis, TN (Abstract Co-Author) Nothing to Disclose
Asim F. Choudhri, MD, Memphis, TN (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
There are varied renal manifestations of tuberous sclerosis complex (TSC), which can be challenging to diagnose and characterize
on imaging. We will review the imaging appearance of different Tuberous Sclerosis renal findings on CT, MRI, angiography, and
ultrasound, based upon an imaging database of more than 500 patients with TSC renal disease. Imaging techniques will be
reviewed, with an emphasis on MRI, and correlated with histology. The genetic and histologic basis for different imaging features
will be reviewed.
1) Imaging features of various renal menifestations of Tuberous Sclerosis Complex (TSC) which will include:Angiomyolipoma- typical,
with macroscopic fat- with microscopic fat but no macroscopic fat- with no microscopic or macroscopic fat- with hemorrhageRenal
cystsAutosomal dominant polycystic kidney disease2) Genetic and histologic features reviewed include: Origin of renal
angiomyolipoma from renal pericytes; Co-location of autosomal dominant polycystic kidney disease gene with TSC-2 gene
UR167-ED-X
"Imaging of Urinary Diversions and Postoperative Complications: What the Radiologist Needs to Know"
Participants
Arvind Shergill, MBBS, Toronto, ON (Presenter) Nothing to Disclose
Seng Thipphavong, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Alexandre Zlotta, FRCPC, PhD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Nasir M. Jaffer, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Both continent and incontinent diversions are available for urinary reconstruction after radical cystectomy. Ileal conduit is a
prototype of incontinent diversions. Continent diversions include cutaneous catheterizable reservoirs and orthotopic neobladder
formation. Surgical techniques alter normal anatomy and make imaging interpretation challenging if radiologists are unfamiliar with
these procedural details and postoperative imaging appearances. Imaging techniques including CT urogram, fluoroscopic loopogram
and pouchography are used for routine follow up and tumor surveillance. Interventional radiological techniques like percutaneous
nephrostomy and percutaneous ureteral stent placement are indispensible in the evaluation and treatment of urinary tract related
complications.
Learning objectives Description and pictorial review of common surgical techniques Imaging techniques Imaging appearances with
focus on understanding complex postoperative anatomy Postoperative complications I. Early (<30 days): Intestinal complications:
Ileus, Obstruction, Fistulas, Ischemia Collections: Hematoma, Lymphocele, Abscess Anastomotic leak Urinary Obstruction II. Late
(>30 days): Infection Lithiasis Hydronephrosis Herniation Conduit stenosis/stricture Tumoral Recurrence 6. Conclusion
UR168-ED-X
Adrenal Mass Imaging: A Pictorial Review
Awards
Participants
Masahiro Tanabe, MD, Ube, Japan (Presenter) Nothing to Disclose
Takaaki Ueda, Ube, Japan (Abstract Co-Author) Nothing to Disclose
Sei Nakao, Ube, Japan (Abstract Co-Author) Nothing to Disclose
Keisuke Miyoshi, Ube, Japan (Abstract Co-Author) Nothing to Disclose
Naofumi Matsunaga, MD, PhD, Ube, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
It is important that the radiologist be familiar with typical imaging features of adrenal masses and the imaging algorithm for adrenal
lesion characterization not only to make the correct diagnosis, but also to avoid unnecessary examinations. The purpose of this
exhibit is: 1.To understand an imaging algorithm for adrenal lesion characterization. 2.To review CT and MR imaging findings of
adrenal masses. 3.To highlight key differential diagnostic points of imaging findings with pathologic correlation.
1.Imaging algorithm for incidental adrenal lesion (tumor growth, CT densitometry, CT washouts, MR imaging)2.Characteristic
findings• Common lesions (adrenal cortical adenoma, pheochromocytoma, metastasis)• Unusual benign lesions (myelolipoma,
ganglioneuroma, schwannoma, hemangioma)• Unusual malignant lesions (adrenal cortical carcinoma, lymphoma, leiomyosarcoma)
UR170-ED-X
Preoperative Assessment of "Zero Ischemia" Robotic-assisted Partial Nephrectomy Should be Performed with
"Kidney Friendly' CT: What Radiologists and Technicians Need to Know about the Low-Energy Low-Contrast
Dose Renal CT
Awards
Participants
Satoru Takahashi, MD, Kobe, Japan (Presenter) Nothing to Disclose
Yoshiko Ueno, MD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Utaru Tanaka, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Yuko Suenaga, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Noriyuki Negi, RT, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Kiyosumi Kagawa, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Kazuro Sugimura, MD, PhD, Kobe, Japan (Abstract Co-Author) Research Grant, Toshiba Corporation Research Grant, Koninklijke
Philips NV Research Grant, Bayer AG Research Grant, Eisai Co, Ltd Research Grant, DAIICHI SANKYO Group
TEACHING POINTS
Robotic partial nephrectomy can minimize ischemic damage to the kidney with super-selective renal artery clumping at the distal
arterial branches. Low-energy contrast enhanced CT requires less contrast medium for the evaluation of both vessels and tumor.
Because both procedures could reduce potential risk to renal function, low energy CT would be desirable for preoperative
assessment of robotic-partial nephrectomy.The purpose of this exhibit is:1. To review the procedures of robotic partial
nephrectomy and understand vital structures/anatomies for the pre-operative assessment2. To explain CT techniques to
demonstrate the required anatomies3. To discuss the usefulness of low-energy CT, particularly 3rd generation dual-source CT, in
the preoperative assessment4. To summarize the pros and cons of low-energy CT
Procedures of robotic partial nephrectomy -approach to the kidney -identification of tumor supplying arterial branchCT scanning
technique - contrast injection - scan timing - image reconstructionPost processing -3D CTA -vessel tracking of tumor supplying
branch -tumor segmentationPros and cons of low-energy CT -amount & rate of contrast injection -concentration of contrast
medium -beam-hardening artifact -Iterative reconstruction
UR171-ED-X
Imaging Characteristics of Central Gland Neoplasms on Multiparametric 3 Tesla MRI of the Prostate
Participants
Robert Villani, MD, Manhasset, NY (Presenter) Nothing to Disclose
Eran Ben-Levi, MD, Roslyn, NY (Abstract Co-Author) Nothing to Disclose
Ardeshir R. Rastinehad, DO, New Hyde Park, NY (Abstract Co-Author) Nothing to Disclose
Pnina Herskovits, MD, Manhasset, NY (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. The central gland of the prostate harbors at least 30% of all prostate gland malignancy. 2. Benign hypertrophic glandular and
stromal nodules in the central gland may have many of the same characteristics as neoplasm in the peripheral zone. This results in
either overcalling of lesions in the central gland or conversely passing by lesions believing them to be benign. 3. This exhibit will
discuss the characteristics of both benign and malignant lesions in the central gland of the prostate with the aim of improving a
reader's accurate detection of both.
Anatomy of the prostate gland. Pathophysiology of benign hyperplasia in the central glandReview of the common MRI appearance
for benign central nodular hyperplasiaReview of the characteristic MRI appearance of malignant central gland lesions. Artifacts and
pitfalls when evaluating 3T multiparimetric MRI prostate imaging of the central gland of the prostate.Management of suspicious
findings in the central gland on MRI of the prostate gland
UR172-ED-X
Study in Contrasts: A Resident's Guide to Contrast Media and Managing Contrast Related Emergencies
Participants
Evan Allgood, MD, Torrance, CA (Abstract Co-Author) Nothing to Disclose
Jordan M. Anaokar, MD, Torrance, CA (Presenter) Nothing to Disclose
TEACHING POINTS
Radiology residents field questions related to the safety and appropriate use of intravenous contrast media and are often the first
to responders to emergencies in the radiology suite. The aim of this presentation is to help residents identify patients at risk for
adverse reactions to intravenous contrast, understand precautions that can be taken to minimize these risks, and prepare them for
handling acute contrast reactions.
Risk factors for adverse events related to intravenous contrast media including allergy, renal insufficiency and other miscellaneous
conditions Premedication strategies for patients with known contrast allergy Precautions for patients with renal insufficiency,
including patients on acute or chronic hemodialysis, to avoid contrast-induced nephrotoxicity and nephrogenic systemic fibrosis
Special considerations for women who are pregnant or breast feeding Common myths and misconceptions about intravenous
contrast Treatment of mild, moderate and severe contrast allergies and their mimics Self assessment questions
UR174-ED-X
Imaging of Penile Implant: What Can Go Wrong?
Participants
Mariana D. Silva, MD, Sao Paulo, Brazil (Presenter) Nothing to Disclose
Aroldo H. Ban, MEd, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Felipe R. Ferreira, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Fernando I. Yamauchi, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Although other imaging methods are sometimes used for the evaluation of penile prosthesis and other devices, MRI is the modality
of choice for investigating malfunctioning or painful penile implants. The purpose of this exhibition is to review all imaging aspects of
implants and their different subtypes, including malleable and inflatable models; present a selection of cases to illustrate all major
complications such as migration, crossover, fracture, expelling, overlong prostheses and infection; and brief summary of penile
implants safety on the MR environment.
. Description of all types of malleable and inflatable penile implants and their aspects on the different imaging modalities, with
emphasis on MRI;. Review MRI protocols to investigate painful penile implants and mechanical failures;. Illustrate several cases of
complications, including:1.migration;2.extrusion;3.fractures;4.overlong prosthesis;5.buckling;6.crossover;7.infection.8.fibrosis of the
corpora cavernosum.. Summary of MRI safety of penile implants
UR175-ED-X
DWI and the Male Pelvis: What This Technique Can Show Us
Participants
Edson D. Barbosa, Nova Iguacu, Brazil (Presenter) Nothing to Disclose
Rachel F. Muffareg, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Felipe A. Mattos, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Gabriella M. Borges, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
- MRI is playing an increasingly important role in the avaliation of the diseases that compromise the male pelvis.- A DWI, in addition
to being a rapid sequence and not needing the use of intravenous contrast, has become a useful and powerful tool, which has been
expanding its borders and gaining new applicabilities, especially in the field of oncology, holding the promise for providing earlier
cancer detection and evaluation of treatment response and providing important information in a noninvasive manner.- The objective
of this study is to analyze and illustrate some applications that DWI plays in the male pelvis and show the most common pitfalls in
the evaluation of the images, recalling also the principles of dwi and how to make the correct interpretation of this images.
- Review the tecniques aspects involving DWI- Demonstrate the increased conspicuity and definition of malignant focal lesions in
the male pelvis, especially in the prostate- Predicting aggression, staging and evaluating response or tumor recurrence of cancers
of the bladder, prostate, rectum and penile- Assisted in predicting which patients will have biochemical recurrence after radical
prostatectomy- Identify pelvic lymph nodes- Evaluation of pelvic collections- New insights- Common pitfalls for DWI imaging in this
anatomic region.
UR176-ED-X
Testicular Adrenal Rests Tumors: Imaging Appearance and Differential Diagnosis
Participants
Sandra M. Tochetto, MD, Sao Paulo, Brazil (Presenter) Nothing to Disclose
Osmar C. Saito, MD, PhD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Raquel A. Moreno, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Fernando L. Pereira, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Maria Cristina Chammas, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this educational exhibit is to:1-Review the embryological development of the male gonad and the adrenal gland;2Discuss the most common findings at US and MR imaging that can help to establish an accurate diagnosis;3-Report our experience
with testicular adrenal rests tumors in patients with congenital adrenal hyperplasia;4-Discuss the differential diagnosis of a bilateral
testicular lesion.
The adrenal glands and the gonads share a common embryological origin. During the embryological development, some cells destined
to become adrenocortical cells may nestle within the descending gonad.Testicular adrenal rests tumors (TART) are benign lesions
that develop due to overstimulation of this ectopic adrenal remnants within the testis. Imaging plays an important role in the
detection and surveillance of testicular adrenal rest tumors. US and MR imaging features are characteristic in the context of
elevated ACTH serum level (CAH). This exhibit will:1-Review the embryological development of the male gonad and the adrenal
gland;2-Discuss the imaging findings (US and MR) of TART;3-Show examples of different presentations of TART with clinical
correlation;4-Discuss the implication for male fertility;5-Discuss the most important differential diagnosis.
UR177-ED-X
MR Imaging of Male-to-Female Sex Reassignment Surgery: A Comprehensive Review of Expected Imaging
Findings in the Normal Post Operative and Common Complications
Participants
Marina A. Ferreira, Sao Paulo, Brazil (Presenter) Nothing to Disclose
Felipe R. Ferreira, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Aroldo H. Ban, MEd, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Francisco T. Denes, PhD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Berenice B. Mendonca, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibition is: 1.Review and summarize the main surgical techniques in male-to-female sex reassignment surgery;
2.Review the role of magnetic ressonance (MR) in the post-operative and the main expected imaging findings; 3. Review and
describe the most commons complications after the male-to-female sex reassignment surgery and their presentations on different
imaging methods, focusing on magnetic ressonance (MR); 4.Present a sample of cases to illustrate normal expected findings and
complications after surgery.
- Definition of transsexualism and its multidisciplinary approach and treatment modalities- The role of sex reassignment surgery for
patients in current society- Male-to-female sex reassignment surgery: summarizing the main steps and objectives- Describe the
expected imaging findings in the normal post-operative, focusing on MRI imaging (including a description of the suggested
protocols)- Describe some of the most common complications after surgery and the imaging findings in those cases- Samples of
cases to exemplify normal post-operative MRI findings and common complications
UR178-ED-X
Eureka! Urachal Abnormalities Made Simpler
Participants
Carolina Parada, MD, Buenos Aires, Argentina (Presenter) Nothing to Disclose
Sharon Z. Adam, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Julie Sanders, MD, Shreveport, LA (Abstract Co-Author) Nothing to Disclose
Paul Nikolaidis, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Vahid Yaghmai, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Frank H. Miller, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Understanding the different urachal abnormalities is based on understanding the embryonal development Imaging features of the
different abnormalities and the potential complications will be discussed
Embryonal development of the urachus Spectrum of urachal abnormalities including epidemiology Complications of urachal
abnormalities Imaging appearance on sonography, CT and MRI of each abnormality - patent urachus, urachal cyst, urachal sinus
and urachal diverticulum Imaging appearance on sonography, CT and MRI of associated complications - infection and carcinoma
Mimickers of urachal abnormalities
Honored Educators
Frank H. Miller, MD - 2012 Honored Educator
Vahid Yaghmai, MD - 2012 Honored Educator
UR179-ED-X
Multidetector CT Urography of 2015: Did the Current State of CTU Change? - Current Techniques, Clinical
Utility and New Applications
Participants
Yukiko Honda, MD, Hiroshima, Japan (Presenter) Nothing to Disclose
Toru Higaki, PhD, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Yoko Kaichi, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Chihiro Tani, MD, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Makoto Iida, Hiroshima, Japan (Abstract Co-Author) Nothing to Disclose
Kazuo Awai, MD, Hiroshima, Japan (Abstract Co-Author) Research Grant, Toshiba Corporation; Research Grant, Hitachi, Ltd;
Research Grant, Bayer AG; Reseach Grant, DAIICHI SANKYO Group; Medical Advisor, DAIICHI SANKYO Group; Research Grant, Eisai
Co, Ltd; Research Grant, Nemoto-Kyourindo; ; ; ; ;
TEACHING POINTS
We focus on matters which have changed for these several years about CTU. First, we describe a current CTU method and various
guidelines critically. Second, we show the diagnostic capability of CTU when considering an exposed problem. Third, we introduce
urothelial carcinoma(UC) staging criteria and pitfall with indicating several actual cases. We also make a clear when we should
perform MR for detecting UC. Finally, we introduce and suggest new CT technologies and future perspective of CTU.
Critically review various multidetector CT urography (CTU) protocols and guidelines The current diagnostic capability of CTU when
considering an exposed problem Staging of urothelial carcinoma by using CT and pitfall When should we perform MR? New
technologies for CTU and future perspective of CTU
UR180-ED-X
Radiological Findings of the Normal and Pathologic Perirenal Space
Participants
Jose A. Jimenez Lasanta SR, MD, Cerdanyola del Valles, Spain (Presenter) Nothing to Disclose
Erika Normantas, Badalona, Spain (Abstract Co-Author) Nothing to Disclose
Monse Tenesa, Badalona, Spain (Abstract Co-Author) Nothing to Disclose
Eva Barluenga, Badalona, Spain (Abstract Co-Author) Nothing to Disclose
Jordi Bechini, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1.-.To describe the normal anatomy of the perirenal space.2.- To present the radiologic features of perirenal space, its main
relationships and boundaries.3-. To show the pathological processes that may involve this space4.- To compare the various imaging
techniques used in the evaluation of this anatomical region.
A detailed anatomic and pathological review of the perirenal space will be presented. Conditions to be considered are classified
as,A. Inflammatory and infectious processes and collections: 1-pyelonephritis - abscess renal, •2. Xanthogranulomatous
pyelonephritis, •3. Emphysematous pyelonephritis, •4. Pancreatitis, •5.Post-renal biopsy hematoma, •6. Post-renal trasnplantation
hematoma.B. Neoplastic-paraneoplastic conditions: •1.Splenic angiosarcoma splenic, 2.Renal angiomyolipoma, •3. Renal cystic
tumor with solid area with enhancement, •4 Retroperitoneal mixoid liposarcoma, •5.Changes after tumor radiofrequency in perirenal
space, •6. Lymphoma with renal-perirrenal and mesenteric involvement (with PET-CT), •8. Splenic metastatic adenocarcinoma with
perirenal extension, 8. Neuroblastoma with perirenal invasion, •10. Erdhein-Chester disease, •11. Renal Lymphangiectasia
UR181-ED-X
If It Aint broke, Don't Fix It. 'Utility of Ultrasound in Evaluation of Penile Pathology: A Pictorial Essay and
Review of Literature.'
Participants
Artur Velcani, MD, Fairfield, CT (Abstract Co-Author) Nothing to Disclose
Jonathan R. Weisiger, MD, New Haven, CT (Presenter) Nothing to Disclose
TEACHING POINTS
1. Provide basic understanding of the role of US in evaluation of the penis. Review of normal sonographic appearance of the penile
soft tissue and vasculature 2. Review non traumatic and traumatic penile pathologies while utilizing ultrasound imaging. 3. Discuss
clinical significance and management for each case.
Introduction General anatomy of the penile soft tissue. Review of normal US evaluation of penile vasculature and functional change
Most commonly encountered penile pathology: Vascular related abnormalities. Erectile dysfunction a- Normal parameters of penile
Dopplerb- Papaverine injection examination with duplex dopplerc- Pre/post injection evaluation of penale blood flow. 2. Priapism aSlow flow and high flow variants.b- Arterial - arterial fistulac- Penile vein thrombosisd- Venous insufficiencye- Venous varixfPseudoaneurysm pre / post embolization Traumaa- Penile/corpus cavernous fracture Infectious a- Cellulitis b- Abscess OtheraPeyronie's disease
UR182-ED-X
Contrast-enhanced Ultrasound in Urology
Participants
Nagaaki Marugami, Kashihara, Japan (Presenter) Nothing to Disclose
Toshiko Hirai, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
Junko Takahama, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
Aki Takahashi, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
Kimihiko Kichikawa, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) To understand the principle of contrast-enhanced ultrasound (CE-US) compared with contrast-enhanced CT or MRI. 2) To
demonstrate the utility of CE-US in diagnosis of urologic disorders compared with multimodality imaging.
1, Introduction: the development of contrast medica of ultrasound, the principle of CE-US.2, Case presentations 1) Kidney: Renal
infarction, Renal cell carcinoma (clear cell RCC, papillary RCC, cystic RCC), Renal oncocytoma, Renal AML, Complicated cysts, etc.
2) Testis: segmental testicular infarction, testicular torsion, testicular abscess, testicular trauma (hemorrhage),3, Discussion4,
Summary: contrast-enhanced US can demonstrate high accuracy in the diagnosis of urologic disorders.
UR183-ED-X
Congenital Abnormalities of Kidney and Ureter: Embryology, Pathophysiology and Imaging with Emphasis on
Role of Fetal MRI
Awards
Participants
Jignesh N. Shah, MD, Memphis, TN (Presenter) Nothing to Disclose
Saurabh Gupta, MD, Milwaukee, WI (Abstract Co-Author) Nothing to Disclose
Harris L. Cohen, MD, Memphis, TN (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
• To review embryogenesis of kidneys and ureters and correlate the aberrant embryological pathways with anatomy of congenital
renal and ureteric anomalies.• To review imaging findings of a wide spectrum of congenital renal and ureteric abnormalities with
emphasis on role of fetal MRI.• To discuss the implications of imaging on management.
Normal embryogenesis of kidneys and ureters; Embryological basis of congenital renal and ureteric abnormalities including renal
agenesis, renal ectopia, fusion and rotational abnormalities of kidneys, supernumery kidney, cystic renal disease (ADPKD, ARPKD,
MCDK), congenital renal neoplasms (mesoblastic nephroma, wilm's tumor, rhabdoid tumor, clear cell sarcoma), retrocaval ureter,
primary megaloureter, duplication of ureter, ectopic ureteric orifice, vesicoureteral reflux; Imaging findings of a wide spectrum of
congenital renal and ureteric anomalies with emphasis on role of fetal MRI. Discuss implications of imaging on management.
UR184-ED-X
Genitourinary and Retroperitoneal Findings in 3 Neurocutaneous Syndromes: Tuberous Sclerosis,
Neurofibromatosis, and Von Hippel-Lindau Disease
Participants
Katryana M. Hanley-Knutson, MD, Winston Salem, NC (Presenter) Nothing to Disclose
George Athanasatos, MD, Winston Salem, NC (Abstract Co-Author) Nothing to Disclose
Raymond B. Dyer, MD, Winston Salem, NC (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Identify the common and uncommon genitourinary and retroperitoneal radiographic manifestations of the presented neurocutaneous
syndromes. Understand the similarities and differences of the genitourinary and retroperitoneal manifestations of the presented
neurocutaneous syndromes.
Tuberous Sclerosis Angiomyolipomas (AML) Renal cysts Renal cell carcinomas (RCC) Retroperitoneal lymphangiomyomatosis
(LAM)Neurofibromatosis-1 (NF-1) Retroperitoneal plexiform neurofibromas Renal artery stenosis PheochromocytomasVon HippelLindau Disease Renal cysts Renal cell carcinomas Pheochromocytomas Papillary cystadenomas of the epididymis and broad ligament
UR186-ED-X
The Good, Bad and Ugly: Cross-Sectional Imaging Spectrum of Fat Containing Genitourinary Lesions and
Clinical Implications
Participants
Yun S. Xie, MD, San Antonio, TX (Abstract Co-Author) Nothing to Disclose
Ameya J. Baxi, MBBS, DMRD, San Antonio, TX (Abstract Co-Author) Nothing to Disclose
Amol S. Katkar, MD, San Antonio, CO (Abstract Co-Author) Nothing to Disclose
Arpit M. Nagar, MBBS, Columbus, OH (Abstract Co-Author) Nothing to Disclose
Vijayanadh Ojili, MD, San Antonio, TX (Presenter) Nothing to Disclose
TEACHING POINTS
1. To describe the cross-sectional imaging findings of fat containing genitourinary lesions and discuss the clinical implications of
specific imaging findings.2. To discuss the complications encountered with the fat containing lesions, role of imaging in detecting
these complications and image-guided interventions in the management of these patients.
1. Introduction, etiopathogenesis and clinical presentation of fat containing genitourinary lesions.2. Role of cross-sectional imaging
modalities (particularly CT).3. Imaging spectrum of fat containing genitourinary lesions (adrenal adenoma, adrenal myelolipoma, renal
AML, renal liopma, clear cell RCC, bladder lipoma, ovarian teratoma, uterine lipoleiomyoma, extra-medullary hematopoiesis etc).
ED006-SU
Genitourinary Sunday Case of the Day
Sunday, Nov. 29 8:00AM - 11:59PM Location: Case of Day, Learning Center
GU
AMA PRA Category 1 Credit ™: .50
Participants
Theodora A. Potretzke, MD, Saint Louis, MO (Presenter) Nothing to Disclose
Naoki Takahashi, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Meghan G. Lubner, MD, Madison, WI (Abstract Co-Author) Grant, General Electric Company; Grant, NeuWave Medical, Inc; Grant,
Koninklijke Philips NV
Anup S. Shetty, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Richard Tsai, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
George A. Carberry, MD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Vincent M. Mellnick, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
David U. Kim, MD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Yaseen Oweis, MD, MBA, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Zachary J. Viets, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Bernard F. King JR, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1) Recognize imaging findings seen in disorders of the genitourinary systems. 2) Develop differential diagnosis based on the clinical
information and imaging findings. 3) Recognize the clinical importance of diagnosis.
Honored Educators
Naoki Takahashi, MD - 2012 Honored Educator
Meghan G. Lubner, MD - 2014 Honored Educator
SSA09
Genitourinary (New Technologies for Imaging the Genitourinary Tract)
Sunday, Nov. 29 10:45AM - 12:15PM Location: E351
GU
BQ
MR
US
AMA PRA Category 1 Credits ™: 1.50
ARRT Category A+ Credits: 1.50
FDA
Participants
Julia R. Fielding, MD, Chapel Hill, NC (Moderator) Nothing to Disclose
Erick M. Remer, MD, Cleveland, OH (Moderator) Nothing to Disclose
Sub-Events
SSA09-01
Simultaneous Conventional Dynamic MR Urography and High Temporal Resolution Perfusion MRI of
Bladder Tumors Using a Novel Free-Breathing Golden-Angle Radial Compressed-Sensing Sequence
Sunday, Nov. 29 10:45AM - 10:55AM Location: E351
Participants
Nainesh Parikh, MD, New York, NY (Presenter) Nothing to Disclose
Justin M. Ream, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Hoi Cheung Zhang, New York, NY (Abstract Co-Author) Nothing to Disclose
Kai Tobias Block, PhD, New York, NY (Abstract Co-Author) Royalties, Siemens AG;
Hersh Chandarana, MD, New York, NY (Abstract Co-Author) Equipment support, Siemens AG; Software support, Siemens AG;
Consultant, Bayer, AG;
Andrew B. Rosenkrantz, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the feasibility of simultaneous conventional dynamic MR urography (MRU) and high temporal resolution perfusion MRI
of bladder tumors using a novel free-breathing golden-angle radial acquisition scheme with compressed sensing reconstruction
METHOD AND MATERIALS
22 patients with bladder lesions underwent MRU using the GRASP (Golden-angle RAdial Sparse Parallel) technique. Following
contrast injection, GRASP was performed of the abdomen and pelvis during free breathing (voxel size 1.4x1.4x3.0 mm, 1,000 radial
spokes, acquisition time 3:44 min). Two dynamic data-sets were retrospectively reconstructed from this single acquisition by
combining a distinct number of spokes into each dynamic frame: 110 spokes per frame to provide a resolution of approximately 30
seconds, serving as conventional MRU for clinical interpretation, and 8 spokes per frame to provide 2 second resolution images for
quantitative perfusion. Using the 2 second resolution images, ROIs were placed within the bladder lesion and normal bladder wall for
all patients, an arterial input function was generated from the femoral artery, and the GKM perfusion model was applied.
RESULTS
Follow-up cystoscopy and biopsy demonstrated 16 bladder tumors (13 stage≥T2, 3 stage≤T1) and 6 benign lesions. All lesions were
well visualized using the conventional 25 second clinical dynamic images. Based on the 2 second resolution images, Ktrans was
significantly higher in bladder tumors (0.38±0.24) than in either normal bladder wall (0.12±8, p<0.001) or in benign bladder lesions
(0.15±0.04, p=0.033). The ratio between Ktrans of the lesion and of normal bladder wall in each patient was nearly double in
tumors than in benign lesions (4.3±3.4 vs. 2.2±1.6), and Ktrans was nearly double in stage≥T2 tumors than in stage≤T1 tumors
(0.44±0.24 vs. 0.24±0.24), although these did not approach significance (p=0.180-0.209), likely related to small sample size.
CONCLUSION
GRASP DCE-MRI provides simultaneous conventional dynamic MRU and high temporal resolution perfusion MRI of bladder tumors.
Quantitative evaluation of bladder lesions based on the 2 second temporal resolution reconstructions showed associations with
pathologic findings in our preliminary cohort.
CLINICAL RELEVANCE/APPLICATION
The novel GRASP sequence allows quantitative perfusion evaluation of bladder lesions within the context of a clinical MRU
examination using a single contrast injection and without additional scan time.
SSA09-02
Magnetic Resonance Fingerprinting in Diagnosis of Prostate Cancer: Initial Experience
Participants
Shivani Pahwa, MD, Clevelnad, OH (Presenter) Nothing to Disclose
Chaitra A. Badve, MD, MBBS, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Yun Jiang, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Alice Yu, BS, MS, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Mark D. Schluchter, PhD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Mark A. Griswold, PhD, Cleveland, OH (Abstract Co-Author) Research support, Siemens AG Royalties, Siemens AG Royalties, General
Electric Company Royalties, Bruker Corporation Contract, Siemens AG
Lee E. Ponsky, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Vikas Gulani, MD, PhD, Ann Arbor, MI (Abstract Co-Author) Research support, Siemens AG
PURPOSE
To describe initial experience in detecting prostate cancer (PCa) using quantitative MRI parameters - T1 and T2 relaxation times
To describe initial experience in detecting prostate cancer (PCa) using quantitative MRI parameters - T1 and T2 relaxation times
derived from magnetic resonance fingerprinting (MRF-FISP), in combination with conventional ADC maps.
63 patients with clinical suspicion of prostate cancer were imaged on 3T Siemens Skyra /Verio scanners. MRF has been shown to
measure T1 and T2 relaxation times with high accuracy and precision2. In addition tothe standard multiparametric MRI exam, MRFFISP was acquired (slice thickness: 6 mm, in-plane resolution:1×1 mm2,FOV:400 mm, TR:11-13 ms, flip angle:5-75 deg,
duration:50s per slice).b-valuesfor DWI were0, 500, 1000 s/mm2.T1, T2 maps were generated from MRF-FISP dataand regions of
interest (ROI)were drawn on T1, T2 and ADC maps in areas suspicious for cancer identified based on PIRADS score, and normal
peripheral zone (NPZ). Matched pairs t-tests were used to compare T1, T2, ADC values in biopsy provenPCa and NPZ. Logistic
regression model was applied to these parameters in differentiating PCa from NPZ. Receiver operating characteristic (ROC) analysis
was performed for the parameters singly and in combination and area under the curve (AUC) was calculated
RESULTS
29 patients were diagnosed with cancer on transrectal biopsy. T1, T2, ADC values were significantly lower in cancer compared to
NPZ (p<0.0001). Mean T1, T2, ADC for prostate cancer were 1413±60ms, 66±3ms, 745±54 x 10-6mm2/s, respectively. For NPZ,
these values were 2058±77ms, 165±8ms, 1736±37 x 10-6mm2/s.The AUC for T1, T2, ADC values in separating PCa from NPZ was
0.978, 0.982, 0.801, respectively. The combination of T2 and ADC produced the most complete separation between cancer and
normal tissues, resulting in AUC of 0.995.
CONCLUSION
MRF-FISP is a novel relaxometry sequence that allows quantitative examination of prostate in a clinical setting. The T1 and T2
relaxation times so obtained, in combination with ADC values show promising results in detecting prostate cancer.
Quantitative MR parameters can help identify prostate cancer non-invasively. This could have broad applications in diagnosis,
guiding biopsy, and following treatment
SSA09-03
Contrast-enhanced Ultrasound for Renal Mass Characterization: Comparison of Low MI Timeintensity Curves and Destruction Reperfusion Techniques
Participants
Wui K. Chong, MD, Chapel Hill, NC (Presenter) Nothing to Disclose
Emily Chang, MD, Chapel Hill, NC (Abstract Co-Author) Nothing to Disclose
Sandeep Kasoji, Chapel Hill, NC (Abstract Co-Author) Nothing to Disclose
Paul Dayton, PhD, Chapel Hill, NC (Abstract Co-Author) Co-founder, SonoVol LLC; Board Member, SonoVol LLC
Ersan Altun, MD, Istanbul, Turkey (Abstract Co-Author) Nothing to Disclose
Julia R. Fielding, MD, Chapel Hill, NC (Abstract Co-Author) Nothing to Disclose
Kevin O. Herman, MD, Raleigh, NC (Abstract Co-Author) Nothing to Disclose
W K. Rathmell, Chapel Hill, NC (Abstract Co-Author) Research support, GlaxoSmithKline plc
Lee Mullin, PhD, Chapel Hill, NC (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate contrast enhanced US (CEUS) for renal mass characterization in chronic renal insufficiency (CRI), comparing
nondestructive (low MI) and destruction-reperfusion techniques.
Prospective study comparing 48 subjects: 24 with normal function and renal masses scheduled for excision; 24 with CRI and
indeterminate renal lesions on non-contrast US/CT.CEUS was performed on an Acuson Sequoia with CPS software. Perflutren
(Definity) 1.3ml was administered IV. Lesions were imaged at a low MI of 0.2. A 3 minute videoclip was recorded. Time Intensity
curves (TICs) of the lesion and adjacent parenchyma were generated. After 30 minutes, a 2nd dose of Definity was given and a
Destruction Reperfusion (DR) sequence performed on the same lesion. DR was performed under an IND exemption from the FDA.
Bubble destruction was performed at an MI of 0.9. Reperfusion images were obtained using Motion Stabilized Persistence software
(Siemens). A color-coded parametric map quantifying arrival time was generated in which Green=faster arrival, Red=slower,
Black=no contrast. (Arrow=Bosniak IV mass).Reference standard was pathology, contrast CT/MR or absence of change on follow up
imaging for benign lesions. Two blinded readers reviewed the low MI images and classified the lesions using Bosniak criteria.
RESULTS
Lesion size ranged from 1.7-7.6cm (mean 3.5cm). Histopathology of resected masses showed no cavitation or cellular injury from
high MI of DR. DR arrival times correlated with low MI TIC parameters. Sensitivity for distinguishing Bosniak I/II/IIF from III and
higher was: Reader 1-96%, Reader 2-100%. Specificity was 78% and 63%. Specificity is lower because CEUS detects smaller
amounts of contrast than CT/MR, leading to 'overstaging' with standard Bosniak. Reduced time to peak and arrival time (p<0.05)
was seen in the parenchyma of CRI subjects compared to parenchyma of those with normal renal function.
CONCLUSION
CEUS can characterize renal lesions, but Bosniak criteria must be modified because US is more sensitive to slight enhancement. DR
does not cause tissue injury, correlates with low MI findings, and takes less time. The parenchyma in CRI showed reduced/ delayed
contrast uptake, suggesting CEUS may also be useful for renal functional imaging.
CEUS can evaluate indeterminate renal lesions and renal function in CRI, a population where CT and MR contrast are
contraindicated.
SSA09-04
ARFI Evaluation of Small (<4 cm) Renal Masses. A Preliminary Study
Participants
Costanza Bruno, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Alessandra Bucci, MD, Verona, Italy (Presenter) Nothing to Disclose
Matteo Brunelli, PhD, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Salvatore Minniti, MD, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Chiara Dalla Serra, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Roberto Pozzi Mucelli, Verona, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate if ARFI can be a reliable technique in distinguish ccRCCS from other solid and fluid-containing small renal masses.
31 small (<4 cm) renal masses (27 were solid - 17/27 ccRCCs, 3/27 papillary RCCs, 2/27 chromophobe RCCs, 4 oncocytomas and 1
angiomyolipoma - and 4 were cysts) were prospectively evaluated using US and ARFI. Each lesion was assigned an ARFI value
obtained from the average of 12 measurements.All the solid masses underwent resection; all the cystic lesions were Bosniak 2, so
were evaluated with follow up.The difference existing between the two groups was evaluated by means of Student's t test.A cut
off value was determined to distinguish between ccRCCs and other lesions and sensibility, specificity, PPV, NPV and accuracy were
determined.
RESULTS
ccRCCs are characterized by an higher ARFI value and - when compared with all the other lesions - the difference existing between
the two groups was statistically significant (p<0.001). Considering a cut off value of 1.95 m/sec sensibility, specificity, PPV, NPV
and accuracy were respectively 94.1%, 78.6%, 84.2%, 91.7% and 87.1%.
CONCLUSION
ccRCC is characterized by an higher ARFI value which can be used to distinguish it from other solid and fluid containing masses.
ARFI can be an useful tool in the evaluation of small renal masses, helping distinguish cc RCCs from other lesions.
SSA09-05
Fusion Imaging of (Contrast-enhanced) Ultrasound with CT or MRI for Kidney Lesions
Participants
Thomas Auer, Innsbruck, Austria (Abstract Co-Author) Nothing to Disclose
Tobias De Zordo, MD, Innsbruck, Austria (Presenter) Nothing to Disclose
Daniel Junker, Innsbruck, Austria (Abstract Co-Author) Nothing to Disclose
Isabel M. Heidegger, Innsbruck, Austria (Abstract Co-Author) Nothing to Disclose
Werner R. Jaschke, MD, PhD, Innsbruck, Austria (Abstract Co-Author) Nothing to Disclose
Friedrich H. Aigner, MD, Innsbruck, Austria (Abstract Co-Author) Nothing to Disclose
PURPOSE
The aim of the study was to evaluate the feasibility of fusion imaging (FI) of (contrast-enhanced) ultrasound (CEUS) with CT/MRI
in localization of sonographically challenging kidney lesions and usefulness for assessment of indeterminate kidney lesions
From March 2013 to January 2014, 30 consecutive patients were included in this retrospective studyAll patients presented with
previously in CT/MRI detected indeterminate kidney lesions that were either not detectable or hard to distinguish in conventional
gray-scale ultrasoundIn these patients additional FI was performed by fusion of ultrasound with CT/MRI datasets. In 26 (86.7%) of
these patients FI and CEUS was simultaneously conducted
RESULTS
FI could be performed in all of the 30 patientsFI-indication: In 18 of 30 patients (60%) FI was performed because a lesion of
interest could not clearly be allocated due to multiple and directly adjacent similar lesions within one kidney. In 12 of 30 patients
(40%) the kidney lesions were solitary or at least isolated but could not be detected with gray-scale US alone.CEUS-indication:
Insufficient CT protocol (without NECT) and a not-water-isodens lesion (>20 HU ) in 8 (30.8%) patients borderline CE in CT (10HU20HU) in 11 (42.3%) patients non-conclusive CT/MRI studies in 5 (19.2%) patients CEUS for follow-up in 2 (7.7%)
patients.Combined FI-CEUS: FI-CEUS could clearly differentiate between a surgical and non-surgical finding in 24 (80%) of 30
patients In 2 (6.7%) of 30 patients with conducted FI-CEUS lesions remained indeterminateFinal dignosis: Histology revealed a
surgical lesion in 6 (20%) patients, while in 18 (60%) patients a non-surgical lesion such as BII/BIIF cysts, abscess formations,
cicatricial tissue and a pseudotumor could be found. FI-CEUS didn't determine a final diagnosis in 2 patients (6.7%) In one elderly
patient (3.3%) FI was conducted without CEUS because only size control of was demanded In 3 (10%) patients kidney lesions were
not confidently detected with FI due to general US limitations
CONCLUSION
Our data suggest that FI of the kidney is a feasible examination regarding the localization and further assessment of indeterminate
kidney lesions.
The combination of FI with a synchronous CEUS examination can clarify indeterminate renal CT or MRI findings, reduce radiation
exposure and is cost effective.
SSA09-06
Optimal Energy for Kidney Parenchymal Visualization in Monoenergetic Images Generated from Dual
Energy CT
Participants
Jason DiPoce, MD, Jerusalem, Israel (Presenter) Nothing to Disclose
Zimam Romman, Haifa, Israel (Abstract Co-Author) Employee, Koninklijke Philips NV
Jacob Sosna, MD, Jerusalem, Israel (Abstract Co-Author) Consultant, ActiViews Ltd Research Grant, Koninklijke Philips NV
PURPOSE
To evaluate image quality of kidney parenchyma in a spectrum of CT monoenergy levels and to select the optimal Monoenergy
levels for visualization.
IRB approval was obtained. 30-corticomedullary phase, IV contrast-enhanced CT abdomen scans (18 males, 12 females, mean age
of 50 years) were evaluated. In each scan, kidney parenchyma (60 regions) was assessed. The scans were obtained from a 64slice spectral detector CT prototype (Philips Healthcare, Cleveland, OH, USA) at 120 kVp with an average of 150 mAs. For each
scan, simultaneous conventional polyenergetic and monoenergetic image datasets at 50, 60, 70, 100, and 140 keV were
reconstructed. Two experienced radiologists analyzed subjectively in consensus visualization of the kidney parenchyma and
selected the optimal visualization dataset based on the conspicuity of the cortex and medulla and compared to the conventional
images. Objective kidney signal-to-noise ratio (SNR) in the optimal monoenergy images was measured and compared to data from
the conventional CT images.
RESULTS
Optimal image quality for kidney visualization was subjectively selected with 60 - 70 keV monoenergy images and was judged to be
better than the conventional dataset. The kidney SNR values in optimal monoenergy were highly significantly different (p<0.01)
from conventional CT images. Average SNR was 10.9 and 16.3 in the conventional and optimal monoenergy respectively.
CONCLUSION
Optimal visualization of the kidney parenchyma on dual energy CT images is achieved with monoenergy image reconstruction at 60 70 keV based on both subjective and objective assessments and seems to improve image quality compared to conventional images.
Optimal image quality in monoenergy images may be supplemental to conventional polyenergetic images and potentially increase the
diagnostic yield.
Honored Educators
Jason DiPoce, MD - 2013 Honored Educator
Jacob Sosna, MD - 2012 Honored Educator
SSA09-07
The Use of New Tissue Strain Analytics Measurement in Testicular Lesions
Participants
Dirk-Andre Clevert, MD, Munich, Germany (Presenter) Speaker, Siemens AG; Speaker, Koninklijke Philips NV; Speaker, Bracco Group;
Matthias Trottmann, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Julian Marcon, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Melvin D'Anastasi, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Alexander Karl, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Maximilian F. Reiser, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Virtual touch tissue imaging quantification (VTIQ) is a newly developed technique for the sonographic quantification of tissue
elasticity. It has been used in the assessment of breast lesions. The purpose of this study was to determine the diagnostic
performance of VTIQ in unclear testicular lesions.
Twenty patients with known testicular pathology underwent conventional B-mode sonography with additional VTIQ of the testicular
lesions using a Siemens Acuson S2000™ and S3000™ (Siemens Medical Solutions, Mountain View, CA, USA) system. Tissue
mechanical properties were interpreted and compared in the VTIQ examination. The pathologic diagnosis was established after
surgery or in the follow up examination in highly suspicious of benign lesions.
RESULTS
Over 36 months, 22 focal testicular lesions (median lesion size, 18 mm; range, 4-36 mm in 20 patients (median age, 43 years;
range, 22-81 years) were examined. Lesions were hyperechoic (n = 1), hypoechoic (n = 14), isoechoic (n = 1), mixed echogenicity
(n = 3) or anechoic (n = 3). Histological examination showed one benign lesion (6.25 %) with a mean size of 7 mm and 15 malignant
lesions (93.75 %) with a mean size of 20 mm. The value of the shear wave velocity in normal testis tissue showed a mean shear
wave velocity of 1.17 m/s. No value of the shear wave velocity could the measured in cystic lesions. The rest of the benign lesions
showed a mean shear wave velocity of 2.37 m/s. The value of the shear wave velocity in germ cell tumours showed a mean shear
wave velocity of 1.94 m/s and for seminoma it showed a mean shear wave velocity of 2.42 m/s.
CONCLUSION
VTIQ is a reliable new method for measuring qualitative and quantitative stiffness of testis lesions and tissue. The qualitative shear-
wave elastography features were highly reproducible and showed good diagnostic performance in unclear testicular lesions. The
VTIQ technique is a useful in assessing small testicular nodules and pseudo lesions.
VTIQ is a reliable user independent new method for measuring qualitative and quantitative stiffness of different testis lesions and
tissue. The VTIQ technique allows to distinguished different testis lesions and pseudo lesions.
SSA09-08
One-stop-shot MRI for Infertility Evaluation: Comparison with US and CT-HSG
Sunday, Nov. 29 11:55AM - 12:05PM Location: E351
Participants
Javier Vallejos, MD, MBA, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
Jimena B. Carpio, MD, Buenos Aires, Argentina (Presenter) Nothing to Disclose
Ezequiel Salas, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Carlos Capunay, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Mariano Baronio, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Patricia M. Carrascosa, MD, Buenos Aires, Argentina (Abstract Co-Author) Research Consultant, General Electric Company
Lorena I. Sarati, Vicente Lopez, Argentina (Abstract Co-Author) Nothing to Disclose
PURPOSE
Demonstrate the utility of MRI-HSG in the diagnosis of infertility, can through this method show uterine, tubal, ovarian and pelvic
causes.
14 patients between 31 and 41 year-old diagnosed with infertility were studied. We performed a transvaginal ultrasound, virtual CTHSG and MRI- HSG at the same day. MRI protocol include high-resolution T2 sequences, fat-suppressed T1, diffusion weighted
imaging and contrast dynamic sequence (3D time-resolved imaging of contrast kinetics [TRICKS]). A contrast dilution of saline,
iodine and gadolinium was instilled. Antral follicle counts, endometrial cavity findings, uterine wall pathology, tubal patency, and
pelvic cavity findings were assessed with modalities.
RESULTS
In all cases it was observed more ovarian follicles on MRI-HSG than in US. In 65% of patients, Fallopian tubes were visualized
completely with MRI-HSG, whereas in the remaining 35% only look at its distal portion. In all cases was demonstrated tubal patency
with free peritoneal spillage. In 45% of patients, MRI-HSG showed endoluminal lesions, likes polyps and miomas, that were
corroborated with CT-HSG. In 14% of patients, MRI-HSG detected endometrial implants in pelvic cavity that could not be
corroborated by the other methods.
CONCLUSION
MRI-HSG allows a comprehensive evaluation for infertility diagnosis, with visualization and quantification of antral follicles,
endometrial cavity, uterine wall and fallopian tubes as well as pelvic cavity findings such as endometrial implants.
MRI techniques could be combined with HSG procedure in order to enables a one-step-shot imaging for evaluation of female
infertility with the advantages of causing less pain and avoidance of exposure to ionizing radiation.
SSA09-09
4D Ultrasound Cistoscopy with Fly through in the Evaluation of Urinary Bladder Tumors Preliminary
Experience
Sunday, Nov. 29 12:05PM - 12:15PM Location: E351
Participants
Vito Cantisani, MD, Roma, Italy (Abstract Co-Author) Speaker, Toshiba Corporation; Speaker, Bracco Group; Speaker, Samsung
Electronics Co, Ltd;
Nicola Di Leo, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Valerio Forte, MD, Rome, Italy (Presenter) Nothing to Disclose
Flavio Malpassini, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Mauro Ciccariello, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Francesco Flammia, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Francesco M. Drudi, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Carlo Catalano, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Federica Flammia, Roma, Italy (Abstract Co-Author) Nothing to Disclose
Giuseppe Schillizzi, Roma, Italy (Abstract Co-Author) Nothing to Disclose
Ferdinando D'Ambrosio, Rome, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the feasibility and diagnostic efficacy 4D Ultrasound cystoscopy with Fly through as compared with trasditional
cystoscopy in evaluating Urinary Bladder tumors.
30 consecutive patients with previous detected urinary bladder lesions at cystoscopy were prospectively evaluated with 2D
baseline US, and 4D Ultrasound with fly through (US virtual navigation system) by an expert radiologist blinded to cystoscopy
results. The two imaging modalities were compared with cystoscopy and surgical results (N=8 patients) in order to assess the
sensitivity and specificity in tumor detection and characterization. The diagnostic performance of 2D features and 4D ultrasound
were estimated and compared using ROC curve analysis.
RESULTS
24/33 and 31/33 urinary bladder lesions were detected by 2 D US and 4 D Ultrasound respectively. The latter was also able to
24/33 and 31/33 urinary bladder lesions were detected by 2 D US and 4 D Ultrasound respectively. The latter was also able to
identify two additional lesions not previously detected at traditional cystoscopy. The US features of the lesions were consistent
with the one provided at cystoscopy with not significant differences in term of characterization.Conclusion: Our preliminary results
shows that 4 D ultrasound cystoscopy with fly through is more accurate than baseline 2D ultrasound to detect and characterize
urinary bladder lesions with results comparable with traditional cystoscopy.
CONCLUSION
Our preliminary results shows that 4 D ultrasound cystoscopy with fly through is more accurate than baseline 2D ultrasound to
detect and characterize urinary bladder lesions with results comparable with traditional cystoscopy.
New ultrasound software such as 4 D ultrasound cystoscopy with fly through may help us to follow-up patients treated
conservatively for urinary bladder lesions.
SSA10
Genitourinary (Adrenal and Renal Imaging)
Sunday, Nov. 29 10:45AM - 12:15PM Location: E353B
CT
GU
MR
FDA
Participants
Steven C. Eberhardt, MD, Albuquerque, NM (Moderator) Nothing to Disclose
Claudia P. Huertas, MD, Medellin, Colombia (Moderator) Nothing to Disclose
Seung Hyup Kim, MD, Seoul, Korea, Republic Of (Moderator) Nothing to Disclose
Sub-Events
SSA10-01
The Role of Peak Enhancement Values in Differentiating Pheochromocytomas from Adrenal Adenomas
on CT
Sunday, Nov. 29 10:45AM - 10:55AM Location: E353B
Participants
Mohammed F. Mohammed, MBBS, Vancouver, BC (Presenter) Nothing to Disclose
David Ferguson, MBBCh, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Alison C. Harris, MBChB, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
William C. Yee, MD,FRCPC, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose of this study is to establish the role of the peak enhancement Hounsfield Unit (HU) value of focal adrenal lesions in
differentiating potential pheochromocytomas from adrenal adenomas.
The peak enhancement HU values of histologically confirmed pheochromocytomas (n = 24) were retrospectively compared with
those of histologically confirmed adrenal adenomas (n = 28) on the 60-second contrast enhanced venous phase and compared
utilizing a chi-square test. The studies were performed over a period of 5 years (2009-2014) on multi-detector CT scanners
(MDCT). HU values were also measured on unenhanced (n = 34) and 15-minute delayed contrast enhanced (n = 27) phases.
Measurements were obtained by drawing a representative region of interest over the target lesion. Peak enhancement values were
recorded and absolute washout, relative washout and absolute enhancement (60-second enhanced minus unenhanced) were also
calculated when available. Mass size was also recorded. The Student t test was used for comparing absolute enhancement and
mass size.
RESULTS
83.3% (n = 20) of pheochromocytomas demonstrated a peak enhancement value of 85 HU or greater, compared to 10.7% (n = 3)
of adrenal adenomas (p < 0.001, PPV = 86.96%, NPV = 86.2%). Absolute enhancement of pheochromocytomas was also higher
than that of adrenal adenomas (mean = 66.2 HU [range, 51-95 HU] vs. 48.1 HU [range, 18-74]; p < 0.005). Of the
pheochromocytomas imaged with a triphasic protocol (n = 9), 77.8% (n = 7) met absolute and relative washout criteria for the
diagnosis of a lipid-poor adenoma (>= 60% and >=40% respectively). Pheochromocytomas were significantly larger than adrenal
adenomas (mean diameter, 4.5 cm [range, 1-8.3 cm] vs. 1 cm [range, 0.8-6.2 cm]; p < 0.0001).
CONCLUSION
Peak enhancement values of 85 HU or greater in an adrenal lesion on the 60-second post contrast phase strongly suggest a
diagnosis of pheochromocytoma rather than adrenal adenoma, regardless of whether or not the lesion demonstrates absolute or
relative washout characteristics compatible with a lipid poor adenoma.
Peak enhancement values on the 60-second post contrast phase should be routinely assessed in the workup of an adrenal lesion to
avoid missing a pheochromocytoma.
SSA10-02
Proton-Density Fat Fraction: A Viable Tool for Differentiating Adenomas from Nonadenomas in
Adrenal Glands, Compared with In-phase and Out-of-phase MR Imaging
Participants
Meng Xiaoyan, BMedSc, Wuhan, China (Presenter) Nothing to Disclose
Hu Daoyu, PhD, Wuhan, China (Abstract Co-Author) Nothing to Disclose
Chen Xiao, Wuhan, China (Abstract Co-Author) Nothing to Disclose
Zhen Li, MD, PhD, Wuhan, China (Abstract Co-Author) Nothing to Disclose
Yanchun Wang, Wuhan, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the application of proton-density fat-fraction (PDFF) measurements for accurately quantifying the fat-content of
adrenal nodules, differentiating adenomas from nonadenomas, and compare with in-phase (IP) and out-of-phase (OP) MR imaging.
This study was compliant with HIPAA and approved by the Institutional Review Board, with the waivers of informed consent. The
consecutive research was performed between Aug 2013 to Aug 2014, 37 patients with 40 adrenal nodules (21 histopathologically
proven adenomas, 13 proved pheochromocytomas and 6 clinically proven metastases) who underwent MRI scanning with T1
independent volumetric multi-echo gradient-echo imaging with T2*correction (IDEAL-IQ), following with an axial 3D dual-echo Dixon
sequence (LAVA-FLEX) which performed IP and OP images. All MRI examinations were performed on a 3.0-T MR scanner. PDFF, SI
index (SII), SI adrenal-to-liver ratio (ALR) and SI adrenal-to-spleen ratio (ASR) were calculated. All statistical analyses were
performed by using statistical software SPSS 17.0.
RESULTS
PDFF of adenomas (21.39±10.09%)was significantly higher than of nonadenomas (2.25±2.73)(p=0.000, <0.05).PDFF was an
effective tool for distinguishing adenomas from nonadenomas with an area under the curve (AUC) of 0.982, higher than 3.20
predicted adenomas with a sensitivity of 100% and a specificity of 89.5%.While,the sensitivities and specificities for adenomas
were 90.0% and 100%, both for SII, ALR and ASR on IP/OP images, with AUC of 0.942, 0.937, 0.932, respectively.
CONCLUSION
PDFF measurements provided a more accurate estimation for fat content in adrenal nodules than with IP/OP images, and it could be
a precisely parameter for differentiating adenomas from nonadenomas.
In conclusion, IDEAL-IQ could be a valuable diagnostic tool for discriminating adenomas from nonadenomas with a high sensitivity
and a relatively high specificity, avoiding radiation exposure, contrast media side-effect and complicated data calculation. IDEAL-IQ
would be a prospective, reliable, and widely used method for diagnosing adrenal gland nodules in clinical study.
SSA10-03
Adrenal Calcifications on CT Associated with Familial Cerebral Cavernous Malformation Type I: An
Imaging Biomarker for a Hereditary Cerebrovascular Condition
Participants
Corinne D. Strickland, MD, MS, Boston, MA (Presenter) Shareholder, Thayer Medical Corporation
Steven C. Eberhardt, MD, Albuquerque, NM (Abstract Co-Author) Nothing to Disclose
Leslie Morrison, MD, Albuquerque, NM (Abstract Co-Author) Nothing to Disclose
Li Luo, PhD, Albuquerque, NM (Abstract Co-Author) Nothing to Disclose
Blaine L. Hart, MD, Albuquerque, NM (Abstract Co-Author) Nothing to Disclose
PURPOSE
Cerebral Cavernous Malformation Type I (CCM1) is an autosomal dominant disorder characterized by multiple cavernous
malformations in the brain that may cause seizures, cerebral hemorrhage, or focal neurologic deficits. Abdominal manifestations are
unproven and poorly described. Individuals of Hispanic descent in the Southwestern US are disproportionately affected by this
condition due to a founder mutation in the CCM1/KRIT1 gene. Our aim was to investigate whether adrenal calcifications on CT are
associated with CCM1 in carriers of the common Hispanic mutation (CHM).
In an IRB-approved, HIPAA-compliant study, abdomen CT scans of 23 CCM1 subjects (10 F, 13 M, mean 48 yrs, range 24-73 yrs)
were retrospectively reviewed. All subjects had multiple CCM lesions on brain MRI; 11 had confirmed CHM genotype. As controls,
abdomen CTs from 38 unaffected matched subjects (18 F, 20 M, mean 48 yrs, range 23-73 years) and 13 subjects with sporadic
(non-familial) CCM (6 F, 7 M, mean 51 yrs, range 26-72 yrs) were reviewed. Size, location, number, laterality of calcifications, and
adrenal morphology were recorded. Brain lesion count was recorded for CCM1 subjects. Statistical comparisons between groups
were calculated using Fisher exact test and two-sample t test.
RESULTS
15 of 23 CCM1 subjects (65%) had small (≤ 5mm), focal calcifications (SFC) in one or both adrenals, compared with 0 in unaffected
and sporadic CCM subjects (p<0.001). SFC were either left-sided or bilateral. Glands with SFC had normal adrenal morphology. The
presence of SFC correlated positively with number of CCM brain lesions (p=0.048); bilateral SFC correlated positively with patient
age (p=0.030).
CONCLUSION
SFC are found in a majority (65%) of adults with CHM-related CCM1 and may be a clinically silent disease manifestation. SFC in this
population are predominantly left-sided, more often bilateral with increasing age, and more common in patients with greater number
of brain lesions. These findings add to existing evidence that CCM1 is a multi-system disorder with effects beyond the central
nervous system. CCM1 should be considered in the differential diagnosis for focal adrenal calcifications encountered incidentally on
CT.
Incidental adrenal calcifications on CT may detect unrecognized CCM1 and improve diagnostic confidence in equivocal cases.
Recognition of this entity is important for management of neurologic manifestations and genetic counseling.
SSA10-04
Clinical Value of Dual-Energy Virtual Non-Contrast of Dual-Source CT for Adrenal Adenoma
Participants
Yang Shitong, Zhengzhou, China (Presenter) Nothing to Disclose
PURPOSE
To explore the feasibility of using virtual non-contrast (VNC) images in diagnosis of adrenal adenoma in dual-energy scans, and
evaluate the sensitivity, specificity, and accuracy of VNC images for the lipid-poor adenoma.
The clinical manifestations and CT images for 30 patients with 31 lesions confirmed by pathological results from surgery were
reviewed retrospectively. All of the patients were examined by a pre-contrast scan (true non contrast; TNC) and then arterial and
venous phase enhanced scan. Then enhanced examinations were performed with dual-energy scan mode (SOMATOM Flash,
Siemens Healthcare, Forchheim, Germany). The dedicated post processing application Liver VNC was used to get VNC images at the
arterial and venous phase respectively.Mean CT values, signal-to-noise ratio, subjective image quality, and radiation dose were
compared between routine TNC and VNC.The correlation between TNC and VNC images of the adrenal adenoma was evaluated.
Sensitivity, specificity and accuracy of VNC images for the characterization of lipid-poor adenoma were calculated from chi-square
tables of contingency.
RESULTS
No significant differences were seen for mean CT values in normal adrenal tissue,adrenal adenoma and the muscles of posterior
spine between TNC and VNC images (p>0.05),except the abdominal aortic and spleen which the mean CT values in VNC images was
higher than TNC image and the differences were statistically significant (p<0.05).SNR of all tissues in VNC images were higher than
that in TNC image,and the differences were statistically significant (p<0.05) expect the abdominal aortic(p>0.05).The subjective
score of VNC images was lower than that of TNC image, but the difference was no statistically significant(p>0.05).The radiation
dose of VNC images was lower than that of TNC(p<0.05).A positive correlation was found for CT values of adrenal adenoma
between TNC and VNC images.Sensitivity,specificity,and accuracy from VNC images of arterial phase for the characterization of
lipid-poor adenoma were 86.9%,100%,90.3% and from venous phase were 60.9%,87.5%,67.7%.
CONCLUSION
VNC images calculated from contrast-enhanced dual-energy CT have a potential to replace the TNC images to diagnose the adrenal
adenoma and thus reduce the patient's radiation dose.
Dual-energy VNC have a potential to replace the TNC images to diagnose the adrenal adenoma and thus reduce the patient's
radiation dose.
SSA10-05
Characterization of Adrenal Lesions Using Rapid Kilovolt-Switching Dual Energy CT: Utility of
Contrast-Enhanced Material Suppression Imaging
Participants
Jason A. Pietryga, MD, Birmingham, AL (Presenter) Nothing to Disclose
Mark E. Lockhart, MD, Birmingham, AL (Abstract Co-Author) Nothing to Disclose
Therese M. Weber, MD, Birmingham, AL (Abstract Co-Author) Nothing to Disclose
Lincoln L. Berland, MD, Birmingham, AL (Abstract Co-Author) Consultant, Nuance Communications, Inc; Stockholder, Nuance
Communications, Inc;
Bradford Jackson, Birmingham, AL (Abstract Co-Author) Nothing to Disclose
Desiree E. Morgan, MD, Birmingham, AL (Abstract Co-Author) Research support, General Electric Company
PURPOSE
To characterize adrenal lesions as benign or malignant on contrast-enhanced dual energy CT using material suppression imaging
(MSI) virtual unenhanced images and pseudo-unenhanced monoenergetic 140keV images.
IRB-approved HIPAA-compliant study. A retrospective search identified consecutive adult outpatients who had undergone
multiphasic dual energy CT(DECT) with an adrenal lesion (≥1cm) reported. Two patients weighing ≥300 lbs were excluded. A single
board-certified radiologist reviewed the CTs and placed ROIs on the adrenal lesions on the noncontrast (NC) series and
simultaneously placed matching ROIs on MSI virtual unenhanced and virtual monoenergetic 140 keV images. The lesions were
characterized by accepted clinical standards. Spearman rank correlation was performed to evaluate for associations between the
virtual unenhanced, pseudo-unenhanced HU and NC HU and t tests to evaluate means. Regression analysis was performed to
identify threshold values to characterize adrenal lesions as benign vs malignant. Myelolipomas were excluded from the regression
analysis.
RESULTS
104 patients (52M,52F, mean age 62, weight 188 lb) with a total of 140 adrenal lesions were identified. 56%(78/140) of the lesions
were lipid-rich adenomas, 6%(9/140) lipid-poor adenomas, 20%(28/140) malignancies, 8%(11/140) myelolipomas and 10%(14/140)
indeterminate. The mean HUs for adenomas were -6.5 (NC), 11.3 (MSI), 12.5 (140 keV); mean HUs for malignant lesions were 34.2
(NC), 39.1 (MSI) 38.7 (140 keV), all p<0.0001. There were very strong Spearman correlations between NC and MSI HU (.83), NC
and 140keV HU (.81) and MSI and 140keV HU (98). Excluding 1 obvious necrotic RCC metastasis, a threshold of 20 HU on MSI and
16 HU on 140keV images correctly characterizes lesions as adenomas with a sensitivity of 68%(59/87) and 53%(46/87),
respectively, both with specificity of 100%.
CONCLUSION
MSI virtual unenhanced and virtual 140keV monoenergetic contrast-enhanced DECT images can be used to characterize adrenal
adenomas with a sensitivity of 72% and 59%, respectively, when using new HU threshold values of 20 and 16, respectively.
Excluding an obvious necrotic RCC metastasis, both threshold values are 100% specific.
In this largest DECT series of adrenal lesions, new HU criteria are presented that can characterize lesions on contrast-enhanced
DECT, potentially obviating the need for further imaging for most patients.
SSA10-07
MASS Criteria as a Predictor of Survival in Sunitinib Treated Metastatic RCC - A Secondary Post-hoc
Analysis of a Multi-institutional Prospective Phase III Trial
Participants
Andrew D. Smith, MD, PhD, Jackson, MS (Presenter) Research Grant, Pfizer Inc; President, Radiostics LLC; President, Liver
Nodularity LLC; President, Color Enhanced Detection LLC; Pending patent, Liver Nodularity LLC; Pending patent, Color Enhanced
Detection LLC;
Frederico F. Souza, MD, Madison, MS (Abstract Co-Author) Nothing to Disclose
Manohar Roda, MD, Jackson, MS (Abstract Co-Author) Nothing to Disclose
Haowei Zhang, MD, PhD, Jackson, MS (Abstract Co-Author) Nothing to Disclose
Xu Zhang, PhD, Jackson, MS (Abstract Co-Author) Nothing to Disclose
PURPOSE
To validate MASS Criteria as a predictive imaging biomarker in metastatic RCC treated with anti-angiogenic therapy.
As part of a published multi-institutional prospective phase III trial, 375 adult patients with metastatic clear cell RCC were treated
with sunitinib. In this secondary post-hoc retrospective analysis, initial post-therapy CT images were evaluated by RECIST, Choi
Criteria, and MASS Criteria in patients with DICOM format images. Comparison of PFS and OS among MSKCC risk and imaging
response groups was evaluated using log-rank test. Inter-observer agreement between 3 readers was assessed in 21 randomly
selected cases using intra-class correlation coefficient (ICC).
RESULTS
Median PFS and OS of the full cohort (N=270) were 1.1 and 2.6 years, respectively. PFS and OS of all MASS Criteria objective
response categories were significantly different from one another (p<0.0001 for each). By comparison, PFS of MSKCC low (N=186)
and intermediate (N=84) risk groups, PFS of RECIST PR (N=33) and SD (N=228) groups, and OS of Choi Criteria SD (N=36) and PD
(N=13) groups were not significantly different (p=0.225, 0.810 and 0.311, respectively). Median PFS for patients with baseline
MSKCC Criteria low (N=186) and intermediate (N=84) risk were 1.2 and 0.9 years, respectively. By comparison, median PFS for
patients with MASS criteria FR (N=177), IR (N=84), and UR (N=9) were 1.4, 0.5, and 0.1 years, respectively. Inter-observer
agreement among 3 readers interpreting 21 randomly selected cases using MASS Criteria was substantial (ICC=0.70).
CONCLUSION
In patients with metastatic RCC treated with sunitinib, MASS Criteria response on the initial post-therapy CT is predictive of PFS
and OS.
MASS Criteria is currently the only quantitative biomarker for predicting response to anti-angiogenic therapy in metastatic RCC that
has been validated in a multi-institutional study and it may potentially be useful in guiding therapy, reducing drug toxicities and
costs, and planning adaptive design clinical trials.
SSA10-08
Prediction of Survival in Patients with Metastatic Clear Cell Carcinoma Treated with Targeted Antiangiogenic Agent Sunitinib via CT Texture Analysis
Sunday, Nov. 29 11:55AM - 12:05PM Location: E353B
Participants
Masoom A. Haider, MD, Toronto, ON (Presenter) Consultant, Bayer AG
Alireza Vosough, MD, MRCP, Aberdeen, United Kingdom (Abstract Co-Author) Nothing to Disclose
Farzad Khalvati, PhD,MSc, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Alexander Kiss, PhD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Balaji Ganeshan, PhD, London, United Kingdom (Abstract Co-Author) Scientific Director, TexRAD Limited
Georg Bjarnason, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the role of CT Texture analysis in prediction of progression free and overall survival and assessment of response to
treatment with Sunitinib in patients with metastatic clear renal cell carcinoma (RCC).
Contrast enhanced CT texture parameters were assessed in 40 patients with metastatic clear RCC who were treated with Sunitinib.
Appropriate measurable lesions were selected based on RECIST criteria before and about two months after treatment with Sunitinib.
Texture and histogram analysis of the lesions were performed using TexRad software. Using a Cox regression model, correlation of
texture parameters with measured time to progression and overall survival were assessed.
RESULTS
"Size normalized tumor Entropy" (NE) was found as an independent predictor of time to progression and overall survival and can add
to Heng; a well-known prognostic model for metastatic RCC patients. Cox proportional hazards regression analysis (HR) showed that
NE was an independent predictor of time to progression. (HR = 0.01 and 0.02; 95% confidence intervals (CI): 0.00 - 0.29 and 0.00
- 0.39; p=0.01 and p=0.01 for NE before and two months after treatment, respectively). NE was also shown to be an independent
predictor of overall survival. (HR = 0.01 and 0.01; 95% CI: 0.00 - 0.31 and 0.001 - 0.22; p=0.01 and p=0.003 for NE before and
two months after treatment, respectively).
CONCLUSION
Tumor heterogeneity is a well-known feature of malignancy reflecting areas of increased cellular density, hemorrhage and necrosis.
CT texture analysis can quantify heterogeneity by using a range of parameters including size normalized Entropy (NE) as a measure
of texture irregularity. Our study showed that NE is an independent predictor of the outcome of treatment with Sunitinib in patients
with metastatic RCC and can be used for prediction of time to progression and overall survival in these patients. This can help
identify non-responders from the outset with the potential to avoid unnecessary toxicity and to start alternative therapies earlier.
The ability to identify poor responders early in the course of treatment or before starting the treatment can help patients be spared
from toxicity usually associated with these treatments and could potentially receive alternative therapies earlier. Using the costly
drugs of treatment only in patients who benefit from them will be a potential for cost-effectiveness improvement.
SSA10-09
Arterial Spin Labeling MR Imaging for Detecting Perfusion of Defect of Renal Cell Carcinoma Pseudocapsule and Predicting Renal Capsule Invasion: Initial Experience
Sunday, Nov. 29 12:05PM - 12:15PM Location: E353B
Participants
Hanmei Zhang, Chengdu, China (Presenter) Nothing to Disclose
Yinghua Wu, MD,PhD, Chengdu, China (Abstract Co-Author) Nothing to Disclose
Panli Zuo, Beijing, China (Abstract Co-Author) Nothing to Disclose
Niels Oesingmann, PhD, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG
Bin Song, MD, Chengdu, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
The defect of pseudo-capsule is tightly correlated with the invasiveness of tumors.This study aimed to prospectively evaluate the
performance of combining morphological imaging and functional imaging for detecting the defects of pseudo-capsule in renal
tumors,and to predict renal capsule invasion which were confirmed histopathologically.
Twelve patients with suspicious renal tumors underwent T2-weighted imaging and contrast-free renal ASL imaging at a 3.0T MR
scanner.Renal ASL was performed using a prototype flow-sensitive alternating inversion recovery trueFISP (FAIR-trueFISP)
sequence with a TI of 1200 ms for perfusion images and without inversion for M0 images.A modified Look-Locker inversion-recovery
(MOLLI) sequence was used for T1 mapping.Renal blood flow (RBF) was quantitatively measured on the perfusion images which
were determined on a pixel by pixel basis.For T2-weighted images alone,the discontinuous hypo signal intensity rim was defined as
the defect of tumors' pseudo-capsule,for combination of T2-weighted images and ASL,the hypo signals in T2-weighted images as
well hyper signals in perfusion images was defined as the defect of tumors' pseudo-capsule.The diagnostic performance was
assessed using diagnostic test's index.
RESULTS
Twelve renal lesions (11 clear cell RCCs and 1 chromophobe RCC) were evaluated in 12 patients.All ccRCCs showed defect of
tumors' pseudo-capsule on T2-weighted images.Of the 11 ccRCCs cases,10 cases showed blood flow right on the defect area of
tumors' pseudo-capsule on perfusion images and 1 case did not.All the defect areas of tumors' pseudo-capsule seen in the surgery
operation had renal capsule invasion.For defecting of tumors' pseudo-capsule,i.e. predicting renal capsule
invasion,sensitivity,specificity,positive predictive value and negative predictive value were 100%,33.3%,81.8%,100% for T2weighted images alone and 100%,66.7%,90%,100% for combination of T2-weighted images and ASL images.
CONCLUSION
The combination of T2-weighted images and ASL images produced promising diagnostic accuracy for predicting renal capsule
invasion,which could offer additional imaging information for clinical diagnosis of renal tumors.
Noninvasively and prospectively evaluated the presence of the defect pseudo-capsule in renal tumors may help predict the
invasiveness of tumor and influence clinical therapy strategy.
GUS-SUA
Genitourinary Sunday Poster Discussions
Sunday, Nov. 29 12:30PM - 1:00PM Location: GU/UR Community, Learning Center
GU
Participants
Paul Nikolaidis, MD, Chicago, IL (Moderator) Nothing to Disclose
Sub-Events
GU200-SDSUA1
Obstetrical Ultrasound Sweeps Show Promise for Point-of-Care Diagnosis in Resource-poor Areas
Station #1
Participants
Matthew D. LeComte, PhD, Burlington, VT (Presenter) Nothing to Disclose
Mary Streeter, RT, Burlington, VT (Abstract Co-Author) Nothing to Disclose
Sarah Ebert, BS, Burlington, VT (Abstract Co-Author) Nothing to Disclose
Betsy L. Sussman, MD, Burlington, VT (Abstract Co-Author) Nothing to Disclose
David Jones, MD, Burlington, VT (Abstract Co-Author) Nothing to Disclose
Anne Dougherty, MD, Burlington, VT (Abstract Co-Author) Nothing to Disclose
Kristen K. DeStigter, MD, Burlington, VT (Abstract Co-Author) Medical Advisory Board, Koninklijke Philips NV; Luminary, McKesson
Corporation; Research collaboration, Koninklijke Philips NV;
PURPOSE
Resource-poor communities lack basic obstetrical (OB) imaging. Imaging the World's program integrates inexpensive ultrasound (US)
technology with image compression and Internet data transfer to enable expert obstetrical evaluation. However, effectiveness of
this system requires individuals minimally trained as sonographers to acquire images at the point-of-care. This study evaluates
whether these providers can acquire quality OB US images for later evaluation by trained readers.
Pregnant women were recruited after having a traditional OB US study performed by an expert sonographer (gold standard). Then
an individual taught to generate anatomically guided sweeps (scanner) with an ultrasound probe acquired images on consenting
subjects. These studies were evaluated by two obstetricians and one radiologist (readers) and compared to the gold standard. The
scanner and readers were blinded to the subjects' OB status. The studies were evaluated for visibility of maternal and fetal
anatomy, gestational features, placental features and fetal biometry. The readers were asked to rank their confidence level for
each feature (confident, probable or uncertain).
RESULTS
61 individual studies evaluated by the three readers were included in this preliminary analysis. We found 62% of responses
described the fetus as "well visualized" and 36% were "partially visualized" with high confidence. Additionally 97% of reports were
rated as confident for intrauterine pregnancy and 98% of reports were rated as confident of fetal position. Placental position was
reported in 98% of reads. Features of biometry for dating and fetal cardiac, urinary, abdominal and neuro-anatomy were also
appreciated in > 50% of reads. Image quality was also assessed by the readers.A thorough analysis of this data is warranted. We
will report on concordance between the sweep and the gold standard diagnostic ultrasound reads as well as inter-observer
reliability.
CONCLUSION
The preliminary data suggests that an individual minimally trained as a sonographer using only anatomical landmarks can generate
diagnostic quality OB US images upon which clinical decisions can be made.
The ability to identify complications early with point-of-care obstetric ultrasound using a pre-prescribed protocol can directly
improve perinatal outcomes in resource poor regions.
GU201-SDSUA2
Is PIRADs-score more Accurate versus DWI+T2w Based Data at 3T MRI: Analysis According to 189
MR-guided Prostate Biopsies
Station #2
Participants
Ansgar Malich, MD, Nordhausen, Germany (Presenter) Nothing to Disclose
Dino Kovacevic, Nordhausen, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
PIRADS-score was established as the combination of T2w+DWI+contrast uptake analysis suggesting equivalent importance of all
features. Due to several contraindications of contrast agent application study aimed to verify, whether DWI+T2w are similar
accurate based on MR-guided prostate biopsy results.
213 prostatic lesions were MR-guided biopsied (3T MRI Philips Ingenia) after inconclusive ultrasound guided biopsy and after
multiparametric MRI (T2w, dynamic analysis (>5min, single dynamic scan <13s, calculation using DynaCAD+Confirma-CAD) and DWIanalysis (b-value 0-1000). PI-RADs-scheme vs. T2w+DWI were matched to histopathologic outcome. At least 10pt. (DWI+T2w+CE-
MRI) or 7pt (DWI+T2w) were accepted as cut off for malignancy.
RESULTS
82/213 lesions were PCA and 17/213 ASAP (41/213 cases prostatitis, 35/213 hyperplasia, 32/213 dystrophic prostatic tissue, 6/189
cases paraglandular tissue).Using PIRADS, 3/82 PCA had 9pt and 4 10pt (PIRADS-score 3); 9x11; 14x12; 12x13 (PIRADS-score 4)
and 11x14 and 29x15pts (PIRADS-score 5).Using T2w+DWI only, 1 had 5pt; 1 6pt (PIRADS-equivalent 3), 8 7pts; 17 cases 8pts, 16
cases 9pts and 39 10pts. Distribution of ASAP-lesions was: 1x6pt; 4x7pt; 7x8pt; 3x9pt; 2x10pt. Prostatitis was scored according
to PIRADS: 2x14/15pt; 23x11-13pts.;15x10pts or less. Using T2w+DWI only, 4 had a sum of 9/10; 25 a score of 7/8 and 11 less.
Hyperplastic nodules were scored according to PIRADs 3x14/15pts.; 20x11-13pts; 12xless points. Using DWI+T2w only 6 lesions
were scores with 9-10, 21x7/8 points and 8 with less points. Related PPV was: PIRADS: 95/184 (51.6%); DWI/T2w: 96/178
(53.9%); Sensitivity: PIRADS: 95/99 (96.0%); Sens: DWI/T2w: 96/99 (97%).
CONCLUSION
Especially in case of contraindications for contrast agent application, reliable prostate diagnostic analysis can be obtained without
dynamic contrast uptake using PIRADs-scheme without a lowered sensitivity, even for discrimination of prostatitis vs. cancer.
Further dynamic parameter such as kep, slope and peak uptake might be of additional use for the diagnostic procedure but not yet
embedded in the PIRADS-scheme.
In case of renal insufficiency reliable prostate MRI at 3T can be performed without contrast application. Point scale of contrast
uptake of prostate lesions should be more precise and should include quantitative parameter.
GU204-SDSUA5
Utility of CAD Derived Enhancement to Quantify Wash-out Characteristics of Clear Cell Renal Cell
Carcinoma Low Grade and High Grade Lesions at Four-Phase MDCT
Station #5
Participants
Heidi Coy, Los Angeles, CA (Presenter) Nothing to Disclose
Jonathan R. Young, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Pechin Lo, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Matthew S. Brown, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Jonathan G. Goldin, MBChB, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
James Sayre, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Although clear cell RCC (ccRCC) are typically detected incidentally by imaging, grading these lesions has only been possible
histologically on biopsy or nephrectomy. A robust imaging based method to grade ccRCC correlating with established Furhman Grade
(FG) would enable surveillance of low grade lesions and surgical or ablative treatment of high grade lesions.. The purpose of our
study was to assess wash-out characteristics of low grade and high grade ccRCC lesions on four-phase CT using a CAD algorithm
to quantify lesion enhancement at each phase.
With IRB approval for this HIPAA-compliant retrospective study, our pathology and imaging databases were queried to obtain a
cohort of ccRCC with preoperative multiphasic multidetector CT imaged with a four-phase renal mass protocol (unenhanced (UN),
corticomedullary (CM), nephrographic (NE), and excretory (EX)). A whole lesion 3D contour was obtained in all phases with
proprietary software. The CAD algorithm determined a 0.5cm diameter region of peak enhancement <=300HU within the 3D lesion
contour. All contours were confirmed by a radiologist. Absolute wash-out was calculated using the adrenal wash-out formula: (CAD
lesion enhanced CT (HU) -CAD lesion Delayed CT (HU)/ (CAD lesion Delayed CT (HU)-CAD lesion Unenhanced CT (HU))* 100%). Ttests were used to compare % wash-out between low grade and high grade lesions. P values less than 0.05 were considered to be
significant.
RESULTS
107 patients (71 (64%) men and 40 (35%) women) with 111 unique ccRCC lesions (80 (72%) low grade (FG I and II) lesions and 31
(28%) high grade (FG III and IV)) lesions were analyzed. Mean lesion size of the low grade lesions was 2.9 cm (range 0.8-6.4).
Mean lesion size of the high grade lesions was 5.6 cm (range 1.6-14.4). . High grade lesions had a significantly higher washout
percentage (60.2% vs 32.1% p=0.0047) as compared to low grade lesions from the CM to NE phase but similar wash out rates
between NE and EX phases (41.9% vs. 44.2%, p=0.6642).
CONCLUSION
High grade ccRCCs wash out at a significantly faster rate than low grade ccRCCs from the CM to NE phases
CAD derived ccRCC %wash-out was significantly greater in high grade vs. low grade ccRCC providing a non invasive method of
grading at imaging, enabling more aggressive treatment for high grade lesions
UR105-EDSUA6
Interactive Experience with Prostate Imaging and Reporting and Data System Version 2
Station #6
Awards
Participants
Elmira Hassanzadeh, MD, Boston, MA (Presenter) Nothing to Disclose
Erik Velez, BS, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Fiona M. Fennessy, MD, PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Ruth M. Dunne, MBBCh, Aclare, Ireland (Abstract Co-Author) Nothing to Disclose
Mukesh G. Harisinghani, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Clare M. Tempany-Afdhal, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Daniel I. Glazer, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibit is:•To describe the experience of using PIRADS v2 in a teaching hospital•To help readers identify various
PIRADS v2 scores with an interactive method•To discuss common challenges using PIRADS v2 in the clinical setting
•PIRADS v2 overview•Representative images of various PIRADS v2 scores•Challenges and pitfalls of PIRADS v2
UR157-EDSUA7
Pitfalls of Adrenal and Renal Imaging: A Pictorial Review
Station #7
Participants
Matthew J. Wu, MD, Halifax, NS (Abstract Co-Author) Nothing to Disclose
Seng Thipphavong, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Magdi A. Akl, FRCR, Halifax, NS (Abstract Co-Author) Nothing to Disclose
Andreu F. Costa, MD,FRCPC, Halifax, NS (Presenter) Nothing to Disclose
TEACHING POINTS
The learning objectives of this exhibit are: To present a variety of common renal and adrenal lesions with potential pitfalls in
diagnosis To review how CT attenuation density, enhancement on CT and MRI, and the presence of fat on MRI, both intra-voxel fat
and gross, will influence the diagnosis or differential diagnosis in the kidney and adrenal gland
1. Title slide2. Disclosures and target audience3. Case-based, image-rich review of common renal and adrenal lesions with potential
pitfalls in diagnosis. Cases will include but will not be limited to: Adrenal lesions with gross fat: myelolipoma, extramedullary
hematopoiesis, adrenal teratoma, and lipomatous degeneration of adenoma. Adrenal lesions with intra-voxel fat: adenoma, clear-cell
RCC and HCC metastases0. Adrenal lesions measuring < 10 HU: adenoma, cyst and myelolipoma without gross fat on CT. Enhancing
renal lesions without gross fat: RCC, oncocytomas, lipid-poor angiomyolipomas. Renal lymphoma mimicking lobar pyelonephritis on CT
Renal lesions with intra-voxel fat: clear cell RCC, AML, papillary RCC4. Summary5. References6. Author contact
GUS-SUB
Genitourinary Sunday Poster Discussions
Sunday, Nov. 29 1:00PM - 1:30PM Location: GU/UR Community, Learning Center
GU
Participants
Sub-Events
GU205-SDSUB1
"Surrounding Endometrium Sign" to Differentiate Eccentric Cornual Intra-uterine Pregnancies from
Interstitial Ectopic Pregnancy
Station #1
Participants
Allison L. Grant, MD, MSc, Toronto, ON (Presenter) Nothing to Disclose
Ally Murji, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Glen Lo, MBBS,BMedSc, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Mostafa Atri, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
PURPOSE
The aim of this study was to investigate whether a sign we have observed, "surrounding endometrium sign" (SES), can be used to
reliably differentiate eccentric cornual intra-uterine pregnancy (IUP) from interstitial ectopic pregnancy (EP).
This was an REB approved retrospective review of all cases in our radiology database with keywords "interstitial" or "cornual"
pregnancy from 2007 to 2015. Acquisition of consent was waived. One expert reader reviewed video-clips blindly using the SES
sign, defined as extension of the endometrial lining to surround the eccentrically located gestational sac. Cases were called
eccentric IUP if SES was present and interstitial EP if SES was absent. Correlation with outcome was made.
RESULTS
Forty-four evaluable cases were included. Patients were 20 to 42 years old (mean 32.6±5.7). Twenty-four cases were negative for
SES sign, supporting a diagnosis of interstitial EP. These cases were managed either with methotrexate (MTX), MTX and surgery, or
expectantly because of dropping β-hCG. None of 24 patients had passing of tissue vaginally.Twenty cases were positive for SES.
Of those, 11 were prospectively called as eccentric IUPs and therefore appropriately managed. Six had spontaneous abortion, 4
continued to pregnancy > 20 weeks, and one underwent DandC for a desired therapeutic abortion.The remaining 9 cases were
called interstitial EP prospectively, and managed as such. Seven patients were treated with MTX, with some evidence in 4 of them
of inappropriate management; 2 had f/u imaging which showed definite IUPs that had moved down the uterus, 1 had documentation
of passed tissue per vagina (which should not occur with an interstitial ectopic), and one underwent a DandC that showed retained
products of conception (which again should not be possible with an interstitial pregnancy). Two patients underwent surgical
management where pregnancy tissue was removed transcervically, again questioning the original diagnosis of interstitial pregnancy.
CONCLUSION
We propose the new 'surrounding endometrial sign' to accurately differentiate between eccentric cornual IUP and interstitial EP.
'Surrounding endometrial sign' on US can differentiate between eccentric cornual pregnancy and interstitial pregnancy, thereby
potentially salvaging some pregnancies that may otherwise be terminated.
GU206-SDSUB2
Utility of Using Abdominal Wall Thickness in Prenatal Ultrasound in Predicting Fetal Outcome for
Fetuses at Risk for Intrauterine Growth Restriction
Station #2
Participants
Lei Wu, MD, Seattle, WA (Presenter) Nothing to Disclose
Theodore J. Dubinsky, MD, Seattle, WA (Abstract Co-Author) Stockholder Global Cancer Technology
PURPOSE
With 2nd or 3rd trimester prenatal ultrasound (US), fetal growth is routinely evaluated by calculating the estimated fetal weight
(EFW). An EFW < 10th percentile for gestational age is defined as small for gestational age (SGA), and generally thought to be
associated with increased risk of IUGR. However, only a small number of these fetuses (5.2%) are affected by adverse perinatal
outcome, and majority are constitutionally small. Besides abnormal UA doppler, other routinely measured biometric parameters do
not accurately predict pathologic growth restriction (PGR) (1). Thus, there is a need for better predictors of PGR. Neonates
exposed to PGR tend to have lower percent body fat. Thus, we propose the measurement of abdominal wall thickness (AT) as a
measure of fetal metabolic reserve and as a possible predictor of PGR.
Our study population included singleton live IUP with gestational age (GA) > or = 28w0d based on 1st trimester US with EFW < 90th
percentile and no history of maternal diabetes. Fetuses are categorized as normal if the EFW is between 40th and 90th percentiles
and no anatomic anomalies are present on US. Those with EFW < 10th percentile are considered SGA. 50 normal and 50 SGA
fetuses are included in the study. Adverse perinatal outcome for SGA is evaluated and defined as admission to NICU or neonatal
death. AT is measured at its thickest portion in the same slice as the AC measurement. AT of SGA fetuses is compared to that in
normal fetuses using a 2-tailed paired T-test. Chi-squared test was used to evaluate the relationship between mean AT in SGA
fetuses and adverse outcome.
RESULTS
The mean GA is 32w0d for normal fetuses and 33w6d for SGA fetuses. The mean AT is 8mm for normal fetuses and 4mm for SGA
fetuses (p<0.01). 6 of 50 SGA fetuses were lost to follow up prenatally. Overall, 28 of 44 (63.6%) remaining SGA neonates had
adverse outcome, 1 of which (2.2%) resulted in neonatal death. In those with AT > 3mm, 50.0% experienced adverse outcome
compared to 100% in fetuses with AT = 3 mm (p<0.01). AT of 3 mm had an OR of 25.0 for adverse outcome.
CONCLUSION
Using a cutoff value of 3mm, AT is a useful biometric parameter as a predictor of adverse outcome especially if IUGR is questioned.
Most biometric parameters on prenatal US do not accurately predict pathologic growth restriction. There is a need for better
predictors such as our proposed abdominal wall thickness measurement.
Honored Educators
Theodore J. Dubinsky, MD - 2012 Honored Educator
Theodore J. Dubinsky, MD - 2013 Honored Educator
GU207-SDSUB3
Favorable Outcomes and Fertility Perspective in Women Treated by MRgFUS for Uterine Fibroids:
Pregnancy Results
Station #3
Participants
Fabiana Ferrari, MD, L'Aquila, Italy (Presenter) Nothing to Disclose
Francesco Arrigoni, Coppito, Italy (Abstract Co-Author) Nothing to Disclose
Anna Miccoli, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
Fernando Smaldone, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
Giulio Mascaretti, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
Carlo Masciocchi, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose of this study was to discuss about fertility perspective in women treated by MRgFUS and to report pregnancy after
this treatment.
Fourteen patients, aged between 23 and 42 (mean age 32.5), affected by uterine fibroids, who wanted to get pregnant, were
treated in our department with MRgFUS. This study evaluates the findings on 14 patients presenting difficulties to conceive and
uterine fibroids smaller than 6 cm. We preliminarily excluded the other causes of infertility with a gynaecological evaluation. All
patients had only one treatment. We made a c.e. MRI, in order to control the Non-Perfused-Volume, immediately after treatment,
and then after 3, 6 and 12 months from the treatment. After 17-20 months from the treatment, the patients started the course to
become spontaneously pregnant.
RESULTS
After 12 months from treatment, 10 patients had a complete reabsorption of the necrotic areas and 4 had a partial reabsorption.
Five months later, the patients started the course to become spontaneously pregnant. Two of them succeeded and 1 has already
given birth at term to a healthy infant without any perinatal complications. Another patient with partial reabsorption of the necrotic
area gave birth to a baby and another is now in her seventh month of pregnancy.
CONCLUSION
MRgFUS permits a significant reduction of the symptoms and is a valid alternative method to surgery in fertile women, without any
complications in case of uterine implanting.
MRgFUS is a mini-invasive treatment that permits to save neighbouring healthy structures, and avoid post-surgical complications
allowing the uterine implanting.
GU208-SDSUB4
Predictive Models for Lymph Node Metastases in Patients with Testicular Germ Cell Tumors
Station #4
Participants
Vishala Mishra, MBBS, Boston, MA (Presenter) Nothing to Disclose
Yun Mao, MD, Chongqing, China (Abstract Co-Author) Nothing to Disclose
Sandeep S. Hedgire, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Duangkamon Prapruttam, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To develop predictive models for lymph node metastasis in testicular germ cell tumors.
To develop predictive models for lymph node metastasis in testicular germ cell tumors.
291 patients with testicular germ cell tumors were included, which were divided into seminomatous and nonseminomatous groups.
For screening the risk factors for LN metastasis, the tumor-related characteristics (including histopathological information and tumor
markers) alpha fetoprotein and the lymph node-related features on CT were compared between metastatic cases and
nonmetastatic cases. Two logistic regression models were built for each histological group, one depending on all tumor- and lymph
node-related risk factors (Model 1) and another only on tumor-related factors (Model 2). Receivers operating characteristic curves
were used to evaluate the predictive abilities of these models.
RESULTS
117 positive nodes/regions were identified in 68 patients, including 51 metastases and 17 occult metastases. Based on the selected
independent risk factors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Model 1
and 2 in senimomatous and nonseminomatous groups were (95.5%, 95.3%, 95.3%, 77.8%, and 99.2%), (63.6%, 83.6%, 80.7%,
40.0%, and 93.0%), (93.5%, 94.7%, 94.3%, 89.6%, and 96.8%), and (89.1%, 44.2%, 58.9%, 43.6%, and 89.4%), respectively.
CONCLUSION
In our study, four models for predicting lymph node metastases in testicular cancer were established based on lymph node- and
tumor-related risk factors. In patients without tumor-related factors, regular CT surveillance may be a good choice after
orchiectomy, while in patients without lymph node- and tumor-related factors, long interval-time CT follow-up could be considered.
The predictive abilities of LN-related CT factors (esp. SD) on LN involvement were obviously superior to those of tumor-related
factors. In patients without any IRF of Model 2, regular CT surveillance may be enough for predicting LN status, while in the
patients without any IRF of Model 1, a long interval-time CT follow-up could be considered. Additionally, right side tumors tend to
involve contralateral LNs compared to left side ones, as well as positive inguinal LNs more frequently occur in patients with a history
of groin surgery.
GU209-SDSUB5
Beyond Virtual Non-Contrast: Dual-Energy CT Fat Fraction for Differentiation Between Benign and
Indeterminate Adrenal Nodules
Station #5
Participants
Gregory A. Bonci, MD, Boston, MA (Presenter) Nothing to Disclose
Urvi P. Fulwadhva, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Aaron D. Sodickson, MD, PhD, Wayland, MA (Abstract Co-Author) Research Grant, Siemens AG; Consultant, Bracco Group
PURPOSE
To evaluate whether dual-energy CT (DECT) can differentiate benign from indeterminate adrenal nodules based on the fat fraction
derived from three-material decomposition.
The study included 22 patients with adrenal nodules detected on routine Emergency Department portal venous phase DECT scans
who also had gold standard non-contrast CT or MRI with chemical shift imaging. Adrenal nodules were categorized as benign if they
demonstrated attenuation <= 10 HU on non-contrast CT or loss of signal on chemical shift MR imaging. They otherwise remained
indeterminate. DECT scans were performed on a 128x2 slice dual-energy scanner (Siemens FLASH, Forchheim Germany) using tube
current modulation (CareDose4D) with reference mAs 400/155 at 80/Sn140 kVp or 201/155 at 100/Sn140 kVp, with the kVp pair
selected based on patient size. Source images from each tube were reconstructed as 0.75 x 0.5 mm slices and used for postprocessing on a thin-client server (Syngo via, version VA30). Nodule regions of interest (ROI) were placed to record HU values on
the mixed high/low kVp images, and the Liver Virtual Non-Contrast (VNC) application was used to calculate ROI VNC HU values and
fat fraction (defined as 0 for a purely soft tissue attenuation lesion and 100% for a purely fat-containing lesion).
RESULTS
15 benign and 7 indeterminate adrenal nodules were identified based on gold standard imaging. Contrast-enhanced mixed
attenuation values (HU ± STD) could not accurately differentiate between the lesions, with benign nodules measuring 39.9 ± 24.9
and indeterminate nodules 61.6 ± 23.6 (t-test p = 0.07). However, benign and indeterminate lesions demonstrated significantly
different fat fraction values (33.5 ± 12.6% versus 6.8 ± 12.0%, p < 0.001) as well as VNC HU attenuation values (7.2 ± 16.2
versus 38.6 ± 14.9, p < 0.001).
CONCLUSION
DECT fat fraction analysis shows promise in this proof-of-principle cohort for differentiating between benign and indeterminate
adrenal nodules.
Adrenal nodule fat fraction derived from DECT three-material decomposition may provide additional information about nodule tissue
composition to aid in differentiating benign from indeterminate lesions.
Honored Educators
Aaron D. Sodickson, MD, PhD - 2014 Honored Educator
UR108-ED-
PIRADS v2: A Case-Based Tutorial
SUB6
Station #6
Participants
Dennis Toy, New Haven, CT (Presenter) Nothing to Disclose
Jay K. Pahade, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Mahan Mathur, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Mike Spektor, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The objectives of the exhibit are to: 1. Familiarize trainees with the newly introduced scoring system that is aimed at standardizing
prostate MRI performance and assessment. 2. Offer hands on experience scoring basic and challenging prostate MRI cases,
highlight key findings, provide explanations and discuss pitfalls. 3. Provide tables and flow charts to assist in accurate scoring.
Table of contents/Outline:1. Normal prostate anatomy on MRI2. Overview of PIRADS v2 a. Patient preparation b. Technical
parameters and requirements c. Scoring d. Reporting3. Quiz format cases followed by labelled answers with explanations and
relevant teaching points a. Peripheral zone cases b. Transition zone cases c. Pitfalls d. PIRADS Assessment Category "X"4.
Summary tables of scoring system algorithm
UR164-EDSUB7
How to Optimize the Adquisition and Analysis of Diffusion-weighted Imaging in the Prostate for
Cancer Assessment
Station #7
Awards
Participants
Teodoro Martin, MD, Jaen, Spain (Presenter) Nothing to Disclose
Lidia Alcala Mata, MD, Jaen, Spain (Abstract Co-Author) Nothing to Disclose
Jordi Broncano, MD, Cordoba, Spain (Abstract Co-Author) Nothing to Disclose
Javier Sanchez, MD, PhD, Madrid, Spain (Abstract Co-Author) Research Consultant, Koninklijke Philips NV
Mariano Volpacchio, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Learn how to improve the sequence design of DWI in the prostate according to the clinical indication2. Analyze the different
models of analysis of diffusion signal decay in the prostate and enhance the most useful approach for cancer detection and
characterization3. Enhance the current established indications to perform DWI in the prostate and review other new potential ones
1. Introduction2. DWI sequence design- b values according to analysis method- 1.5 and 3T protocol3. QuantificationMonoexponential model- IVIM- Kurtosis4. Clinical applications- Cancer detection according to PIRADS v2.0 criteria- Nodule
characterization (cancer vs chronic prostatitis)- Locoregional staging- Therapy monitoring- Detection of recurrence- Screening of
cancer with DWI5. Conclusions
VSIO11
Interventional Oncology Series: Percutaneous Management of Renal Tumors: Updates and Ongoing
Controversies in 2015
Sunday, Nov. 29 1:30PM - 6:00PM Location: S405AB
GU
IR
OI
RO
FDA
Participants
Debra A. Gervais, MD, Chestnut Hill, MA (Moderator) Nothing to Disclose
LEARNING OBJECTIVES
1) To review management options for small renal masses as well as indications for each. 2) To review the data supporting the
energy based thermal ablation modalities for ablation of renal masses. 3) To describe the role and limitations of biopsy of renal
masses. 4) To review the management of benign solid renal masses. 5) To describe the evidence for ablation of T1b renal masses.
Sub-Events
VSIO11-01
Updates in the Management of Small (T1a) Renal Masses: Resect, Ablate, or Follow?
Participants
LEARNING OBJECTIVES
View learning objectives under main course title.
VSIO11-02
Small Renal Mass (T1a): The Case for Ablation in 2015
Participants
Jeremy C. Durack, MD, New York, NY (Presenter) Scientific Advisory Board, Adient Medical Inc Investor, Adient Medical Inc
LEARNING OBJECTIVES
VSIO11-03
Small Renal Mass (T1a): The Case for Resection in 2015
Participants
Adam S. Feldman, MD, Boston, MA (Presenter) Consultant, Olympus Corporation
LEARNING OBJECTIVES
VSIO11-04
Small Renal Mass (T1a): Both Cases for Intervention are Weak. Active Surveillance Will Do Just as
Well
Participants
Stuart G. Silverman, MD, Brookline, MA, (sgsilverman@partners.org) (Presenter) Author, Wolters Kluwer nv
LEARNING OBJECTIVES
VSIO11-05
Age Impacts Choice of Partial Nephrectomy vs. Percutaneous Ablation for Stage T1a Renal Cell
Carcinoma: a Surveillance, Epidemiology and End Results (SEER)-Medicare Population Study
Participants
Minzhi Xing, MD, New Haven, CT (Presenter) Nothing to Disclose
Nima Kokabi, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Di Zhang, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
Hyun S. Kim, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate survival outcomes in patients with stage 1a renal cell carcinoma (RCC) undergoing open or laparoscopic partial
nephrectomy (PN) vs. percutaneous cryoablation (CRA) or radiofrequency ablation (RFA) in a large-scale population study.
The most recently updated SEER-Medicare linked database was queried for patients with T1aN0M0 RCC (≤4cm, ICD-O-3 C64.9)
The most recently updated SEER-Medicare linked database was queried for patients with T1aN0M0 RCC (≤4cm, ICD-O-3 C64.9)
diagnosed between 2000 and 2011 and followed to 2012. Patients who underwent therapy were selected from Medicare via CPT
carrier claim codes (percutaneous RFA 50592; percutaneous CRA 50593; open PN 50240; laparoscopic PN 50543). Mean overall
survival (OS) from therapy was compared between patients who underwent percutaneous ablation vs. partial nephrectomy, with
subgroup survival analysis of individual therapies. Kaplan-Meier estimation and Cox proportional hazard models were used for survival
analyses and to assess independent prognostic factors for OS.
RESULTS
A total of 5,983 T1a RCC patients underwent percutaneous ablation or PN within the study period, median age 72.0 yrs, 61.0%
male. Of these, 3150 received open PN, 1785 received laparoscopic PN, 419 received CRA and 629 received RFA. Of these, 47.9%
of patients undergoing PN were >72 yrs, vs. 67.1% of patients in the ablation group. Mean age of patients receiving ablation was
significantly higher than that of the PN group, 80.1 vs. 70.6 yrs, p<0.001. Other factors including gender, ethnicity, mean index
tumor size and tumor grade were not significantly different between comparison groups. Patients who underwent PN had
significantly higher mean OS compared to the ablation group, 128.7 vs. 75.5 months, p<.001. On Cox regression analysis, younger
age was the only independent prognostic factor for survival, HR 0.91 (0.87-0.93, p<0.001).
CONCLUSION
In T1aN0M0 RCC, patients undergoing ablation were significantly older compared to PN patients. Age was found to be an
independent prognostic factor for survival from treatment.
In T1aN0M0 RCC, age was found to be an independent prognostic factor for survival from treatment and may impact choice of
therapy.
VSIO11-06
Ablation for Renal Cell Carcinoma: Radiofrequency, Cryoblation, or Microwave?
Participants
LEARNING OBJECTIVES
VSIO11-07
Small Renal Mass (T1a): The Case for RFA in 2015
Participants
Debra A. Gervais, MD, Chestnut Hill, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
Honored Educators
Debra A. Gervais, MD - 2012 Honored Educator
VSIO11-08
US-guided Percutaneus Radiofrequency Ablation of Renal Cell Carcinoma: Experience from Treating
120 Renal Masses Over 7 Years
Participants
Adriana C. Montealegre Angarita, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Xavier Serres Creixams, PhD, Barcelona, Spain (Presenter) Nothing to Disclose
Enrique Trilla, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Milton R. Villa III, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Juan Halaburda Berni, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Esteban Ramirez Pinto, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Xavier G. Azogue JR, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
PURPOSE
Evaluate the efficacy and safet of ultrasound (US) guided percutaneous radiofrequency ablation (RFA) for small renal masses.
Describe the complications of RFA guided by US. Evaluate the technique in their initial ablative capacity and rate of tumor
recurrence at one year minimum follow up. Illustrate postablation findings of residual or recurrent renal tumor by using Contrastenhanced US (CEUS) Evaluate the effect of renal function in patients undergoing RFA guided by US
Over a 7 year 105 patients with 120 renal masses (tumor size averaged 2.7 cm) were reviewed treated with US-guided
percutaneous RFA. Biopsy was performed at the same moment of the procedure from 2009. Cool-tip RFA system was
percutaneously inserted under ultrasound guidance. RF was emitted at 100-120 W for 12 minutes to attain temperatures sufficient
to ensure tumor kill. The treatment response and technical success were defined by absence of contrast enhancement within the
tumor on contrast enhanced CT and CEUS. The patients were followed up with CEUS and computed tomography at 3.6 months and
every 6 months thereafter. Multivariate analysis was performed to determine variables associated with procedural outcome.
RESULTS
Follow-up ranged from 24 months to 84 months.The initial treatment success rate was 95.8%.Five of the remaining tumors were
successfully re-treated.Four tumors had recurrence (defined as the occurrence of contrast enhancing tumor 12 months after
complete ablation) three of whom required a second ablation and one nephrectomy.The overall technical success rate was 99%.
Complications were seven self-limited included hematomas subcapsular or perirenal. In all 104 (99%) patients have preservation of
renal function,only one patient developed significant renal function deterioration associated with perirenal hematoma. There were
no bowel complications despite the fact that 6 of the tumors were within 1 cm of bowel. Protective strategies progressed from
reliance on electrode positioning to hydro dissection.
CONCLUSION
Our experience to date suggests that US-guided RFA of small renal tumors is a safe and effective, minimally invasive technique in
selected patients.
US-guided RFA of renal tumors can provide benefits compared to other techniques: Intraprocedural monitoring affords visualization
of the forming hot ball, helps detect proximity to surrounding structures and does not use ionizing radiation.
VSIO11-09
Small Renal Mass (T1a): The Case for Cryoblation
Participants
Peter J. Littrup, MD, Providence, RI (Presenter) Founder, CryoMedix, LLC; Research Grant, Galil Medical Ltd; Research Grant, Endo
Health Solutions Inc; Consultant, Delphinus Medical Technologies, Inc
LEARNING OBJECTIVES
ABSTRACT
Cryoablation of smaller renal cancers (i.e., T1a, or <4 cm) is an out-patient treatment that is safe, effective and flexibility for
nearly any renal location. Major cryoablation benefits include its excellent visualization of ablation zone extent, low procedure pain
and flexible protection of tumor ablation sites near calyces, bowel and ureter. CT-guidance is the cryoablation guidance modality of
choice due to circumferential visualization of low density ice and ready availability. US-guidance can augment renal cryoablation,
especially for smaller visible masses and/or placement of interstitial metallic markers during biopsy for selected cases requiring
better eventual CT localization. MR-guidance has little clinical benefit or cost-efficacy. For safety, cases will be considered for
avoidance of direct calyceal puncture, selection of hydrodissection or balloon interposition for bowel protection, and protection of
the uretero-pelvic junction by stent placement. Imaging outcomes of complications and their avoidance will be shown. For optimal
efficacy, tumor size in relation to number and size of cryoprobes emphasize the "1-2 Rule" of at least 1 cryoprobe per cm of tumor
diameter and no further than 1 cm from tumor margin, as well as cryoprobe spacing of <2cm. Thorough extent of visible
cryoablation margins beyond all apparent tumor margins produces very low local recurrence rates for tumors in nearly any renal
location, resulting in excellent cost-efficacy by minimizing the need for re-treatments.
VSIO11-10
Adjunctive Techniques to Improve Image-Guided Percutaneous Cyroablation of Renal Masses in
Difficult Anatomic Locations: Quantifying Procedural Success and Long-term Outcomes
Participants
Ahmed Fadl, MD, Mineola, NY (Presenter) Nothing to Disclose
Andrew Ho, Bayside, NY (Abstract Co-Author) Nothing to Disclose
Samia Sayegh, DO, Mineola, NY (Abstract Co-Author) Nothing to Disclose
April Griffith, Mineola, NY (Abstract Co-Author) Nothing to Disclose
Siavash Behbahani, MD, Mineola, NY (Abstract Co-Author) Nothing to Disclose
Jason C. Hoffmann, MD, Mineola, NY (Abstract Co-Author) Consultant, Merit Medical Systems, Inc; Speakers Bureau, Merit Medical
Systems, Inc
PURPOSE
When performing renal mass cryoablation in difficult anatomic locations, adjunctive techniques such as retrograde pyeloperfusion,
hydrodissection, and angioplasty balloon interposition can improve safety and technical success rates. Prior studies have reported
the technical success of these techniques, but correlation with longer-term outcomes has not been reported in this specific patient
population. This study quantifies the success of these techniques, and correlates with long-term cross-sectional imaging outcomes.
Retrospective analysis of percutaneous renal mass cryoablation was performed from September 2011 through October 2014 at a
single, tertiary care institution. Cases using adjunctive techniques were analyzed. The diagnostic cross sectional imaging,
procedural images and report, and follow-up multi-phasic cross-sectional imaging were reviewed by one radiology resident and one
interventional radiology attending. The type of adjunctive technique used, reason for such utilization, and procedural outcome of
the technique were recorded. Specifically, in cases of hydrodissection or balloon angioplasty interposition, measurements of the
displacement distance were made. Minor and major complications were recorded, per Society of Interventional Radiology criteria.
Longer-term outcomes were evaluated by review of follow-up cross-sectional imaging.
RESULTS
Out of 53 cryoablations during the study period, 9 utilized adjunctive techniques, including hydrodissection (n=8), retrograde
pyeloperfusion (n=1), and angioplasty balloon interposition (n=1). Median greatest tumor dimension was 1.9cm (range 1.3-3.5cm).
Prior to adjunctive technique, median tumor proximity to closest organ was 0.4cm (range 0.1-1.3cm). After technique was used,
median distance to closest organ was 2.8cm (range 0.3-3.3cm). One hydrodissection was unsuccessful, thus angioplasty balloon
interposition was then performed. All cases had appropriate ablation zones and protection of adjacent critical structures. No minor
or major complications were reported. No patients had evidence of residual or recurrent tumor on follow-up imaging, ranging from 3
to 30 months.
CONCLUSION
Adjunctive techniques to allow cryoablation of renal masses in difficult anatomic locations have excellent technical success rates
and long-term outcomes.
Improving outcomes of difficult renal mass cryoablations.
VSIO11-11
Small Renal Mass (T1a): The Case for Microwave
Participants
Fred T. Lee JR, MD, Madison, WI (Presenter) Stockholder, NeuWave Medical, Inc; Patent holder, NeuWave Medical, Inc; Board of
Directors, NeuWave Medical, Inc ; Patent holder, Medtronic, Inc; Inventor, Medtronic, Inc; Royalties, Medtronic, Inc
LEARNING OBJECTIVES
VSIO11-12
Long-term Clinical Outcomes Following Radiofrequency and Microwave Ablation of Renal Cell
Carcinoma at a Single Large VA Medical Center
Participants
Salim E. Abboud, MD, Cleveland, OH (Presenter) Nothing to Disclose
Tanay Y. Patel, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Stephanie Soriano, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Nannette Alvarado, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Preet S. Kang, MD, Pepper Pike, OH (Abstract Co-Author) Nothing to Disclose
PURPOSE
Earlier detection and a desire to preserve renal function and decrease surgical morbidity in the treatment renal cell carcinoma (RCC)
has prompted increased use of percutaneous thermal ablation treatments such as radiofrequency ablation (RFA) and more recently
microwave ablation (MWA). MWA has the potential to provide more complete ablation compared to RFA in part due to more uniform
and higher intra-tumoral temperatures, but only a few small studies have examined the short-and long-term outcomes of MWA for
RCC. This retrospective review assesses the experience and technical short- and long-term success rates of using RFA and MWA
for RCC at a large VA medical center.
Patient and tumor characteristics (tumor size, nearness to collecting system, anterior/posterior location, location relative to polar
line, and endophytic/exophytic predominance) were tabulated using descriptive statistics. Group comparisons were performed by
using univariate logistic regression analysis to determine factors impacting primary efficacy, secondary efficacy, and technique
effectiveness. Kaplan-Meier local tumor progression-free survival following ablation was calculated.
RESULTS
71 patients with 78 renal lesions underwent ablation. Mean, primary, and secondary mean follow-up were 35.1, 33.5, and 31.3
months. Total, primary, and secondary technique effectiveness rates were 86%, 82%, and 4%, respectively. Primary efficacy and
total technique effectiveness were associated with size, with p values of 0.02 and 0.001. There was no significant difference in
survival curves between MWA and RFA treated patients. MWA and RFA groups were not significantly different in terms of age, BMI,
or tumor size. Complications occurred in 11.5% of patients, none resulting in death. More than 90% patients were done as
outpatients (sent home day of procedure) with moderate sedation. No cases used intubations or general anesthesia.
CONCLUSION
RFA and MWA both represent effective treatment modalities for RCC. Longer follow-up time and larger tumor size may be associated
with the somewhat lower effectiveness rates; the comparable efficacy/complication rates compared to prior ablation studies
demonstrate the feasibility of performing ablations on an outpatient basis.
Image guided percutaneous ablation is an effective and cost-effective treatment modality for RCC in patients that are not surgical
candidates.
VSIO11-13
To Biopsy or Not Biopsy the Small Renal Mass before Ablation? That Is the Question
Participants
LEARNING OBJECTIVES
ABSTRACT
Characterization of small renal masses has proven challenging. However, with appropriate CT and MR protocols, the majority of
these lesions can now be characterized pre procedurally, enabling a confident diagnosis. In this lecture, we will describe renal mass
characterization protocols and describe the common imaging signatures of RCC subtypes and their common mimics including lipid
poor AML and oncocytoma. This may eliminate need for preprocedural biopsy.
VSIO11-14
Biopsy or No Biopsy Before Ablation? Biopsy Every Renal Mass before Percutaneous Ablation
Participants
William W. Mayo-Smith, MD, Boston, MA (Presenter) Author with royalties, Reed Elsevier; Author with royalties, Cambridge
University Press
LEARNING OBJECTIVES
VSIO11-15
Biopsy or No Biopsy before Ablation? Don't Trouble Yourself or the Patient with the Renal Mass
Biopsy - Imaging Diagnosis Will Do Just as Well in 2015
Participants
Steven S. Raman, MD, Santa Monica, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
VSIO11-16
Thermal Ablation of a Confluent Lesion in the Porcine Kidney with Magnetic Resonance Guided High
Intensity Focused Ultrasound (MR-HIFU)
Participants
Johanna M. van Breugel, MSc, Utrecht, Netherlands (Presenter) Nothing to Disclose
Martijn de Greef, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Joost W Wijlemans, MD,PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Gerald Schubert, PhD, Vantaa, Finland (Abstract Co-Author) Employee, Koninklijke Philips NV
Chrit T. Moonen, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Maurice V. Bosch, MD, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
Mario G Ries, PhD, Utrecht, Netherlands (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate if MR-HIFU can provide for a reliable confluent volumetric lesion in the renal cortex in a clinically relevant time-frame
in a porcine study.
Nine anesthetized pigs were placed on a clinical Philips Sonalleve MR-HIFU therapy system integrated with a 1.5T Achieva MRI. Both
acoustic energy delivery and MR-thermometry were respiratory gated and active surface cooling was employed to prevent nearfield damage. A honeycomb pattern of at least seven ablation cells (9-25s, 450W acoustic power, 4x4x10 mm3 per cell) were
positioned in the cortex of the kidney. The therapeutic endpoint was evaluated by a non-perfused volume (NPV) measurement
using DCE-MRI. Subsequently, the animal was euthanized and the extent of induced necrosis was examined using a cellular viability
staining (NADH).
RESULTS
Confluent volumes on NPV-imaging (up ~3 mL) and NADH staining (up to ~4mL) were obtained and temperatures exceeding 60°C
were reached in 6 pigs. I.e. heating of the false rib, poor respiratory correction, and a large incidence angle caused poor kidney
heating in 3 pigs.
CONCLUSION
These first results indicate that current clinical MR-HIFU equipment might be suitable for non-invasive therapy of renal masses.
Positioning of the sonications and the subject based on anatomical scans is very important, as well as adequate motion
compensation. Future work will include a first clinical study on renal cell carcinomas.
There is an increasing interest in non-invasive kidney sparing therapy for renal cancer, since ~1.6% of men and women will be
diagnosed with kidney and renal pelvis cancer during their lifetime, in 25% of all abdominal imaging sessions a renal lesion is found,
partial nephrectomy - standard care for tumors <4cm - has a 15% complication rate, and the population is aging and known with
comorbidities and poor physical condition. Therefore, several patient studies investigated the feasibility of HIFU for the thermal
ablation of renal masses. Mainly a hand-held extracorporeal ultrasound device with US B-mode imaging for guidance or a
laparoscopic approach was used. Disadvantages are i.e. the lack of respiratory motion compensation, no real-time visualization of
energy deposition, and the complexity of the probe positioning. Alternatively, feasibility of MR-HIFU interventions on the kidney with
respect to motion compensated real-time thermometry and acoustic energy delivery was established, recently.
VSIO11-17
Outside the Box: Is Ablation Effective for Masses other than T1a RCC
Participants
LEARNING OBJECTIVES
VSIO11-18
Percutantous Ablation for T1b Tumors
Participants
Thomas D. Atwell, MD, Rochester, MN (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
VSIO11-19
Percutantous Ablation for Angiomyolipomas
Participants
Fred T. Lee JR, MD, Madison, WI (Presenter) Stockholder, NeuWave Medical, Inc; Patent holder, NeuWave Medical, Inc; Board of
Directors, NeuWave Medical, Inc ; Patent holder, Medtronic, Inc; Inventor, Medtronic, Inc; Royalties, Medtronic, Inc
LEARNING OBJECTIVES
RC107
Renal Cell Carcinoma: How Imaging Can Be Used to Select among Treatment Options and Monitor Response
Sunday, Nov. 29 2:00PM - 3:30PM Location: N227
GU
Participants
Erick M. Remer, MD, Cleveland, OH, (remere1@ccf.org) (Coordinator) Nothing to Disclose
Steven S. Raman, MD, Santa Monica, CA (Presenter) Nothing to Disclose
Raghunandan Vikram, MBBS, FRCR, Houston, TX (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) The attendee will learn how imaging can be used to predict renal tumor subtype and grade. 2) Imaging findings that guide renal
tumor management toward percutaneous tumor ablation, partial, and radical nephrectomy will be described. 3) The use of imaging
to evaluate patients after tumor ablation and nephrectomy will be reviewed. Assessment methods will be compared and
complications will be illustrated. 4) Methods for assessing tumor response after chemotherapy such as RECIST, WHO, Choi /
Modified Choi, SACT, and MASS criteria will be discussed with illustrative examples. Imaging appearances of post therapy
complications will be reviewed.
ABSTRACT
Honored Educators
Raghunandan Vikram, MBBS, FRCR - 2012 Honored Educator
RC110
Gynecologic Ultrasound (An Interactive Session)
Sunday, Nov. 29 2:00PM - 3:30PM Location: E353B
GU
OB
US
Participants
Sub-Events
RC110A
Uterus and Endometrium
Participants
Ruth B. Goldstein, MD, San Francisco, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Be able to state the acceptable standards for endometrial assessment in women with abnormal vaginal bleeding. 2) Be able to
recognize a uterine abnormality in a postmenopausal woman that warrants further evaluation including tissue sampling or MRI. 3) Be
able to recognize and diagnose adenomyosis.
Active Handout:Ruth Beth Goldstein
http://abstract.rsna.org/uploads/2015/15001988/RC110A.pdf
RC110B
Ovarian Masses
Participants
Phyllis Glanc, MD, Toronto, ON (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Evaluate critical ultrasound features of adnexal masses that permit stratification into benign, indeterminate or suspicious for
malignancy. 2) Incorporate the role of guidelines, consensus statements, risk prediction algorithms and serum biomarkers. 3)
Consider the role of alternate imaging modalities such as MRI, CT, PET-CT. 4) Utilize appropriate management strategies.
ABSTRACT
There remains a gap between the state of the knowledge and translation into practice for the diagnosis and management of
adnexal masses. Pelvic ultrasound remains the primary imaging modality in the greater majority of cases. Most ovarian masses can
be correctly classified on the basis of their ultrasound characteristics, nonetheless many masses that are 'almost certainly benign'
or even 'indeterminate' come to prompt surgical exploration, which is not always apprpriate or without its potential risks.. This
session will explore further these characteristic findings but also will evaluate the role of serial ultrasound, additional modalities such
as MR or CT, serum biomarkers, strategies such as IOTA simple rules and optimization of referral patterns.
Active Handout:Phyllis Glanc
http://abstract.rsna.org/uploads/2015/15001989/RC110B.pdf
RC110C
Endometriosis
Participants
Luciana P. Chamie, MD, PhD, Sao Paulo, Brazil (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Define clinical and epidemiological aspects of endometriosis. 2) Define the importance of imaging mapping for endometriosis
before clinical counseling. 3) Apply the most appropriate technique to investigate endometriosis. 4) Define the bowel preparation
required for the transvaginal ultrasound to investigate endometriosis. 5) Apply the imaging algorithm to map deeply infiltrative
endometriosis. 6) Assess the ultrasonographic findings of deeply infiltrative endometriosis in the most common sites such as
bladder, vesicouterine pouch, retrocervical space, vagina, ureters, appendix and rectosigmoid colon. 7) Assess the ultrasonographic
findings of ovarian endometriomas and differentiate them from functional cysts.
ABSTRACT
Endometriosis is a very common gynecological disease affecting millions of women in their reproductive life, often causing pelvic
pain and infertility. Clinical history and physical examination may suggest endometriosis, but imaging mapping is necessary to
identify the disease and mandatory for clinical couseling and surgical planning. Transvaginal ultrasound after bowel preparation is
the best imaging modality as the first-line technique to evaluate patients suspected of endometriosis. The bowel preparation is
relatively simple and include the day before and the day of the examination. This method is highly accurate to identify intestinal
endometriosis and to determine which layers of the bowel wall are affected. In addition, it provides better assessment of small
peritoneal lesions of the retrocervical space, vagina and bladder. Pelvic adhesions can also be evaluated during the exam.
URL
http://chamie.com.br/download
Active Handout:Luciana Pardini Chamie
http://abstract.rsna.org/uploads/2015/15001990/Active RC110C.pdf
RC113
Pediatric Series: Fetal/Neonatal
GU
OB
MR
PD
Participants
Daniela Prayer, MD, Vienna, Austria (Moderator) Nothing to Disclose
Amy R. Mehollin-Ray, MD, Houston, TX, (armeholl@texaschildrens.org) (Moderator) Nothing to Disclose
Sub-Events
RC113-01
Fetal MRI of Genitourinary Tract Abnormalities
Participants
Ann M. Johnson, MD, Philadelphia, PA, (johnsona@email.chop.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Learn basic fetal MRI techniques and relevent embryology. 2) Understand what fetal MRI can add in evaluation of genitourinary
(GU) abnormalities. 3) Become familiar with patterns of fetal GU abnormalities with an emphasis on complex lesions affecting multiple
organ systems, such as cloacal malformation spectrum and exstrophy. 4) The purpose of the course is to understand the potential
role of fetal MRI in the evaluation of fetal genitourinary tract abnormalities. There will be an emphasis on complex lesions affecting
multiple organ systems, such as cloacal malformation spectrum and exstrophy.
RC113-02
Novel Nanoparticle Gd Contrast Agent Does Not Penetrate the Placental Barrier
Participants
Anil N. Shetty, PhD, Houston, TX (Presenter) Nothing to Disclose
Ketan B. Ghaghada, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Robia Pautler, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Wesley Lee, MD, Houston, TX (Abstract Co-Author) Research support, General Electric Company Research support, Koninklijke
Philips NV Research support, Siemens AG Research support, Samsung Electronics Co Ltd
Haijun Gao, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Chandra Yallampalli, DVM,PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
David Rendon, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Ananth Annapragada, PhD, Houston, TX (Abstract Co-Author) Stockholder, Marval Pharma Ltd Stockholder, Alzeca Biosciences LLC
Stockholder, Sensulin LLC Stockholder, Abbott Laboratories Stockholder, Johnson & Johnson
PURPOSE
Gd contrast agent usage in placental imaging is generally contraindicated, for concerns related to fetal contrast agent exposure.
We therefore developed a A novel liposomal Gd nanoparticle contrast agent for T1-MRI, retaining the Gd on the maternal side, thus
shielding the fetus from potential toxicities. In this study, we tested this agent in placental imaging in a mouse model, and
measured its transplacental permeability.
Female C57BL/6 mice, pregnant at gestational age E16.5±1 days, were imaged by T1-MRI on a 9.4T small animal MRI (Bruker
Instruments) using a conventional contrast agent (Multihance, a meglumine salt of Gd-BOPTA chelate) (13 mice) and using the
novel nanoparticle Gd agent (9 mice). DCE-MRI was conducted using consecutive 3D-SPGRE sequences at a constant flip angle of
16°, TE/TR=1.93ms/6ms, FOV = 3x3x2.5cm, matrix = 128x128x16. Each image was converted to a T1 map, and the contrast agent
concentration on a pixel-by-pixel basis, estimated from the known relaxivity. After imaging, the mice were sacrificed and the Gd
content of the placenta and fetus measured using ICP-AES.
RESULTS
Image and data shown below are representative of each cohort. The placentae are rather small (2mmx3mm) but are still clearly
defined, and obviously not invasive into the uterine wall. Signal intensities in the placental and fetal ROI's, indicative of Gd
concentration in each compartment, clearly show that the conventional Gd chelate agent penetrates the placental barrier and
enters the fetus. The nanoparticle agent however, does not do so, indicated by zero signal in the fetal compartment throughout
the duration of this experiment. The ICP-AES study confirmed the imaging study results, with no detectable Gd in the fetal
compartment. A separate study in human placentae using an ex vivo perfused placenta preparation, also confirmed these results.
CONCLUSION
The nanoparticle contrast agent does not penetrate the placental barrier in a mouse model. The data are consistent with separate
tests on a perfused human placenta model.
The incidence of placenta accreta has increased 8-fold in the last 30 years, and improved methods for placental imaging are sorely
needed. Nanoparticle Gd contrast agents described in this work could be useful for placental imaging, while maintaining fetal safety.
RC113-03
Normal and Abnormal Development of the Cerebellar Vermis - A Quantitative Fetal MRI Study
Participants
Gregor Kasprian, MD, Vienna, Austria (Presenter) Nothing to Disclose
Gregor Dovjak, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Peter C. Brugger, MD, PhD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Gerlinde Gruber, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Georg Langs, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Michael Weber, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Ernst Schwartz, MSc, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Dieter Bettelheim, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Daniela Prayer, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
PURPOSE
Postnatal neurodevelopmental outcome of fetuses with hindbrain malformations is dependent on normal growth and development of
the cerebellar vermis. This comparative in vivo and post mortem fetal MRI study aims to quantitatively assess the relative
dimensions of respective vermian lobules between 18 to 32 gestational weeks (GW) in normal and pathological conditions.
75 fetuses (18-32 GW, mean 25.7GW) with normal brain development and 20 fetuses with different types of hindbrain malformations
were scanned prenatally (1.5T, T2-TSE, voxel size 0.72/0.72/4.4mm - 1.0/1.0/4.4mm) and seven fetuses (16-30GW, mean 21.9GW,
3T, CISS sequence, resolution: 0.33/0.33/0.33mm) scanned within 24 hours postmortem were selected for postprocessing. A T2weighted midline sagittal slice was identified and 2D vermian segmentation was performed using ITK snap (Figure).
RESULTS
The mean proportional size of 7/9 discriminable vermian lobules did not differ between in vivo and post mortem measurements. The
relative size of the following lobules increased during gestation (Pearson, p<0.05): Culmen (r²=.460) and Declive/Folium/Tuber
(r²=.453). The proportions of Lingula (r²=-.439), Centrum (r²=-.554), Pyramis (r²=-.303) and Nodulus (r²=-.491) decreased with
gestational age. The relative size of the Uvula did not show age specific changes (p=.201). Certain types of hindbrain
malformations showed common patterns of cerebellar lobular hypoplasia.
CONCLUSION
Fetal vermian lobulation can be accurately assessed by MRI between 18 and 32GW in normal and pathological conditions in vivo .
Growth of specific vermian lobules is nonuniform during the second and third trimester. Distinct patterns of vermian lobular
hypoplasia can be described antenatally.
Knowledge about the distinct growth patterns of specific vermian lobules is helpful in the prognostic classification of fetal hindbrain
malformations.
RC113-04
MRI-US Fusion Imaging in Real-Time Virtual Sonography for the Evaluation of Fetal Anomalies:
Preliminary Stud
Participants
Silvia Bernardo, MD, Rome, Italy (Presenter) Nothing to Disclose
Valeria Vinci, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Matteo Saldari, MD, PhD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Antonella Giancotti, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Lucia Manganaro, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Camilla Aliberti, Rome, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
Magnetic resonance imaging (MRI) and ultrasound (US) scanning complement each other in the screening and diagnosis of fetal
anomalies. Real-time virtual sonography (RVS) is a new technique that uses magnetic navigation and computer software for the
synchronized display of real-time US and multiplanar reconstruction MRI images. The purpose of this study was to evaluate the
feasibility and ability of RVS to assess the main pathologies in fetuses with suspected US anomalies.
This study was conducted over a two-month period march-april 2015 in 30 patients referred for a morphological fetal US-based
evaluation. Patients undergone Fetal MRI at 1.5 T for fetal anomalies were offered fusion imaging (Hitachi HI Vision Ascendus).The
MRI image dataset acquired at the time of the examination was loaded into the fusion system and displayed together with the US
image on the same monitor. Both sets of images were then manually synchronized and image were registered using multiple planes
MR imaging.The ability of this combined image (RVS imaging) to assess the main anatomical sites and fetal anomalies was evaluated
and compared with standard B-Mode US and MRI images previously acquired.
RESULTS
In all cases RVS was technically possible, with a 100% match between MR images and US images. Data registration, matching and
fusion imaging were performed in less than 15-20 minutes. On a total of 30 fetuses, 20 were for the encephalic district and 10 for
the body (8 thoraco- abdominal; 2 heart). In all cases RVS was technically possible, with a 100% match between MR images and
US images. In 10 cases of body abnormalities, fusion imaging helped the diagnosis in 20%. In the 10/20 cases of encephalic
pathology, fusion imaging improved the diagnosis; in the other 10 cases MRI was superior to US even using the RVS.
CONCLUSION
The present work is a preliminary study on the feasibility and practical use of a Fetal MRI-US real-time fusion imaging. Thanks to
informations from both US and MRI, fusion imaging allows better identification of the different fetal pathologies and could improve
the performance of ultrasound examination.
Fusion imaging is feasible for the assessment of fetal abnormalities. Because it combines information from both US and MRI
techniques, fusion imaging allows better identification of the different fetal pathologies.
RC113-05
Predictive Value of the MRI-based Ratio of Fetal Lung Volume to Fetal Body Volume in Congenital
Diaphragmatic Hernia in Comparison to the MR Fetal Lung Volume and the Sonographic Lung-to-Head
Ratio
Participants
Claudia Hagelstein, MD, Mannheim, Germany (Presenter) Nothing to Disclose
Silke von Mittelstaedt, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Meike Weidner, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Christel Weiss, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Regine Schaffelder, MD, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Thomas Schaible, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
Stefan O. Schoenberg, MD, PhD, Mannheim , Germany (Abstract Co-Author) Institutional research agreement, Siemens AG
Wolfgang Neff, MD, PhD, Alzey, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate prognostic accuracy of the MRI-based ratio of fetal lung volume to fetal body volume (MR-FLV/FBV) in fetuses with
congenital diaphragmatic hernia (CDH) and to compare it to established prognostic parameters (the observed-to-expected MR fetal
lung volume [o/e-MR-FLV] and the US-based observed-to-expected lung-to-head ratio [o/e-LHR]) with regard to survival,
extracorporeal membrane oxygenation (ECMO) requirement and development of a chronic lung disease (CLD).
Fetal MRI was performed in 132 patients with isolated CDH (mean gestational age 32.8±3.8 weeks) to measure FLV and FLV/FBV.
Sonographic assessment of the LHR was performed within three days before or after fetal MRI. To obtain parameters that were
independent from gestational age, the o/e-MR-FLV and the o/e-LHR were calculated based on normal controls, whereas calculation
of the MR-FLV/FBV is independent from normal controls.
RESULTS
91% of the neonates survived, 37% needed ECMO therapy and 45% developed a CLD. All prenatal parameters revealed an excellent
correlation with patients´ clinical outcome. MR-FLV/FBV, o/e-MR-FLV and o/e-LHR were significantly higher in survivors (p always
<0.0001). Patients with ECMO requirement and patients with CLD showed a significantly lower MR-FLV/FBV, o/e-MR-FLV or o/e-LHR
(p always <0.0001). Prognostic accuracy regarding survival was quite similar for the three parameters (AUC MR-FLV/FBV : 0.830,
AUC o/e-MR-FLV : 0.868, AUC o/e-LHR : 0.845). Regarding ECMO requirement (AUC MR-FLV/FBV : 0.844, AUC o/e-MR-FLV : 0.843,
AUC o/e-LHR : 0.736) and development of CLD (AUC MR-FLV/FBV : 0.778, AUC o/e-MR-FLV : 0.795, AUC o/e-LHR : 0.738) the MRFLV/FBV and o/e-MR-FLV showed a slightly better prognostic accuracy compared to the o/e-LHR.
CONCLUSION
In CDH, assessment of pulmonary hypoplasia based on the MR-FLV/FBV, the o/e-MR-FLV or the o/e-LHR is quite similar in predicting
survival. Regarding ECMO requirement and development of CLD, the o/e MR-FLV and the MR-FLV/FBV showed a slightly better
prognostic accuracy compared to the US-based o/e-LHR. Compared to other prognostic parameters, MR-FLV/FBV has the
advantage of being independent from the reference to a normal control group.
In CDH, MRI-based MR-FLV/FBV and o/e-MR-FLV as well as US-based o/e-LHR are excellent and almost equivalent parameters to
predict survival, ECMO-requirement and development of CLD.
RC113-06
Correlation between Fetal and Postmortem Magnetic Resonance Imaging and Conventional Autopsy
in the Detection of Fetal Abnormalities
Participants
PURPOSE
To compare Fetal and postmortem MRI and conventional autoptic findings in cases of major pathological abnormalities.
In this prospective study we enrolled 128 fetuses with identified US findings of severe fetal malformations, with local research
ethics committee approval. Among these, we performed 94 whole body Fetal MRI on 94 fetuses using a 1.5 T MR scanner and of
these, only 89 women undewent termination of pregnancy because of the fetal abnormalities. Of the 89 patients, 80 (90%)
consented to postmortem MRI alone; 59 (66%) women consented to both postmortem MRI and conventional autopsy and formed
our study group. Following delivery, fetuses were stored in refrigerated compartments prior to MR imaging and autopsy. Also for the
post-mortem imaging evaluation we acquired whole body MR imaging using a 1.5 T MR scanner. MR images were reviewed by a team
of two radiologists blinded to the autoptic data. Pathologists who performed conventional autopsy were blinded to the MR data;
autoptic data were considered the gold standard.
RESULTS
Final autoptic diagnoses were: polycystic kidney disease (n=15), diaphragmatic hernia (n=10), lissencephaly (n=4), type-2 ArnoldChiari malformation (n=6), Dandy-Walker syndrome (n=13), cloacal malformation (n=1), anencephaly (n=1), holoprosencephaly
(n=4), rhombencephalosynapsis (n=2), Walker-Warburg syndrome (n=2), schizencephaly (n=1).MRI-autopsy provided additional
information in 10/59 (17%) compared to fetal MRI.In 6 cases (10%) conventional autopsy provided superior diagnostic information
compared to MRI-autopsy. On the other hand, in 7 cases (12%) the disruption of the anatomy during autoptic dissection of the
fetal body couldn't allow a correct identification of the pathology.
CONCLUSION
MR autopsy is accepted by nearly all mothers while conventional autopsy is accepted by about two-thirds of mothers, it provides
similar information compared to conventional autopsy in case of fetal malformations and it allows the evaluation of the pathology in
case of tissue disruption during the autoptic evaluation.
Fetal MRI can add significant additional information and may be use to guide conventional autopsy
RC113-07
Imaging of Ambiguous Genitalia
Participants
Jeanne S. Chow, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) The purpose of this course is to understand the important role of the radiologists in infants with ambiguous genitalia. Imaging
techniques as well as important imaging findings will be detailed.
ABSTRACT
PS12
Sunday Afternoon Plenary Session
Sunday, Nov. 29 4:00PM - 5:45PM Location: Arie Crow n Theater
CH
GI
GU
MK
NR
ER
Participants
Ronald L. Arenson, MD, San Francisco, CA (Presenter) Nothing to Disclose
Sub-Events
PS12A
Report of the RSNA Research and Education Foundation
Participants
Burton P. Drayer, MD, New York, NY (Presenter) Advisor, Hologic, Inc
Abstract
The RandE Foundation - Our Future is Now This year marks the 100th anniversary of the RSNA's founding. As radiology looks toward
the future, one wonders what the next 100 years will look like for our specialty and whether the central role of radiologists in
healthcare will be sustained. Analogous to our clinical radiology mantra, if we are not at the radiology research table we will be on
the menu. As a leading global force in radiology, the RSNA is poised to lead the specialty into the next century and exceed the
incredible success of the past 100 years. The RandE Foundation will play a key role in radiology's future by continuing its support of
inspiring investigators and those pursuing innovative approaches to education. To meet these research and education needs headon, the Foundation launched Inspire-Innovate-Invest, The Campaign for Funding Radiology's Future® at last year's annual meeting.
This bold campaign seeks to raise $17.5 million to fund grants in radiologic research and education, bridging the gaps in funding for
promising investigators and educators. To date our campaign has been a success with individuals, private practice and corporate
donors generously pushing us to the mid-way point in our goal. There is still a long way to go. The future of our specialty depends
on the commitment and generosity of each of us, the members of the imaging community. This year, the Foundation will fund 92
grants totaling $3.6 million. The RandE is funding 25% of our ever increasing number of excellent grant applications. While pleased
with these achievements, imagine what the RandE Foundation could fund with additional support from all of us as radiology
colleagues? During the meeting week, please take time to visit the RandE Foundation Booth, located on Level 3 of Lakeside Center
to learn more about how you can be a part of the campaign and support the RandE Foundation and the future robustness of our
specialty.
PS12B
Image Interpretation Session
Participants
Jonathan B. Kruskal, MD, PhD, Boston, MA (Presenter) Author, UpToDate, Inc
Donald P. Frush, MD, Durham, NC (Presenter) Nothing to Disclose
Bruce B. Forster, MD, Vancouver, BC (Presenter) Travel support, Siemens AG; Travel support, Toshiba Corporation;
Christine M. Glastonbury, MBBS, San Francisco, CA (Presenter) Author with royalties, Reed Elsevier
Michelle M. McNicholas, MD, Dublin, Ireland (Presenter) Nothing to Disclose
Melissa L. Rosado De Christenson, MD, Kansas City, MO (Presenter) Author, Thieme Medical Publishers, Inc; Author, Reed Elsevier;
Author, American Registry of Pathology; Author, Oxford University Press; ; ; ;
Jorge A. Soto, MD, Boston, MA (Presenter) Nothing to Disclose
Honored Educators
Melissa L. Rosado De Christenson, MD - 2012 Honored Educator
Jorge A. Soto, MD - 2013 Honored Educator
Jonathan B. Kruskal, MD, PhD - 2012 Honored Educator
ED006-MO
Genitourinary Monday Case of the Day
Monday, Nov. 30 7:00AM - 11:59PM Location: Case of Day, Learning Center
GU
Participants
TEACHING POINTS
Honored Educators
SPSH20
Hot Topic Session: PET/MR and Hyperpolarized MR for GU Imaging
Monday, Nov. 30 7:15AM - 8:15AM Location: E450B
GU
MR
NM
OI
AMA PRA Category 1 Credit ™: 1.00
ARRT Category A+ Credit: 1.00
Participants
Zhen J. Wang, MD, Hillsborough, CA, (jane.wang@ucsf.edu) (Moderator) Nothing to Disclose
LEARNING OBJECTIVES
1) To become familiar with current PET-MR imaging strategies. 2) To learn the current and future applications of PET-MR in
genitourinary oncology including gynecological cancers and prostate cancer. 3) To understand the principles of hyperpolarized
carbon-13 MR metabolic imaging 4) To learn the clinical utility of hyperpolarized carbon-13 MR for measuring prostate cancer
aggressiveness and response to therapy
ABSTRACT
URL
Sub-Events
SPSH20A
PET/MRI of Gynecological Malignancies
Participants
Raj M. Paspulati, MD, Cleveland, OH (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) PET-MRI protocol and workflow for Gynecological cancer. 2) Role of PET-MRI in Gynecological cancer staging, treatment planning
and follow up for treatment response. 3) PET-MR Imaging pit falls and limitations.
SPSH20B
Imaging of Prostate Cancer: Potential of PET/MRI with Tracers beyond FDG
Participants
Matthias Roethke, MD, Heidelberg, Germany (Presenter) Speaker, Siemens AG
LEARNING OBJECTIVES
Handout:Matthias Roethke
http://abstract.rsna.org/uploads/2015/15006404/Roethke Prostate RSNA handout.pdf
SPSH20C
Hyperpolarized 13C MR Clinical Trials of Prostate Cancer
Participants
John Kurhanewicz, PhD, San Francisco, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
MSCM21
Case-based Review of Magnetic Resonance (An Interactive Session)
Monday, Nov. 30 8:30AM - 10:00AM Location: S100AB
GI
GU
MK
MR
Participants
John R. Leyendecker, MD, Dallas, TX (Director) Nothing to Disclose
LEARNING OBJECTIVES
1) Be familiar with the MRI appearance of common musculoskeletal derangements of the hip. 2) Develop a differential diagnosis for
musculoskeletal soft tissue tumors based on MRI appearance. 3) Distinguish between common benign and malignant liver neoplasms.
4) Be familiar with the typical MRI appearance of select female pelvic disorders.
ABSTRACT
This session will help attendees recognize and manage select, commonly encountered musculoskeletal and abdominopelvic
abnormalities based on their MRI appearances using a case-based, interactive format.
Sub-Events
MSCM21A
Musculoskeletal MRI of the Hip and Pelvis
Participants
Mini N. Pathria, MD, San Diego, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
Active Handout:Mini Nutan Pathria
http://abstract.rsna.org/uploads/2015/15002720/Active -MSCM21A.pdf
MSCM21B
MRI of Soft Tissue Masses of the Extremities
Participants
Kirkland W. Davis, MD, Madison, WI, (kdavis@uwhealth.org) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Distinguish characteristic extremity soft tissue masses on the basis of signal characteristics, such as high signal on T1-weighted
images or low signal on all sequences.
ABSTRACT
MSCM21C
MRI of the Liver
Participants
Nicole M. Hindman, MD, New York, NY, (Nicole.Hindman@nyumc.org) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Recognize and analyze benign but unusual liver lesions. 2) Analyze uncommon presentations of liver lesions. 3) Recognize
neoplastic mimics of benign lesions in the liver (eg, a colon metastasis mimicking a hemangioma) .
ABSTRACT
This session will cover common and uncommon presentations of liver lesions on several modalities (ultrasound, CT and MRI). A brief
interactive review of common, but atypical presentations of both benign and malignant liver lesions will be presented. Malignant
mimics of benign liver lesions will also be shown, with features that should be analyzed in order to better characterize the lesion,
and appropriately raise concern (eg, for a metastasis or intrahepatic cholangiocarcinoma instead of a benign hemangioma). Recent
advances in liver lesion characterization will be covered.
MSCM21D
MRI of the Female Pelvic Organs
Participants
Christine O. Menias, MD, Scottsdale, AZ, (menias.christine@mayo.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
Honored Educators
MSRO21
BOOST: Gynecology-Oncology Anatomy - Radiologic Evaluation of Pelvic Malignancies in the Era of Imaging
Biomarkers (An Interactive Session)
Monday, Nov. 30 8:30AM - 10:00AM Location: S103AB
GU
BQ
RO
FDA
Participants
Saurabh Gupta, MD, Milwaukee, WI (Presenter) Nothing to Disclose
Robert S. Hellman, MD, Milwaukee, WI (Presenter) Nothing to Disclose
Paul M. Knechtges, MD, Milwaukee, WI (Presenter) Nothing to Disclose
Mark D. Hohenwalter, MD, Milwaukee, WI (Presenter) Nothing to Disclose
Beth A. Erickson, MD, Milwaukee, WI (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Review uterine/cervical anatomy and current anatomic imaging methods for the evaluation of pelvic malignancy. 2) Review the
current role of PET in the imaging of pelvic malignancy. 3) Discuss the growing role of imaging biomarkers ( e.g. diffusion weighted
imaging and perfusion imaging) in determining prognosis and treatment response for pelvic malignancies.
RC207
Genitourinary Series: Prostate MR 2015: Current Role in Staging and Surveillance and Intervention
Monday, Nov. 30 8:30AM - 12:00PM Location: N227
GU
MR
OI
FDA
Participants
Peter L. Choyke, MD, Rockville, MD, (pchoyke@nih.gov) (Moderator) Researcher, Koninklijke Philips NV Researcher, General Electric
Company Researcher, Siemens AG Researcher, iCAD, Inc Researcher, Aspyrian Therapeutics, Inc Researcher, ImaginAb, Inc
Researcher, Aura Biosciences, Inc
LEARNING OBJECTIVES
1) To understand why prostate cancer is currently under- and over-diagnosed. 2) To understand the role of multiparametric
prostate MRI in guiding biopsy of the prostate. 3) To understand the role in the diagnosis, surveillance and recurrence of cancer. 4)
To review current progress in the focal treatment of prostate cancer.
ABSTRACT
The paradox of prostate cancer is that it is currently being overdiagnosed and underdiagnosed. PSA and blind biopsy has resulted in
the overtreatment of men with low risk disease and the undertreatment of men with intermediate high risk tumors that evade blind
biopsy. Multiparametric MRI is a major breakthrough in the diagnosis of prostate cancer. Moreover it can be used to monitor
patients for active surveillance and guide treatment. New standards for reporting of prostate MRI have been recently development.
This course will not only review these important developments but will provide new research results to participants.
Sub-Events
RC207-01
Intro to Prostate Cancer
Monday, Nov. 30 8:30AM - 8:55AM Location: N227
Participants
Peter L. Choyke, MD, Rockville, MD, (pchoyke@nih.gov) (Presenter) Researcher, Koninklijke Philips NV Researcher, General Electric
LEARNING OBJECTIVES
1) To understand the limitations of PSA screening and random prostate biopsy. 2) To introduce the concepts of novel screening
tests and genomic analysis of prostate biopsies. 3) To review the importance of MRI in improving tumor localization, guiding biopsy,
monitoring active surveillance and focally ablating prostate cancer.
ABSTRACT
See overview abstract
ABSTRACT
The diagnosis of prostate cancer is evolving quickly. There is increasing recognition that the combination of routine PSA screening
and random prostate biopsy overdiagnoses low grade disease and underdiagnoses high grade disease. Autopsy studies show that
the normal prostate harbors many low grade and microscopic cancers that never becomes clinically apparent. On the other hand,
random biopsies undersample the anterior prostate gland. More accurate screening tests (e.g. PCA-3) are under development for
determining which men warrant biopsy. Genomic testing of prostate biopsy samples is also becoming more common and it is thought
to improve the prediction of tumor aggressiveness. The increased use of genomics to guide therapy clearly requires that the biopsy
sample be representative of the tumor. MR guided biopsies, whether performed in gantry or using MR-US fusion, will improve the
quality of the prostate biopsy specimen enabling more accurate genomic testing. Armed with more accurate and reliable tissue
diagnosis, more rational decisions regarding active surveillance and/or focal therapy can be made. This course will review advances
in MR guided diagnosis, biopsy and therapy of prostate cancer.
RC207-02
Detection and Characterization of Prostate Cancer with Multiparametric MRI (mpMRI): Do Learning
and Experience Matter for Diagnostic Accuracy?
Participants
Rajan T. Gupta, MD, Durham, NC (Presenter) Consultant, Bayer AG; Speakers Bureau, Bayer AG; Consultant, Invivo Corporation
Daniele Marin, MD, Cary, NC (Abstract Co-Author) Nothing to Disclose
Bhavik N. Patel, MD,MBA, Durham, NC (Abstract Co-Author) Nothing to Disclose
Kirema Garcia-Reyes, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Kingshuk Choudhury, PhD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Lisa M. Ho, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Tracy A. Jaffe, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Thomas J. Polascik, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate effect of dedicated reader education on accuracy/Gleason score estimation of index and anterior prostate cancer
(PCa) diagnosis with mpMRI in attending radiologists compared to abdominal imaging fellows.
4 blinded attending abdominal imagers with 2-16 years of experience evaluated 31 prostate mpMRIs in this IRB-approved, HIPAAcompliant, retrospective study for index lesion and anterior PCa detection (including Gleason score estimation). Following dedicated
education program, readers reinterpreted cases after a 2-4 month memory extinction period, blinded to initial reads. Reference
standard was established combining whole mount histopathology with mpMRI findings by a board-certified radiologist with 5 years of
prostate mpMRI experience. Multivariate analysis was performed to assess the effects of learning and reader experience. Results for
attending radiologists were then compared with prior reader study results in radiology fellows (using the same set of cases).
RESULTS
Index cancer detection (attending vs. fellow): pre-education accuracy 64.5% vs. 74.2%; post-education accuracy 71.8% vs.
87.7% (p=0.12 vs. p=0.003). Gleason score estimation (index): pre-education accuracy 46.8% vs. 54.8%; post-education
accuracy 57.3% vs. 73.5% (p=0.04 vs. p=0.0005). Anterior PCa detection: pre-education accuracy 46.4% vs. 54.3%; posteducation accuracy 75% vs. 94.3% (p=0.02 vs. p=0.001). Gleason score estimation (anterior): pre-education accuracy 42.9% vs.
45.7%; post-education accuracy 67.9% vs. 80% (p=0.03 vs. p=0.002). These effects were all attributable to learning and not to
reader experience based on multivariate analysis.
CONCLUSION
Accuracy of anterior PCa detection and Gleason score estimation for both index and anterior cancers significantly increased
following dedicated reader education for both attendings and fellows. In addition, accuracy for index cancers was statistically
significantly improved for fellows post-education. The degree of statistically significant improvement was higher for fellows vs.
attendings overall.
Performance in detection and characterization of PCa on mpMRI can be improved with dedicated reader education, however, it may
be that the earlier the educational intervention is done, the more significant the improvement.
RC207-04
Abbreviated Prostate MRI (AP-MRI)
Awards
Participants
Robin Bruhn, Aachen, Germany (Presenter) Nothing to Disclose
Simone Schrading, MD, Aachen, Germany (Abstract Co-Author) Nothing to Disclose
Christiane K. Kuhl, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
It has recently been shown that an Abbreviated MRI Protocol is suitable for breast cancer screening. Aim of this study was to
investigate whether an Abbreviated Prostate MRI protocol (AP-MRI), consisting of 2 pulse sequences only (high resolution T2-TSE
and DWI in a single plane), acquired without endorectal coil, is sufficient to diagnose prostate cancer (PCa) in men presenting with
elevated PSA-levels.
Ongoing prospective reader study on 222 men (mean age 53.6 years) with median PSA of 7.1 who underwent multiparametric 3.0TMRI with multi-element surface coil. The AP-MRI took a table time of just under 10 min. The full diagnostic protocol (FDP) took 30
min and included the pulse sequences of the AP-MRI (0.4 mm in-plane axial T2-TSE and DWI with 4 b-values up to 1400 s/mm²),
plus additional T2-TSE planes, coronal T1-TSE, and DCE. All MRI studies were read prospectively by two GU-radiologists in
consensus according to PIRADS 2.0. Readers first read the AP-MR images and made their diagnoses. Then, they read the FDP.
Results of MR-guided biopsy, TRUS/saturation biopsy, and/or final surgical pathology, or MRI and PSA follow up of at least 24
months served as SOR.
RESULTS
PCa was finally diagnosed in 85/222 men (38.3%), with median size 12 mm, classified as Gleason-6 in 25 patients, Gln-7 in 31, Gln ≥
8 in 29. Diagnostic indices of the AP-MRI vs. the FDP were: Sensitivity: 93% (79/85) vs. 94% (80/85); Specificity: 89% (122/137)
vs. 87% (120/137); PPV: 84% (79/94) vs. 82% (80/97), NPV: 95% (122/128) vs. 96% (120/125). The single cancer that went
undetected by AP-MRI was a Gln-6-cancer diagnosed by DCE. A total five additional cancers (Gln-6 in 3, and Gln-7 in 2 patients)
went undetected by both, AP-MRI and FDP, and were detected by TRUS biopsy. NPV for biologically relevant prostate cancer (>
Gln-6) was 98.8% (95%CI: 95.7%-99.9%) for both, AP-MRI and FDP.
CONCLUSION
Abbreviated prostate MRI allows diagnosis of biologically relevant PCa in under 10 minutes magnet time, without endorectal coil and
without contrast agent, and offers a diagnostic accuracy that is equivalent to that of a full state-of-the-art multi-parametric
prostate MRI protocol.
Abbreviated prostate MRI, if confirmed by further studies, may open the door for systematic MRI screening for prostate cancer.
RC207-05
The Natural History of Low-grade Prostate Cancer: Lessons from an Active Surveillance Cohort
Participants
Francesco Giganti, MD, Milan, Italy (Presenter) Nothing to Disclose
Neophytos Petrides, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Caroline M. Moore, London, United Kingdom (Abstract Co-Author) Speakers Bureau, Myriad Genetics, Inc; Research Grant,
GlaxoSmithKline plc; Consultant, STEBA Biotech NV
Mark Emberton, London, United Kingdom (Abstract Co-Author) Consultant, GlaxoSmithKline plc; Consultant, sanofi-aventis Group;
Consultant, Glide Pharmaceutical Technologies Limited; Consultant, SonaCare Medical, LLC
Clare M. Allen, MBBCh, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Alex P. Kirkham, BMBCh, MD, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
PURPOSE
To describe the natural history of low-grade prostate cancer by mpMRI changes in patients under active surveillance (AS).
This study had an authorization from our institutional ethics review board. From our database on patients with prostate cancer, a
total of 86 were enrolled in an AS program and had their first mpMRI in 2012 or before. The two reading radiologists, in consensus,
knew tumor location and PSA but were blinded to both patient demographics and date of scan. The scans were reported randomly
(reducing any bias assuming an increase in size with time). For each visible lesion we measured volume on the sequence best
showing the tumor (the same for all scans), as well as attributing a score based on the European Society of Uroradiology -ESUR2012 guidelines.
RESULTS
1. 66/86 patients had Gleason 3+3 and 20/86 Gleason 3+4 tumor. Median maximum cancer core lengths were 1 and 3.5 mm,
respectively.2. 38/86 patients did not have a visible lesion on the initial MRI (< 3, ESUR criteria). Of these patients, none had
developed at a median of 3.56 years of follow up.3. 40/86 patients had a lesion scoring 3/5 or more (ESUR criteria) on more than 2
scans, enabling an estimation of annual growth rate. 25 had Gleason 3+3, and 15 Gleason 3+4. Median monthly increase in volume
was 0.4% for Gleason 3+3 and 1.2% for 3+4 (p=0.049, Mann-Whitney test). No significant difference in the median monthly PSA
increase between these groups (0.9 vs 0.6%, p=0.42) was observed.4. In 38/40 patients having 2 scans separated by a median of
1.19 years, 9/38 showed a decrease in lesion size between 5 and 50 %.
CONCLUSION
In a group of men on AS, we never observed development of a convincing lesion in those negative on the first scan. Conversely, it
was possible to measure a growth rate in visible tumors, and it was significantly different for Gleason 3+3 and 3+4. Finally, there is
considerable inter-scan variability in volume: this must be taken into account when attrbuting a significant increase to a small
lesion.
The significant difference in rate of increase between small tumors of different grades under AS suggests that it is possible to
monitor their size on MRI.
RC207-06
Multi-parametric MRI (including PIRADS)
Participants
Clare M. Tempany-Afdhal, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) The state of the art mpMR protocols/sequences for prostate cancer imaging. 2) How to acquire and interpret high quality
images. 3) What ACR-Pi-Rads is and how it can be implemented in clinical practice. 4) Current and future role of Prostate MR and
ACR- PiRads.
ABSTRACT
The current state of the art approaches to prostate cancer Multi-parametric MR(mpMR) Prostate imaging will be presented. MRI
techniques at 1.5T and 3.0T and pulse seqeunce optimization for a state of the art mpMRI exam will be reviewed. The roles of each
seqeunce will be illustrated with clinical case examples to outline technical aspects and interpretative approaches. As the
examinations have become complex and the clinical demands are increasing there isa need for standarization of our techniques and
interpretative reporting. Thus in keeping with Bi-Rads and Li-Rads, we are developing Pi-Rads. The current ACR-PiRads will be
reviewed - goals, methods and clinical applications will be presented and future vision for the role of prostate MR and ACR-PiRADS
will be presented
RC207-07
Active Surveillance with MRI
Participants
Sadhna Verma, MD, Cincinnati, OH (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) What is active surveillance and how it is done. 2) Who is a candidate for active surveillance. 3) The role of mpMRI in risk
stratification for active surveillance. 4) The relevance of mpMRI in addition to clinical parameters in disease management.
ABSTRACT
ABSTRACT
Active Surveillance with MRI Active surveillance is increasingly acknowledged as a preferred strategy for most men with low-risk
disease. This lecture will discuss low risk prostate cancer and how it is managed clinically. Role of mpMRI will be reviewed with
clinical case examples to show selection, follow- up or possible removal of patients from active surveillance protocols.
Honored Educators
RC207-08
Longitudinal Follow-up Study of Prebiopsy Multiparametric MRI with Cancer- Negative Findings in
Patients with Suspicious Prostate Cancer: A Single Institution Experience
Participants
Jun Gon Kim, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Chan Kyo Kim, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jung Jae Park, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Byung Kwan Park, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
Few follow-up studies of prebiopsy prostate multiparametric MRI (mpMRI) with cancer-negative findings have been reported. The
aim of this study was to investigate the chance and characteristics of missing cancers on prebiopsy mpMRI with cancer-negative
findings based on Prostate Imaging Reporting and Data System (PI-RADS) in patients with suspicious prostate cancer (PCa).
584 consecutive patients (mean, 62.7 years; range, 30-86 years) with suspicious PCa who performed initial (n= 391) or repeated
prostate biopsies (n= 193) were enrolled in this retrospective study. All patients underwent prebiopsy 3-T mpMRI including T2weighted, diffusion-weighted and dynamic contrast-enhanced imaging. Random systemic core biopsies and MR-targeted core
biopsies in cases of cancer-positive MRI findings were performed, while cases with cancer-negative MRI findings underwent random
systemic core biopsies during subsequent follow-up. Biopsy-based definition of clinically significant cancer (CSC) was Gleason ≥ 3 +
4 or Gleason 6 with maximal cancer core length (MCL) ≥ 4 mm. The likelihood of PCa on mpMRI was evaluated based on PI-RADS
version 2: score 4 or 5 was considered cancer positive.
RESULTS
Pathologically the cancers were found in 25% (146/584). The cancer-positive MRI findings were found in 17% (99/584) patients
and of these, 85.9% (85/99) had pathologically cancer cores. Of 485 patients with cancer-negative MRI findings, a total of 61
(12.5%) had cancer cores [Gleason 6 (n= 42), 3 + 4 (n= 14), 4 + 3 (n= 2), 8 (n= 2), and 9 (n= 1)]: biopsy-naive patients (n= 38)
and patients with negative previous biopsy (n= 23). The mean MCL was 3.4 mm (range, 1-12.6 mm). The CSCs were found in
47.5% (29/61). Accordingly cancer-negative MRI findings missed 6% (29/485) CSCs: 4.1% (20/485) in biopsy-naive patients and
1.9% (9/485) in patients with negative previous biopsy.
CONCLUSION
Prebiopsy 3-T mpMRI with cancer-negative findings misses approximately 12.5% PCa including 6% CSCs in a cohort of biopsy-naive
patients and patients with negative previous biopsy.
In a cohort of biopsy-naive patients or patients with negative previous biopsy, 3-T multiparametric MRI can improve the detection
of clinically significant prostate cancers, which can help to select optimal treatment strategies.
RC207-09
Magnetic Resonance/Ultrasound (MR/US) Fusion Biopsy in Clinical Practice: Is Systematic Biopsy still
Needed to Detect Clinically Significant Prostate Cancers?
Participants
Andrei S. Purysko, MD, Cleveland, OH (Presenter) Nothing to Disclose
Andrew J. Stephenson, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Erick M. Remer, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Brian R. Herts, MD, Cleveland, OH (Abstract Co-Author) Research Grant, Siemens AG
Erika Schneider, PhD, Cleveland, OH (Abstract Co-Author) Stockholder, General Electric Company Stockholder, Pfizer Inc
Stockholder, NitroSci Pharmaceuticals, LLC
Jennifer Bullen, MSc, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Cristina Magi-Galluzzi, MD, PhD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Eric Klein, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare the detection rates of clinically significant (CS) prostate cancer (PCa), herein defined as a tumor with Gleason score
>= 3 + 4, by MR/US fusion biopsy and systematic extended-sextant TRUS (S-TRUS) biopsy.
IIRB-approved, HIPAA compliant retrospective study included 256 men (mean age: 62.3 yrs.) with either suspected PCa (n = 187)
or enrolled on active surveillance (n = 69). All patients underwent multiparametric MRI (mpMRI) of the prostate on a 3.0 T magnet
without endorectal coil as part of clinical care prior to biopsy, with T2, high B-value diffusion, and dynamic contrast enhancing
imaging. Patients with potential tumor by mpMRI (n= 193) underwent MR/US fusion biopsy followed by 12-core systematic biopsy
(SB) in the same procedure and performed by the same urologist who was aware of the location of the targets; those with
negative mpMRI underwent SB only (n = 63). The results of both biopsy techniques alone and combined were evaluated.
RESULTS
The overall detection rate of PCa in this population was 51.2% (131/256), and CS PCa was detected in 26.6% (68/256) of the men.
The overall detection rate of PCa in this population was 51.2% (131/256), and CS PCa was detected in 26.6% (68/256) of the men.
In those with positive mpMRI, there was no significant difference in the number of men with CS PCa detected by either biopsy
technique (MR/US fusion biopsy: 46 men [23.8%]; SB: 48 men [24.9%]), and both techniques combined detected more men with
CS PCA (66 men [34.2%]). CS PCa was detected exclusively by MR/US fusion biopsy in 18 men (9.3%), and by SB in 20 men
(10.4%). In most men with CS PCa exclusively detected by SB, the sextants involved were the same (n = 14) or the immediately
adjacent ipsilateral sextant (n = 3) where the MRI target was described; in only 3 men (1.5%) the targets were located in a distant
sextant from the site involved by CS PCa. PCa was detected in 28.6% (18/63) of the men with negative mpMRI, but only 2 cases
(3.2%) were CS PCa.
CONCLUSION
More CS PCa was detected when MR/US fusion biopsy was combined with SB, with greater contribution from biopsies of the same
or immediately adjacent sextants of the MRI targets.
In clinical practice, MR/US fusion biopsy should be performed in conjunction with systematic biopsy of the same and immediately
adjacent sextants of MRI-targets to ensure the detection of CS PCa detected by mpMRI.
RC207-10
MR and MR-US Guided Biopsy
Participants
Daniel J. Margolis, MD, Los Angeles, CA, (daniel.margolis@ucla.edu) (Presenter) Research Grant, Siemens AG
LEARNING OBJECTIVES
1) List the indications for in-bore MR-guided and MR/US fusion-guided prostate biopsy. 2) Optimize the protocol and image postprocessing of prostate MRI for lesion detection, selection, and delineation. 3) Understand the differences between in-bore MRguided and MR/US fusion-guided prostate biopsy. 4) Describe the advantages and disadvantages of the different kinds of MR/US
fusion-guided prostate biopsy. 5) Communicate with referrers to ensure all information is processed correctly for the biopsy session.
ABSTRACT
Interest in, and growth of, prostate MRI has been largely driven by increasing use of this technology for lesion detection rather
than treatment planning. This shift in focus is accompanied by changes in the MRI protocol, and how this information is used. A
growing number of opportunities for targeted biopsy, both in-bore direct MRI-guided and MRI-ultrasound image fusion targeting, is
accompanied by nearly as many different approaches. Each has advantages and disadvantages, some obvious, and some surprising.
Awareness of these issues and how to master them is crucial for providing optimal patient care. These issues range from the
hardware and software necessary to plan and perform the biopsy, to the intricacies of information and data communication, to
referral and follow-up. A comprehensive, service-line approach ensures patients are followed appropriately at all stages of this
process.
ABSTRACT
Multiparametric MRI has transformed from a tool primarily used for staging of known cancer into one for detection, localization, and
sampling of suspected cancer. This has allowed for streamlining and simplifying the protocol use for imaging the prostate, which
presents its own challenges, including managing decreased signal-to-noise ratios and interfacing with image-guided targeted biopsy
software and hardware. The various platforms available for image-fusion targeted biopsy include in-bore MRI-directed, "cognitive-"
or "mental-fusion" MRI-ultrasound targeted biopsy, software image fusion, articulated arm, and electromagnetic tracking. Attendees
will learn how to incorporate image-guided targeted biopsy into their practice, how to interface with clinical collaborators and
referrers, and how image-guided targeted biopsy improves confidence in managing men with suspected or known prostate cancer.
URL
http://1drv.ms/1kzFy7W
RC207-11
12 Months Follow-Up Results of MRI-Guided Transurethral Ultrasound Ablation for Treatment of
Localized Prostate Cancer
Participants
Maya B. Mueller-Wolf, MD, Heidelberg, Germany (Presenter) Nothing to Disclose
Sascha Pahernik, MD, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Boris Hadaschik, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Timur Kuru, MD, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Ionel V. Popeneciu, MD, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Gencay Hatiboglu, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Joseph Chin, MD, London, ON (Abstract Co-Author) Nothing to Disclose
Michele Billia, MD, London, ON (Abstract Co-Author) Nothing to Disclose
James D. Relle, MD, West Bloomfield, MI (Abstract Co-Author) Nothing to Disclose
Jason M. Hafron, MD, West Bloomfield, MI (Abstract Co-Author) Nothing to Disclose
Kiran R. Nandalur, MD, Northville, MI (Abstract Co-Author) Nothing to Disclose
Mathieu Burtnyk, DIPLPHYS, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Heinz-Peter Schlemmer, MD, Heidelberg, Germany (Abstract Co-Author) Nothing to Disclose
Matthias Roethke, MD, Heidelberg, Germany (Abstract Co-Author) Speaker, Siemens AG
PURPOSE
MRI-guided transurethral ultrasound ablation (MR-TULSA) is a novel minimally-invasive technology to treat organ-confined prostate
cancer (PCa), aiming to provide local disease control with a low side-effect profile. Directional plane-wave high-intensity ultrasound
generates a continuous volume of thermal coagulation to the prostate using real-time MR-thermometry control. A prospective,
multi-institutional Phase I clinical study investigated safety, feasibility, and assessed efficacy of MR-TULSA treatment for PCa.
30 patients with biopsy-proven, low-risk prostate cancer were enrolled: age>=65y, T1c/T2a, PSA<=10ng/ml, Gleason<=3+3 (3+4 in
Canada only). Under general anaesthesia, the ultrasound device (TULSA-PRO, Profound Medical Inc., Canada) was positioned in the
prostatic urethra with guidance from a 3T MRI (Siemens, Germany). Treatment planning was performed under MRI visualization with
therapeutic intent of whole-gland ablation. Treatment was delivered under continuous MRI thermometry feedback control.
RESULTS
MR-TULSA was well-tolerated by all patients without intraoperative complications. Median (5th-9th percentile) treatment time and
prostate volume were 36 (24-54) min and 44 (30-89) ml, respectively. Maximum temperature measured during treatment depicted a
continuous region of heating shaped accurately to the prostate to within 0.1 ± 1.3 mm. CE-MRI confirmed the resulting conformal
non-perfused volume, and correlated well with the ablative temperatures on MR-thermometry. Successful treatment was further
indicated by a median PSA decrease from 5.8 (2.8-8.9) ng/ml to 0.8 (0.1-3.2) ng/ml after one month remaining stable at 0.8 (0.13.7) ng/ml to 12 month. MRI and biopsy findings at 12 month show diminutive prostate volumes, averaging 51% fibrosis (n=29).
Positive biopsies (55% of patients) demonstrate 61% reduction in total cancer length.
CONCLUSION
MRI-guidance enables accurate treatment planning, real-time dosimetry and control of the thermal ablation volume. Primary
outcomes show that MR-TULSA is safe and precise for prostate ablation. Phase I data are sufficiently compelling to study MRTULSA in a larger efficacy trial.
Whole-gland ablation can be safely and accurately achieved using MR-TULSA, which represents a minimally-invasive treatment
option for organ-confined prostate cancer.
RC207-12
A Pilot Study to Evaluate Outpatient, Transrectal, Magnetic Resonance-guided Laser Focal Therapy
for Treatment of Localized Prostate Cancer
Participants
Bernadette M. Greenwood, BS, RT, Indian Wells, CA (Abstract Co-Author) Nothing to Disclose
John F. Feller, MD, Indian Wells, CA (Presenter) Consultant, Koninklijke Philips NV Consultant, Visualase, Inc
Stuart T. May Sr, MD, Indian Wells, CA (Abstract Co-Author) Nothing to Disclose
Roger McNichols, PhD, Houston, TX (Abstract Co-Author) Employee, BioTex, Inc
Wes Jones, Indian Wells, CA (Abstract Co-Author) Nothing to Disclose
Axel Winkel, DiplEng, Schwerin, Germany (Abstract Co-Author) Employee, Koninklijke Philips NV
PURPOSE
In the United States alone, new prostate cancer cases for 2014 were estimated at 233,000 and deaths at 29,480. Focal therapies
for low risk and intermediate risk localized prostate cancer are increasingly being explored. Our objective is to investigate the safety
and feasibility of using outpatient MR- (magnetic resonance) guided laser focal therapy for MR-visible prostate cancer utilizing a
transrectal approach for laser applicator placement and therapy delivery.
All MR-guided therapy was delivered using a 1.5T Philips Achieva XR system (Philips Healthcare, Best, The Netherlands) for both
image acquisition and real-time thermometry. Follow-up multiparametric MRI's (mpMRI) were performed on the same scanner as
were all follow-up MR-guided prostate biopsies. DynaCAD and DynaLOC (Invivo, Orlando, FL, USA) software were used for image
analysis and interventional planning. Laser therapy was delivered using a Visualase (BioTex, Houston, TX, USA) 15W 980 nm laser
applicator introduced transrectally using the DynaTRIM (Invivo, Orlando, FL, USA)
RESULTS
34 men were treated. 45 cancer foci were treated. Total procedure time was between 1.5 and 4 hours. MRI volume of coagulation
necrosis ranged from 1.2-5.0cc. No serious adverse events or morbidity were reported. 7 treatment regions were positive at 6
month biopsy, consistent with residual/recurrent cancer (23% of subjects, 15% of treated regions). 4 regions were retreated with
laser focal therapy. We observed a 35% decrease in mean PSA 1 year post-therapy and no statistically significant change is IPSS
and SHIM scores at 6 months post-treatment. 4 patients went on to whole gland therapy: 3 incidence cancer patients (2 Gleason
Score 4+4=8, 1 Gleason Score 4+3=7 multi-focal) elected radical prostatectomy (RP). No additional technical difficulty with
dissection was reported by the surgeon performing RP. 1 Gleason 3+3=6 elected proton beam therapy (PBT) before undergoing 6
month follow-up and biopsy. Incidence cancer rate was 10%.
CONCLUSION
Our data indicate that outpatient transrectally delivered MR-guided laser focal therapy for localized prostate cancer is both safe
and feasible.
In the current climate of cost-reduction and emphasis on minimally-invasive treatment of cancer, focal treatment of prostace
cancer with a precisely delivered energy source under MRI-guidance may have favorable results for cost control and quality of life.
RC207-13
Focal Therapies
Monday, Nov. 30 11:35AM - 12:00PM Location: N227
Participants
Aytekin Oto, MD, Chicago, IL, (oto@uchicago.edu) (Presenter) Research Grant, Koninklijke Philips NV; ; ;
LEARNING OBJECTIVES
1) Emerging paradigm of focal therapy for early stage low risk prostate cancer. 2) Current status of different focal therapy methods
including laser ablation, high intensity focused US, electroporation and cryotherapy. 3) Challenges in patient monitoring following
focal therapy. 4) Future developments in focal therapy of prostate cancer and the importance of radiologist's involvement.
ABSTRACT
TITLE: Image guided focal therapy of prostate cancer Focal therapy of low risk early stage prostate cancer is increasingly
important as a minimally invasive option for many patients. The rationale, patient selection criteria and challenges for image-guided
focal prostate cancer therapy will be discussed. The essential technical details, advantages and disadvantages of clinically
available focal therapy methods will be reviewed. Post-therapy patient monitoring options will be presented. Future developments in
the area of focal therapy of prostate cancer and opportunities for involvement of radiologists in focal therapy will be explored.
Honored Educators
Aytekin Oto, MD - 2013 Honored Educator
GUS-MOA
Genitourinary Monday Poster Discussions
Monday, Nov. 30 12:15PM - 12:45PM Location: GU/UR Community, Learning Center
GU
FDA
Participants
Zhen J. Wang, MD, Hillsborough, CA (Moderator) Nothing to Disclose
Sub-Events
GU210-SDMOA1
Got Stones? Utility of Kidney Graft Computed Tomography Prior to Transplantation
Station #1
Awards
Participants
Monserrat Reig Sosa, MD, Distrito Federal, Mexico (Presenter) Nothing to Disclose
Jorge David Magana, MD, Mexico, Mexico (Abstract Co-Author) Nothing to Disclose
Carlos Mendez Probst, MD, Mexico, Mexico (Abstract Co-Author) Nothing to Disclose
Jorge Vazquez-Lamadrid, MD, Mexico, Mexico (Abstract Co-Author) Nothing to Disclose
PURPOSE
To allow a complete evaluation of a cadaveric kidney graft prior to transplant To reduce the morbidity in kidney recipients caused
by donor nephrolithiasis To encourage the use of non-enhanced kidney graft CT before transplant, and provide a preventive
treatment.
Prospective non-enhanced CT Scanners (Siemens Somatom 64, Munich and GE Lightspeed VCT 64, Milwaukee) ex vivo evaluation of
cadaveric renal allograft transplants from march 2013 through march 2015 in a reference transplant medical center. The protocols
of acquisition included one phase scan with 3 mm thickness cuts and reformatting in 0.6 mm in an overall time of 2 min. After this
the scan was reviewed by a board certified radiologist evaluating the following: Presence, location, number, size and density
(measured in Hounsfield Units) of the urinary stones.
RESULTS
32 cadaveric donors where enrolled in the period of time mentioned (22 males and 8 females), providing a total of 59 kidney grafts.
Nine grafts reported stones, multiple stone disease was found in two grafts with 2 and 3 stones respectively, the latest
corresponding to one of the donors with bilateral disease The median kidney stone diameter was 2.8 mm (ED 1.03-3.74mm) with an
average density of 198.5 HU (ED 51-919 HU) Four of the nine grafts underwent back table retrograde flexible nephroscopy and
basket stone removal while under cold ischemia, three out of these were considered successful; In a single unsuccessful case, a
1.2 mm stone could not be located during the intervention, probably because of inadverted flushing The remaining five kidneys were
transplanted with a follow up CT performed 12 months after the transplantation in which four of the patients were negative for
nephrolithiasis, the fifth patient corresponding to the horseshoe kidney developed new non obstructive stones under 2 mm diameter
CONCLUSION
This data supports the use of non enhanced MDCT scan kidney graft prior to transplantation to allow an accurate screening for the
presence of nephrolithiasis, rendering a helpful diagnostic tool to prevent further complications associated with nephrolithiasis.
Prevention and oportune tratment in renal ex vivo transplants to improve outcome
GU213-SDMOA4
Detection and Characterization of Prostate Cancer with Multiparametric MRI (mpMRI): Do Learning
and Experience Matter for Diagnostic Accuracy?
Station #4
Participants
Daniele Marin, MD, Cary, NC (Abstract Co-Author) Nothing to Disclose
Bhavik N. Patel, MD,MBA, Durham, NC (Abstract Co-Author) Nothing to Disclose
Kirema Garcia-Reyes, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Kingshuk Choudhury, PhD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Lisa M. Ho, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
Tracy A. Jaffe, MD, Durham, NC (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate effect of dedicated reader education on accuracy/Gleason score estimation of index and anterior prostate cancer
(PCa) diagnosis with mpMRI in attending radiologists compared to abdominal imaging fellows.
4 blinded attending abdominal imagers with 2-16 years of experience evaluated 31 prostate mpMRIs in this IRB-approved, HIPAAcompliant, retrospective study for index lesion and anterior PCa detection (including Gleason score estimation). Following dedicated
education program, readers reinterpreted cases after a 2-4 month memory extinction period, blinded to initial reads. Reference
standard was established combining whole mount histopathology with mpMRI findings by a board-certified radiologist with 5 years of
prostate mpMRI experience. Multivariate analysis was performed to assess the effects of learning and reader experience. Results for
attending radiologists were then compared with prior reader study results in radiology fellows (using the same set of cases).
RESULTS
Index cancer detection (attending vs. fellow): pre-education accuracy 64.5% vs. 74.2%; post-education accuracy 71.8% vs.
87.7% (p=0.12 vs. p=0.003). Gleason score estimation (index): pre-education accuracy 46.8% vs. 54.8%; post-education
accuracy 57.3% vs. 73.5% (p=0.04 vs. p=0.0005). Anterior PCa detection: pre-education accuracy 46.4% vs. 54.3%; posteducation accuracy 75% vs. 94.3% (p=0.02 vs. p=0.001). Gleason score estimation (anterior): pre-education accuracy 42.9% vs.
45.7%; post-education accuracy 67.9% vs. 80% (p=0.03 vs. p=0.002). These effects were all attributable to learning and not to
reader experience based on multivariate analysis.
CONCLUSION
Accuracy of anterior PCa detection and Gleason score estimation for both index and anterior cancers significantly increased
following dedicated reader education for both attendings and fellows. In addition, accuracy for index cancers was statistically
significantly improved for fellows post-education. The degree of statistically significant improvement was higher for fellows vs.
attendings overall.
Performance in detection and characterization of PCa on mpMRI can be improved with dedicated reader education, however, it may
be that the earlier the educational intervention is done, the more significant the improvement.
GU214-SDMOA5
Pathologic Correlation between Transperineal in-bore 3-Tesla MR Imaging-Guided Prostate Biopsy
and Radical Prostatectomy
Station #5
Participants
Erik Velez, BS, San Francisco, CA (Presenter) Nothing to Disclose
Christopher B. Allard, Boston, MA (Abstract Co-Author) Nothing to Disclose
Kemal Tuncali, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Andriy Fedorov, PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Adam Kibel, Boston, MA (Abstract Co-Author) Nothing to Disclose
Clare M. Tempany-Afdhal, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the accuracy of in-bore transperineal 3-Tesla (T) magnetic resonance (MR) imaging-guided prostate biopsies for
predicting final Gleason grades among patients who underwent radical prostatectomy (RP).
We reviewed the records of 214 men who underwent transperineal MR imaging-guided biopsy (tpMRGB) from 2010-2015. All patients
received a baseline scan using 3-T multiparametric MRI (mpMR) with endorectal coil and were selected for biopsy based on findings
of a target to biopsy or having a high degree of clinical suspicion for cancer. The tpMRGB were performed in a 70-cm wide-bore 3-T
device. Patients who underwent RP within one year from biopsy were included. Descriptive statistics were performed to assess the
concordance between tpMRGB and final pathology among patients with and without previous transrectal ultrasound (TRUS)-guided
biopsies.
RESULTS
A total of 24 men underwent tpMRGB with subsequent RP within one year. At the time of biopsy median age was 65 years
(interquartile range [IQR] 11.7) and median PSA was 8.7 ng/mL (IQR 8.9). The median time between biopsy and RP was 85 days
(IQR 50.5). Final pathology revealed Gleason 3+4=7 in 12 patients, 4+3=7 in 7 patients, and 4+4=8 in 2 patients. We observed
concordance between MR biopsy and RP in 21 cases (87.5%) in terms of summed Gleason scores. Pathologic Gleason upgrading
occurred in 3 cases (12.5%), all of which had final pathologic grades of 3+4=7.16 of the 24 patients had previously undergone
TRUS biopsies, of which 6 were negative and 10 were positive for Gleason ≤6. tpMRGB revealed Gleason upgrading in 8 of the
positive TRUS biopsies, all of which were concordant with RP pathology. Among all patients with negative TRUS biopsies, MR biopsy
demonstrated evidence of cancer and was concordant with RP results in 83% of cases.
CONCLUSION
Gleason scores determined by tpMRGB at 3-T accurately correlate to final RP Gleason score. This may offer a more precise method
to diagnose and appropriately treat men with prostate cancer, especially in patients with negative or low-grade TRUS in which
clinically significant cancer is suspected.
Prostate cancer affects 1 in 7 American men. MR-guided prostate biopsies may offer a more accurate means of characterizing
prostate pathology than conventional methods.
GU215-SDMOA6
Predicting Renal Calculus Composition: Does the Plane of Imaging Matter?
Station #6
Participants
Ari J. Spiro, MD, Bronx, NY (Presenter) Nothing to Disclose
Alla M. Rozenblit, MD, Bronx, NY (Abstract Co-Author) Nothing to Disclose
David Hoenig, MD, Bronx, NY (Abstract Co-Author) Nothing to Disclose
Victoria Chernyak, MD, Bronx, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare accuracy of renal calculus attenuation values measured on axial vs coronal images in classifying stone composition.
This retrospective study included patients with nephrolithiasis who had non-contrast CT followed by percutaneous nephrolithotomy
(PCNL) and stone composition analysis. By stone composition, patients were divided into Calcium group (with Ca-oxalate
monohydrate, Ca-oxalate dehydrate, Ca-apatite calculi), and Urate group ( with urate calculi). Largest size and attenuation of
calculi were measured on coronal and axial images. Ability of maximum attenuation value measured on axial (Axial-Max) and coronal
(Cor-Max) images to classify stone composition was assessed by receiver-operator curve.
RESULTS
There were 107 calculi, 16 (14.9%) in Urate group and 91 (85.1%) in Calcium group, with mean patient ages 52.8±14.9 and
57.7±10.5 years (p=0.208), respectively. Median time intervals between CT and PCNL were 48 (IQR 31.5-76.5) and 58 (IQR 30-92)
days in Urate and Calcium groups, respectively (p=0.588). Mean calculi sizes were 19.9±9.9mm and 18.2±6.7mm in Urate and
Calcium groups, respectively (p=0.536). In Urate group, mean Axial-Max and Cor-Max were 576±162 HU and 621±184 HU (p=0.04),
respectively. In Calcium group, mean Axial-Max and Cor-Max were 1,193±317 HU and 1,299±310 HU (p=0.0001), respectively. Areas
under the curve were 0.937 (95%CI 0.89-0.99) and 0.941 (95%CI 0.89-0.99) for axial and coronal images, respectively. Axial-Max
≥670 HU has accuracy of 92.5% and LR+ of 7.5 for diagnosing calcium-containing calculi. Cor-Max≥773 HU has accuracy of 94.4%
and LR+ of 7.6 for diagnosing calcium-containing calculi.
CONCLUSION
Maximum renal calculus attenuation values on coronal images are higher than those on axial, but are equally accurate in classifying
stone composition.
We confirm that despite the slight difference in values, coronal images can be used for predicting Ca-containing stones.
UR114-EDMOA7
More Than Just a Stone: What Can be Hidden Behind a Renal Colic?
Station #7
Participants
Elena Inchausti, MBBS, Donostia, Spain (Presenter) Nothing to Disclose
Juan Vega Eraso, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
Carmen Biurrun Mancisidor, MD, Donostia, Spain (Abstract Co-Author) Nothing to Disclose
Miren Zubizarreta, Donostia, Spain (Abstract Co-Author) Nothing to Disclose
Virginia Gomez, San Sebastian, Spain (Abstract Co-Author) Nothing to Disclose
Ane Etxeberria, Donostia, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
- To understand and be concerned of the complications that can turn up from a simple renal colic. - To recognize other situations
that because of their physiopathology (identical to nephritic colic) can simulate this entity.
Epidemiology of renal colic. Physiopathology. Diagnostic imaging. We present some cases in which a simple nephritic colic developed
different complications: Impaction of the stone along the ureter with hydroureter/hydronephrosis. Spontaneous rupture of renal
pelvis(SRRP) with urinoma formation. Recurrent urinary tract infections/pyelonephritis and ureteritis.Other unusual complications
exposed are: Spontaneous renal artery dissection with renal infarction. Acute cortical necrosis. Chronic infection:
xantogranulomatous pyelonephritis. 5.Other situations mimicking renal colic are: Ureteral TBC. Primary carcinoma of the distal ureter
/renal pelvis. Retroperitoneal fibrosis affecting both ureters formig renal abcesses. Peritoneal implant causing hydronephrosis. Blood
clot into the ureter, because of a renal AVM. Calcification of suture thread in the ureter (previous renal surgery).
UR169-EDMOA8
Rare Sighting: A Review of Uncommon Renal Neoplasms and Mimics with Radiologic-Pathologic
Correlation
Station #8
Participants
Lawrence J. Bahoura, MD, Royal Oak, MI (Presenter) Nothing to Disclose
Daniel L. George, MD, Royal Oak, MI (Abstract Co-Author) Nothing to Disclose
Monisha Shetty, MD, Royal Oak, MI (Abstract Co-Author) Nothing to Disclose
Mitual B. Amin, MD, Royal Oak, MI (Abstract Co-Author) Nothing to Disclose
Syed Zafar H. Jafri, MD, Royal Oak, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Renal tumors are commonly encountered on imaging. Although the vast the majority of malignant kidney tumors are clear cell and
papillary renal cell carcinomas, there are many, much more rare neoplams, both malignant and benign, as well as mimics of neoplasm
that can be difficult to distinguish.This exhibit aims to:1. Present examples of extremely rare, pathologically proven renal neoplasms,
mostly malignant, as well as select benign entities and mimics of neoplasm.2. Highlight specific clinical and imaging features, along
with pathologic correlation, of the various rare entities to arm the radiologist with knowledge to expedite diagnosis and more
effectively guide patient care.
I. ObjectivesII. Rare Renal Neoplasms-Collecting duct carcinoma-Birt-Hogg-Dube Syndrome with chromophobe cell carcinomaSynovial sarcoma of the kidney-Mixed papillary and clear cell carcinoma-Plasmacytoma-Mixed epithelial and stromal tumor-Renal
medullary carcinoma-Capsular sarcoma-Capsular leiomyosarcoma-Mixed epithelioid malignant angiomyolipoma-Multilocular cystic
nephroma with carcinoma-Metanephric adenoma-Squamous cell carcinoma of the collecting system-Rhabdoid tumorIII. Mimics of
neoplasm-Renal sarcoidosis-Hydatid cysts-Renal splenosisIV. DiscussionV. Conclusion
GUS-MOB
Genitourinary Monday Poster Discussions
Monday, Nov. 30 12:45PM - 1:15PM Location: GU/UR Community, Learning Center
GU
FDA
Participants
Sub-Events
GU216-SDMOB1
Mini-invasive Treatment of Uterine Adenomyosis Using MRgFUS: Success Rate and MRI Imaging
Follow-up after 4 Years
Station #1
Participants
Fabiana Ferrari, MD, L'Aquila, Italy (Presenter) Nothing to Disclose
Anna Miccoli, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
Francesco Arrigoni, Coppito, Italy (Abstract Co-Author) Nothing to Disclose
Eva Fascetti, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
Giulio Mascaretti, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
Carlo Masciocchi, MD, L'Aquila, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To demonstrate the efficacy of uterine adenomyosis treatment using Magnetic Resonance imaging-Guided Focused Ultrasounds
(MRgFUS) analyzing MRI imaging and success rate after 4 years.
A total of 21 patients aged between 28 and 51, affected by uterine adenomyosis (14 focal and 7 diffuse forms) were treated in our
department with MRgFUS. We submitted the patients to the same MRI protocol, respectively before treatment and then after 1, 2
and 4 years from the treatment. We analyzed the uterine wall morphology and the possible recurrence of the disease measuring the
thickness of the junctional zone. Pre-treatment and post-treatment values were compared. Symptomatology was evaluated
through the symptom-severity-score questionnaire comparing the pre-treatment score with the one obtained after 1 and 4 years
from the treatment. Patients were submitted to one treatment alone employing the specific therapeutic plan of high-energy-gridsonication.
RESULTS
After 1 and 4 years from the treatment, 16 patients (76%) with focal adenomyosis did not present recurrence of pathology and a
good recovery of the uterine wall morphology was observed. Only 5 (24%) out of 21 patients showed a recurrence of adenomyosis
focus after 1 year and were submitted to a second treatment. After 4 years from the treatment, 16/21 patients showed thickness
of the junctional zone less then 12 mm; 5/21 had a junctional zone more then 12 mm. After 1 year from the treatment
symptomatology presented a reduction of about 80% if compared to the pre-treatment one with a progressive improvement after 4
years.
CONCLUSION
In cases of focal adenomyosis, MRgFUS permits a good resolution of symptomatology maintaining the integrity of the uterus,
without significant recurrence of the pathology. Differently, in the diffuse forms of adenomyosis, which are more difficult to be
treated, it is possible to repeat the treatment. MRgFUS allows the control of the pathology which may recur.
The MRgFUS treatment of adenomyosis permits a significant reduction of the junctional zone thickness and a good resolution of the
symptoms especially in the focal forms with the possibility to repeat the treatment in case of recurrences.
GU217-SDMOB2
Voxel-Based Whole Lesion Enhancement Parameters: A New Approach to Discriminating Clear Cell
Renal Cell Carcinoma from Renal Oncocytoma
Station #2
Participants
Frank K. Chen, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Darryl Hwang, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Mittul Gulati, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Steven Cen, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Bhushan Desai, MBBS, MS, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Felix Y. Yap, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Megha Nayyar, BA, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Inderbir Gill, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Vinay A. Duddalwar, MD, FRCR, Aberdeen, United Kingdom (Presenter) Research Grant, General Electric Company
PURPOSE
Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell cancer, and renal oncocytoma (RO) is the second
most common benign renal neoplasm after angiomyolipoma. Differentiating ccRCC from RO is often a diagnostic challenge given
similarities in epidemiology, presentation, and imaging. The purpose of our study is to evaluate the use of voxel-based whole lesion
enhancement parameters on contrast enhanced computed tomography to discriminate ccRCC from RO.
In this institutional review board-approved study, we retrospectively queried the surgical database for post nephrectomy patients
who had pathology proven ccRCC or RO and had preoperative multiphase CECT of the abdomen between June 2009 and August
2013. Preliminary evaluation of 69 patients (46 patients with ccRCC and 23 patients with RO) was performed. Multiphase CT
acquisitions were transferred to a Synapse 3D workstation, and tumor regions of interest were manually segmented. Voxel-based
contrast enhancement values were collected from the lesion segmentation and displayed as a histogram. Mean and median
enhancement, mean and median deenhancement, and histogram distribution parameters skewness, kurtosis, standard deviation, and
interquartile range were calculated for each lesion. Comparison between ccRCC and RO was made using each imaging parameter.
For enhancement and deenhancement, which had normal distribution, independent t-test was used. For histogram distribution
parameters, which did not have normal distribution, Wilcoxon rank sum test was used.
RESULTS
RO had significantly higher mean and median whole lesion enhancement (p < 0.01) on excretory phase than ccRCC while ccRCC had
significantly higher mean (p = 0.01) and median whole lesion deenhancement (p < 0.01). For histogram distribution parameters,
ccRCC had significantly higher interquartile range on arterial (p < 0.01) and excretory phases (p = 0.03), significantly higher
skewness on excretory phase (p = 0.02), and significantly higher standard deviation on arterial (p = 0.01) and nephrographic
phases (p = 0.03) compared to RO.
CONCLUSION
Preliminary results from our study suggest that voxel-based whole lesion enhancement parameters can be used as a quantitative
tool to discriminate ccRCC from RO.
While enhancement characteristics have been described to differentiate ccRCC from RO, this new method is an additional technique
to categorize these lesions.
GU218-SDMOB3
Benign Enhancing Solid Components of Mature Ovarian Teratoma : MR Imaging Features and
Pathologic Correlation
Station #3
Participants
Kyeong Ah Kim, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Hoon Jung Shin, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Chang Hee Lee, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jae Woong Choi, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yang Shin Park, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Cheol Min Park, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
Mature teratoma (MT) is one of the most common benign ovarian neoplasm, but the tumor undergoes malignant transformation in 12% of cases. Squamous cell carcinoma is the most commonly associated malignancy. Enhancing portion of MT is known as
possibility of malignant transformation on contrast enhanced MR. We recently experienced the cases of benign MT with enhancing
solid component on pelvis MR. We have had a question about enhancing solid component within MT of ovary on MR always means
malignant transformation. The purpose of this work is to evaluate the benign enhancing solid component within MT of ovary on
pelvis MR and to correlate MR findings with pathology.
We retrospectively reviewed MR findings and pathologic reports of the 126 patients (n=154 masses) with pathologically confirmed
benign and malignant ovarian teratomas who underwent pelvis MR at our institution from January 2004 to January 2015. We
identified 22 patients (n=24) who had benign enhancing solid components within MTs. MR images were reviewed for the following
characteristics: the largest diameter, appearance, and border of the enhancing solid components and presence of transmural
growth, lymphadenopathy, or metastasis. Pathologic analysis were also performed in available cases (n=13).
RESULTS
The ages of patients ranged from 6 to 68 years (mean; 28.5 years). The enhancing solid components were observed in 24 (18.8%)
of 128 MTs. The largest diameter ranged from 5.9 - 42.2 mm (mean, 18 mm). The appearance was variable. 19 (79.2%) of 24 cases
had regular borders. No cases showed transmural growth, lymphadenopathy, or metastasis. In pathologic analysis, solid components
of MT were confirmed as glial tissue (n=8), thyroid tissue (n=3), and fibrous stroma (n=2).
CONCLUSION
Enhancing solid component associated with MT of ovary is not infrequent. It does not necessarily indicate malignant transformation.
Because of the size and complexity of ovarian MTs, surgical removal is usually recommended; however, excessive surgical
intervention can be potentially avoided with an accurate diagnosis.
Enhancing solid component associated with mature teratoma of ovary on pelvis MR is not infrequent. Excessive surgical intervention
can be potentially avoided with an accurate diagnosis.
GU219-SDMOB4
Clinical Impact of Prostate Cancer Detection with Extrapolated High b-value DWI
Station #4
Participants
Jason W. Young, MD, Cincinnati, OH (Abstract Co-Author) Nothing to Disclose
Sarad Sarkar, Grass Valley, CA (Abstract Co-Author) Employee, Eigen
Rajesh Venkataraman, PhD, Grass Valley, CA (Abstract Co-Author) Employee, Eigen
Xu Yang, Grass Valley, CA (Abstract Co-Author) Nothing to Disclose
Krishnanath Gaitonde, MD, CIncinnati, OH (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the clinical impact of prostate cancer detection using acquired versus extrapolated high b-value diffusion weighted
imaging (DWI) computed using 4 diffusion models.
50 sequential patients from 2013-2015 with pathologically proven prostate cancer (CaP) were chosen for analysis. 3T
Multiparametric prostate MRI exams of the patients included one of 2 low b-value DWI protocols (b=100, 600, 1200 or b=15, 250,
800, 1200) and a high b-2000 DWI. Additionally, high b-2000 DWI was extrapolated from the lower b-value images using 4 diffusion
models - Monoexponential, IVIM, Stretched exponential and Kurtosis. All images were scored on subjective quality and readability
independently by 2 radiologists and 1 resident. Lesions were identified by consensus on all images by the 3 readers and subjectively
graded for lesion conspicuity. Lesion-to-background contrast ratios were computed for each lesion on all images. Pathological
ground truth was established using MRI-Ultrasound fusion prostate biopsy of the identified lesions. Logistic regression analysis was
conducted to compare the CaP predictive capabilities of acquired b-2000 DWI versus computed b-2000 DWI from the 4 models.
RESULTS
All extrapolated b-2000 series demonstrated unanimously higher ratings for subjective quality and readability then acquired b-2000
except the Kurtosis model (Wilcoxon Rank Test, p<0.0001). All extrapolated DWI (except Kurtosis) also demonstrated better lesion
conspicuity in a direct comparison with acquired b-2000 DWI (T-test, p < 0.0001). Mathematical computation demonstrated higher
lesion to background contrast ratio (LBCR) for all extrapolated DWI compared to acquired b-2000 DWI (ANOVA, p<0.0001). Logistic
regression analysis determined that the LBCR of extrapolated b-2000 DWI was a better predictor of CaP than the LBCR of acquired
b-2000 DWI (p-value ~ 0.05). Receiver Operator Curve (ROC) analysis demonstrated higher area under the curve for exponential b2000 DWI (72%) as compared to acquired b-2000 DWI (65%) or PSA (57%) alone
CONCLUSION
The increased lesion conspicuity of extrapolated DWI vs acquired high b-value DWI may be a major advantage in CaP detection.
The increased lesion conspicuity of extrapolated DWI vs acquired high b-value DWI may be a major advantage in CaP detection
Honored Educators
GU220-SDMOB5
Initial Application of T2* Mapping of the Uterine Fibroids in the Screening of MR-HIFU
Station #5
Participants
Ying Zhu, MD, Bejing, China (Presenter) Nothing to Disclose
Queenie Chan, PhD, Hong Kong, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
In our short-term clinical study, we extracted T2* values from T2* map to investigate that if oxygenation of the fibroids correlated
with the efficacy of sonication.
Eighteen patients with 25 uterine fibroids who received MR-HIFU treatment were included in our study. T2* mapping were achieved
when screening. All data were acquired on a 3T MRI scanner , utilizing a 32-channel phased array coil. Multi echo gradient echo
sequence was used. T2* maps of the fibroids were processed by using the post processing software in a proprietary programming
environment. The T2* values of the gluteus muscles were also measured to check the stability of the images. Funaki classification
was used to classify all fibroids into three types on T2WI as low signal intensity (SI) (type1), intermediate SI (type2), and high SI
(type3). Non-perfused volume (NPV) was measured in the contrast-enhanced images immediately after treatment. The volumes of
the whole fibroid and residual parts were also measured in the contrast-enhanced images at both post-treatment and three-month
follow-up. The residual fibroid was defined as the non-necrotic part.
RESULTS
Among the 25 treated fibroids, 12 were type1 and 13 were type2. Independent samples t-test revealed that the mean T2* value of
type 2 fibroids (31.85±7.40ms) was significantly higher than that of type 1 (25.60±5.08ms, t=-2.28, P=0.032). However there was
no significant difference between the two types in the NPV (t=0.54, P=0.60). Spearman correlation analysis showed no significant
correlation between the NPV and the T2* value (r=-0.24, P=0.24). We found the volume of residual fibroids was increasing in four
of the 25 fibroids, and their mean T2* value (37.40±6.57ms) was significantly higher than the others (27.40±5.89ms, t=-3.05,
P=0.006), and the volume change of the residual fibroid had correlation with their T2* value (r=0.499, P=0.011).
CONCLUSION
Our study showed that the oxygenation might be different in fibroids with different Funaki classification. The four fibroids with
growing residual part suggested that T2* mapping may improve the criteria for selecting uterine fibroids amenable to treatment with
MR-HIFU.
The four fibroids with growing residual part suggested that T2* mapping may improve the criteria for selecting uterine fibroids
amenable to treatment with MR-HIFU.
GU221-SDMOB6
Quantification of Renal Stone Composition in Mixed Stones Using Dual-Energy CT: A Phantom Study
Station #6
Participants
Shuai Leng, PhD, Rochester, MN (Presenter) Nothing to Disclose
Alice Huang, Madison, WI (Abstract Co-Author) Nothing to Disclose
Juan Montoya, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Xinhui Duan, PhD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
James C. Williams, PhD, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
Cynthia H. McCollough, PhD, Rochester, MN (Abstract Co-Author) Research Grant, Siemens AG
PURPOSE
To demonstrate the feasibility of using dual-energy (DE) CT to accurately quantify the percent composition of uric acid (UA) and
non-uric-acid (NUA) components of urinary stones having mixed composition.
A total of 24 renal stones were selected and analyzed with microCT to serve as the reference standard for UA and NUA
composition. These stones were then placed in 6 water phantoms with lateral widths of 30, 35, 40, 45, 50, and 55 cm to simulate
the attenuation from slim to obese adults. The stone-containing phantoms were scanned on a third-generation dual-source CT
scanner (Somatom Force, Siemens Healthcare, Germany) using dual-energy modes adaptively selected based on phantom size. The
low energy beam was set to 70, 80, 90 or 100 kV, based on patient size, and the high energy beam was consistently set to150 kV
plus a 0.6-mm tin filter. Dual energy analysis was performed using an in-house software package, in which the CT number ratio
(CTR=low-energy CT number/high-energy CT number) was calculated for each pixel of the stones. Each pixel was then classified as
UA or NUA by comparing the CTR with a single preset threshold, which was determined by finding the threshold with the lowest
root-mean-square error (RMSE) across all stones compared to the reference standard. Minimal and maximal absolute errors were
then calculated. A paired t-test was performed to compare the stone composition determined with DECT with the reference
standard of microCT.
RESULTS
Stone volume ranged from 75.3 to 319.1 mm3. Among these stones, 1 was pure UA, 1 was pure NUA, and the remaining 22 were
mixed stones, with the percentage of UA ranging from 12% to 93% and the percentage of NUA ranging from 7% to 88%. The
optimal CTR threshold ranged from 1.27 to 1.55, based on phantom size and tube potential. The RMSE was from 9.60% to 12.87%
for all phantom sizes. The minimum absolute UA errors ranged from 0.04% to 1.24%, and the maximum absolute UA errors ranged
from 22.05% to 35.46%. Paired t-tests showed no significant difference in the UA percentages estimated by DECT and microCT (p
values ranged from 0.20 to 0.96).
CONCLUSION
Accurate quantification of UA and NUA composition in mixed stones is possible using DECT.
As most urinary stones have mixed compositions, accurate quantification of the composition of mixed stones is essential for clinical
application of dual-energy CT for stone composition analysis.
UR117-EDMOB7
Renal Papillary and Calyceal Lesions on CT Urography
Station #7
Awards
Cum Laude
Participants
Satomi Kawamoto, MD, Baltimore, MD (Presenter) Research Grant, Siemens AG; ;
Sheila Sheth, MD, Cockeysville, MD (Abstract Co-Author) Nothing to Disclose
Elliot K. Fishman, MD, Owings Mills, MD (Abstract Co-Author) Research support, Siemens AG Advisory Board, Siemens AG Research
support, General Electric Company Advisory Board, General Electric Company Co-founder, HipGraphics, Inc
TEACHING POINTS
Renal papillary and calyceal lesions may cause hematuria, are occasionally encountered on CT urography, but they can be easily
overlooked. They are often not seen or subtle on unenhanced or early contrast enhanced CT, and best seen in excretory phase CT
urography. Routine use of wide window setting to view excretory phase CT is critical to detect subtle lesions in the renal papillae
and calyces. Normal anatomy and CT finding of renal papillae and calyces which should not be mistaken for pathology are also
discussed.
1. Anatomy and normal appearance of renal papillae and calyces on CT urography Simple calyx/compound calyx Anatomy and
physiology to explain the mechanism of papillary and calyceal pathology2. Papillary lesions: discuss etiology, typical and atypical
appearance on CT urography Papillary necrosis Renal tubular ectasia/medullary sponge kidney Medullary nephrocalcinosis3. Calyceal
lesions Calyceal diverticulum Small urothelial neoplasm Pyelitis Forniceal rupture - Physiologic/secondary to infection, fistula
formation4. Normal structures which potentially simulate pathology Prominent normal renal papilla which potentially simulates
abnormal filling defect Normal papillary blush
Honored Educators
Elliot K. Fishman, MD - 2012 Honored Educator
Elliot K. Fishman, MD - 2014 Honored Educator
UR173-EDMOB8
Imaging of the Postoperative Genitourinary Tract in Children and Adults
Station #8
Participants
Daniel Wannemacher, MD, Cincinnati, OH (Abstract Co-Author) Nothing to Disclose
Jason W. Young, MD, Cincinnati, OH (Abstract Co-Author) Nothing to Disclose
Chandana G. Lall, MD, Orange, CA (Abstract Co-Author) Nothing to Disclose
Sadhna Verma, MD, Cincinnati, OH (Abstract Co-Author) Nothing to Disclose
Harsha V. Nalluri, MD, Cincinnati, OH (Abstract Co-Author) Nothing to Disclose
Nabeel Arastu, MD, Cincinnati, OH (Abstract Co-Author) Nothing to Disclose
Kyle M. Lewis, MD, Cincinnati, OR (Abstract Co-Author) Nothing to Disclose
Robert E. Hobohm, MD, Cincinnati, OH (Presenter) Nothing to Disclose
TEACHING POINTS
1. Understand the normal basic genitourinary tract anatomy. 2. Overview of common and uncommon GU procedures in children and
adults and their multimodality imaging findings. 3. Discussion of complications of these procedures and multimodality imaging of
complications.
The postoperative imaging of the genitourinary tract in children and adults can be difficult to understand, as the native anatomy
often becomes distorted and unrecognizable following these procedures. Common complications of these procedures include
hydronephrosis and stricture, which can lead to renal failure and long term morbidity. This exhibit will include a discussion of various
common and uncommon non-renal GU procedures in the pediatric and adult population with example cases for illustration. These
cases include but are not limited to bladder augmentation surgery, Mitrofanoff appendicovesicostomy, Deflux procedure,
cystectomy with urostomy formation, prostatectomy, and interventional recannalization of the distal ureter
Honored Educators
Chandana G. Lall, MD - 2013 Honored Educator
MSMI23
Molecular Imaging Symposium: Oncologic MI Applications
Monday, Nov. 30 1:30PM - 3:00PM Location: S405AB
GU
MI
MR
OI
RO
FDA
Participants
Peter L. Choyke, MD, Rockville, MD, (pchoyke@nih.gov) (Moderator) Researcher, Koninklijke Philips NV Researcher, General Electric
Umar Mahmood, MD, PhD, Charlestown, MA (Moderator) Research Grant, Sabik Medical Inc; Advisory Board, Blue Earth Diagnostics
Limited;
LEARNING OBJECTIVES
1) To understand the role of molecular imaging in cancer therapy. 2) To understand the impact that new molecular imaging agents
could have on drug development. 3) To understand the barriers facing the development of new molecular imaging agents.
ABSTRACT
Molecular Imaging is expanding in many new directions. Most research is being performed for PET and SPECT agents. However,
optical and MRI agents are also being developed. Molecular Imaging can play a role in accelerating the development and approval of
new cancer therapeutics by quantifying the impact drugs have in early Phase studies and by selecting the most appropriate
patients for trials. Molecular Imaging agents can be useful in determining the utility and mechanism of actions of drugs that are
already approved and may provide insights to oncologists regarding the best treatment combinations for individual patients.
Molecular Imaging methods have already expanded our knowledge of cancer behavior and this will ultimately lead to new forms of
the therapy that will one day cure this dreaded disease.
Sub-Events
MSMI23A
Overview of MI in Oncology
Participants
Peter L. Choyke, MD, Rockville, MD, (pchoyke@nih.gov) (Presenter) Researcher, Koninklijke Philips NV Researcher, General Electric
LEARNING OBJECTIVES
1) To understand the broad spectrum of activities in molecular imaging including PET, SPECT, optical and MRI. 2) To understand the
potential impact of Molecular Imaging on cancer treatment.
ABSTRACT
Molecular Imaging is expanding at a rapid rate. This overview will provide a panoramic view of the field of Molecular Imaging and
major trends that are emerging among the different modalities, PET, SPECT, optical, ultrasound and MRI that constitute molecular
imaging.
MSMI23B
Hyperpolarized MRI of Prostate Cancer
Participants
Daniel B. Vigneron, PhD, San Francisco, CA (Presenter) Research Grant, General Electric Company
LEARNING OBJECTIVES
MSMI23C
Radiogenomics
Participants
Michael D. Kuo, MD, Los Angeles, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To discuss the principles behind radgiogenomics and to highlight areas of clinical application and future development.
ABSTRACT
MSMI23D
Somatastatin Receptor Imaging
Participants
Ronald C. Walker, MD, Nashville, TN, (ronald.walker@vanderbilt.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe the advantages of 68Ga-somatostatin PET/CT over 111In-DTPA-octreotide ]imaging. 2) Detect patients likely to benefit
1) Describe the advantages of 68Ga-somatostatin PET/CT over 111In-DTPA-octreotide ]imaging. 2) Detect patients likely to benefit
from peptide receptor radiotherapy (PRRT).
ABSTRACT
68Ga-labeled somatostatin analogs (DOTATATE, DOTATOC and DOTANOC) PET/CT imaging provides higher resolution scans than
111In-DTPA-octreotide with less radiation, comparable cost, and imaging completion within 2 hours vs. 2-3 days. 68Gasomatostatin analogs have a higher impact on care than 111In-DTPA-octreotide, including superior ability to identify patients likely
to benefit from PRRT. This activity will provide results from the literature and the author's experience to illustrate the advantages of
68Ga-based PET/CT imaging of neuroendocrine tumors.
Active Handout:Ronald Clark Walker
http://abstract.rsna.org/uploads/2015/15003715/MSMI23D.pdf
MSMI23E
Multimodal MI in Oncology
Participants
Umar Mahmood, MD, PhD, Charlestown, MA (Presenter) Research Grant, Sabik Medical Inc; Advisory Board, Blue Earth Diagnostics
Limited;
LEARNING OBJECTIVES
1) To understand strengths of various imaging modalities for specific target/disease assessment.
ABSTRACT
Each imaging modality has a set of characteristics that helps define optimal use. These constraints include sensitivity, depth of
imaging, integration time for signal, and radiation dose, among other factors. Understanding when each modality can be used and
when combining the relative strengths of differerent modalities can be synergistic allows greater molecular information to be
acquired.
MSRO23
BOOST: Gynecology-Case-based Review (An Interactive Session)
Monday, Nov. 30 3:00PM - 4:15PM Location: S103AB
GU
RO
Participants
Kevin V. Albuquerque, MD, MS, Dallas, TX, (kevin.albuquerque@utsouthwestern.edu) (Presenter) Nothing to Disclose
April A. Bailey, MD, Dallas, TX (Presenter) Nothing to Disclose
Stephen Thomas, MD, Chicago, IL (Presenter) Nothing to Disclose
Yasmin Hasan, MD, Chicago, IL (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Present the multimodality management of selected gynecolgic cancers including surgery, radiation and chemotherapy. 2)
Highlight the importance of imaging in the diagnosis and followup of gynecologic cancers. 3) Highlight the importance of imaging in
the planning and delivery of radiation.
ABSTRACT
The care of patients with gynecologic cancers requires the collaboration of imaging specialists as well as gynecologic and radiation
oncologists. Radiologic imaging is key in defining disease at diagnosis and following patients for detection of recurrence after
treatment. In conjunction with computerised planning , sectional imaging allows for sophisticated planning of external beam and
brachytherapy and is key in maximizing the benefits of radiation while minimizing the risks. Case examples of the pivotal impact of
imaging and its importance in multidisciplinary care will be highlighted in this session
SSE10
ISP: Genitourinary (GU Intervention)
Monday, Nov. 30 3:00PM - 4:00PM Location: E351
GU
CT
IR
MR
FDA
Participants
Douglas S. Katz, MD, Mineola, NY (Moderator) Nothing to Disclose
Cary L. Siegel, MD, Saint Louis, MO (Moderator) Nothing to Disclose
Sub-Events
SSE10-01
Genitourinary Keynote Speaker: Renal Tumor Ablation-Current Status and Future Directions
Participants
Ronald J. Zagoria, MD, San Francisco, CA (Presenter) Nothing to Disclose
SSE10-02
Real-time MR-guided Renal Cryoablation: Technical Feasibility, Complications and Outcomes
Participants
Georgia Tsoumakidou, MD, Strasbourg, France (Presenter) Nothing to Disclose
Herve Lang, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Guillaume Koch, MD,MSc, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Julien Garnon, MD, Strasbourg, France (Abstract Co-Author) Proctor, Galil Medical Ltd
Xavier Buy, MD, Bordeaux, France (Abstract Co-Author) Proctor, Galil Medical Ltd
Afshin Gangi, MD, PhD, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
At present, major improvements in device development, as well as modern special designed MR-suites (with MR-compatible life
support and anesthesia equipment) have made the performance of MR-guided percutaneous procedures not only feasible, but also
attractive. We retrospectively reviewed our single institution experience with percutaneous MR-guided cryoablation of renal
tumours for technical feasibility, complications and outcomes (oncologic, renal function).
Between April 2009 and March 2015, 68 patients underwent percutaneous MR-guided renal cryoablation. All procedures were
performed in an MR-interventional unit, using a 1.5T large bore, supra-conductive system. Real-time BEAT IRTTT (3-simultaneousplane sequence) and high-resolution T2-Blade/HASTE sequences were used for probe positioning and ice-ball monitoring.
RESULTS
A total of 79 lesions in 68 patients were treated. Four patients were excluded because of less than 3 month follow-up. Twenty-one
patients had a history of renal cancer (15 and 2 treated with total and partial nephrectomy, respectively, 4 with cryoablation).
Mean maximal tumour diameter was 22mm (min 5, max 42). Biopsy results were available in 61 patients.Procedure related data
(time, number-type of cryoprobes, ice ball size) were collected. Two freeze-thaw cycles were systematically performed.
Hydrodissection was used in 37 patients.All procedures were technically successful. Local recurrent tumour was identified in six
patients during the first six months of imaging follow-up. The local primary tumour control rate was 92%. One patient developed a
late local recurrence at 3 years follow-up. Five out of six early and the late recurrence were treated percutaneously. Peri-operative
major complication rate was 4.6% (one active bleeding necessitating embolization, one asymptomatic subcapsular hematoma, and
one urothelial damage treated with ureteric catheter insertion). There was no procedural related death. Mean follow-up was 18 (370) months.
CONCLUSION
Percutaneous renal cryoablation can be performed with high technical and clinical success under MR-guidance. The real-time probe
placement, high soft tissue contrast, multi-planar imaging, and the lack of ionizing radiation are some of the advantages of MR vs
the CT-guidance.
Percutaneous cryoablation of T1a renal tumours can be perfromed safely and with high tecnical sucesss under MR-guidance.
SSE10-03
Single Institution Review of Percutaneous Cryoablation in the Horseshoe Kidney: An Initial
Experience
Participants
Junjian Huang, MD, Rochester, MN (Presenter) Nothing to Disclose
Thomas D. Atwell, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Anil N. Kurup, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Stephen Boorjian, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Robert Thompson, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Grant D. Schmit, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
PURPOSE
To present the initial case series of percutaneous cryoablation of tumors in a horseshoe kidney.
This is a single center retrospective review of 5 consecutive patients with a renal mass in a horseshoe kidney treated with
percutaneous image-guided cryoablation from June of 2006 to August of 2013. Patient and tumor characteristics were extracted
from the electronic medical record. Oncologic outcomes were defined using standardized criteria.
RESULTS
Average age of patient was 59 years old(4M, 1F), tumor size was 3cm(±1cm), and serum creatinine was 1.1±0.4. Of the 5 patients,
4 patients had biopsy proven clear cell renal cell carcinoma, and 1 patient had biopsy proven carcinoid. Technical success was
achieved in all patients. The median follow-up duration is 19 months. There were no major complications. Transient elevation of
creatinine, not requiring dialysis, occurred following treatment in one patient which has since normalized to baseline. A single
patient had inguinal nerve pain that resolved within 3 months. Mean creatinine at follow-up was 1.1±0.3. All patients remain free of
local tumor progression. Two patients expired 46 months and 24 months after ablation due to unrelated disease.
CONCLUSION
There is a paucity of data with regard to the safety, efficacy, and long term outcome of percutaneous cryoablation in the
horseshoe kidney. From our initial series it seems that cryoablation is relatively safe in the treatment of small renal tumors, without
impact on renal function. This is the first reported series of cryoablation in the horseshoe kidney and, in select patients, may
present an alternative to surgical management.
Percutaneous cryoablation represents an alternative treatment modality in patients with a small renal mass on a horseshoe kidney.
SSE10-04
Placement of Essure Tubal Occlusion Coils by Fluoroscopy; An Option when Hysteroscopic Placement
Fails
Participants
Amy S. Thurmond, MD, Portland, OR (Presenter) Nothing to Disclose
PURPOSE
Nonsurgical tubal occlusion by Essure coils was FDA (Food and Drug Administration) approved in 2002 for hysteroscopic placement
by gynecologists. Occasionally hysteroscopic placement of one or both coils is not possible--or the coil perforates or is expelled
from the tube. Fluoroscopic fallopian tube catheterization has been used since 1987 as a nonsurgical method for unblocking proximal
tubal occlusion in women with infertility. The feasability of fluoroscopic fallopian tube catheterization for placement of Essure coils
was explored.
Women were referred by their gynecologists because of complications after hysteroscopic placement of the Essure device. No premedication, sedation, or anesthesia was given. Commercially available equipment was used to perform hysterosalpingogram,
fallopian tube catheterization, and Essure placement. Equipment consisted of a 9 Fr balloon catheter for use in the cervix and
uterus (Cook Medical), a 5 Fr catheter and 0.035 inch diameter hydrophilic guidewire for use in the fallopian tube (Cook Medical),
and the Essure device and delivery system (Bayer Pharmaceutical).
RESULTS
Twelve women had attempt at fluoroscopic Essure placement in 14 tubes. Procedure was successful in 12/14 tubes (86%),
including 5 tubes where hysteroscopic placement had failed, 2 tubes where hysteroscopic placement resulted in perforation, 3
tubes in which device was expelled after hysteroscopic placement, and 2 tubes with hydrosalpinx. Fluoroscopic placement failed in
2 tubes, in one because of severe tubal spasm which was also the reason for hysteroscopic failure, and in one tube (in which
device had been expelled) because of pain during the procedure attributed to severe endometriosis.There were no complications.Six
women have had post-procedure confirmation hysterosalpingograms required by the FDA and all 6 tubes with devices placed
fluoroscopically were occluded (100%).
CONCLUSION
Ten of 12 high risk women (83%) who had failed Essure placement by hysteroscopy on one or both sides had subsequent
successful fluosocopic procedures allowing them to rely on the Essure devices for tubal occlusion. Twelve of 14 tubes (86%) were
amenable to fluoroscopic placement of the Essure device.
Ten of 12 women (83%) who would have been considered Essure failures and referred for tubal ligation, were converted to Essure
successes by fluoroscopic placement of the device.
SSE10-05
Percutaneous Embolization of Varicocele By Steel and Platinum Coils
Participants
Syed Muhammad Faiq, MBBS, Karachi, Pakistan (Presenter) Nothing to Disclose
Khair Muhammad, MBBS, Karachi, Pakistan (Abstract Co-Author) Nothing to Disclose
Waseem A. Mirza, MBBS, Karachi, Pakistan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The goal of this study was to present our experience with percutaneous treatment of male varicocele in view of procedural, clinical
aspects in adult population.
45 male with clinical moderate to severe varicocele associated with scrotal swelling with "bag of worms" or discomfort in testes,
such as heaviness or dull pain after standing all day, referred from urology outpatient department to Radiology Department, where
Doppler ultrasound was done which confirms the grade and patient underwent percutaneous varicocele embolization with coil.
RESULTS
The procedural success rate for spermatic vein occlusion was 93%. Follow-up, achieved of every patient after 6 month in urology
outpatient department. Forty two patients (93%) reported disappearance of varicocele and as well as pain relief. In two patients
percutaneous embolization procedure failed due to internal jugular vein approach and congenital venous abnormality. None of
patients reported a reappearance of their varicocele. No significant complications occurred in 42 patients except pain in two
patients and hematoma in two patients at femoral punctured site: none had any 6 months sequelae
CONCLUSION
Percutaneous embolization of varicocele carried out as outpatient procedure under local anesthesia and is more beneficial to patient
in comparison to surgery. It has high procedural success rates, less recurrence rate, when performed by experience interventional
radiologist. We believed primary therapy for varicocele treatment should be embolization if we compared various risk factors
associated with surgery.
Procedural and clinical success in elimination of varicocele by steel or platinum coils with low rate of failure and reappearance up to
6 month. High failure rate was seen in our study through internal jugular vein approach for venous access. We believed primary
therapy for varicocele treatment should be embolization if we compared various risk factors associated with surgery.
SSE10-06
Hysterosalpingo-foam Sonography (HyFoSy): A Prospective Observational Cohort Study of an
Innovative, Radiation Free, Safe and Effective, Non(Embryo) Toxic Technique, to Visualize Tubal
Patency in an Outpatient / Office Setting
Participants
Anurag Singh, MBBS,MD, Sharjah, United Arab Emirates (Presenter) Nothing to Disclose
Tejashree Singh, Dubai, United Arab Emirates (Abstract Co-Author) Nothing to Disclose
Kiran C. Patil JR, MD, Jalgaon, India (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study was conducted to evaluate the efficacy and safety of HyFoSy as a first step routine office procedure for tubal patency
testing.
A prospective observational cohort study was conducted in a medical center from 26/11/2014 - 4/4/2015. 46 patients with
subfertility were examined. The mean age of patients was 31 years. The mean duration of subfertility was 2.2 years. The patients
were asked to report for the test, on days 7-9 of their menstrual cycle. All patients were at low risk for tubal disease and had no
history of tubal surgery. A non(embryo) toxic foam was created by rigorously mixing 10 ml hydroxymethylcellulose glycerol gel
(88.25% water) with 10 ml purified water to give a mixture containing 94.10% water in a 20 ml syringe, and was introduced into the
uterine cavity with the help of a disposable 5F single balloon catheter. This foam had low viscosity and was sufficiently stable to
show echogenicity for at least 5 minutes. Tubal patency was determined by transvaginal ultrasound demonstration of echogenic
dispersion of foam through the Fallopian tubes and the peritoneal spillage. The tubal contour, length and relation of spill with
respect to ipsilateral ovary, were also noted. The pain score was calculated. No precautions with regard to pregnancy were
advised.
RESULTS
In 45/46 (98%) patients (except 1 case of cervical stenosis), a successful procedure was performed. In these cases, there was no
further need for a hysterosalpingogram (HSG). 42 patients (94%) had bilateral patent tubes and 3 patients (6%) had unilateral
patent tubes. Only 1 patient (1/45; 2%) had mild vasovagal discomfort during the procedure that resolved spontaneously. The
average pain score was 2.2. All procedures were uneventful and no serious side-effects were observed. Furthermore, in 10 patients
(22%) conception occurred within a median of 3 months after the procedure. Review of literature found our results comparable with
other similar studies.
CONCLUSION
Thus, HyFoSy is a successful, less painful and radiatian free technique, easily performed in an office setting as a first step test for
tubal patency.Comparison with other tubal patency tests was done as per the literature evaluation and our old experiences. It
showed excellent findings in favor of HyFoSy.
HyFoSy is a radiation free, less painful, non(embryo) toxic, effective alternative to HSG and definitely has a potential to be the new
generation patient friendly first step office test for tubal patency.
SSE11
Genitourinary (Renal Stone Imaging)
Monday, Nov. 30 3:00PM - 4:00PM Location: E353B
CT
GU
MR
FDA
Participants
Naoki Takahashi, MD, Rochester, MN (Moderator) Nothing to Disclose
Sub-Events
SSE11-01
In Vitro Imaging of Kidney Stones in Pig Kidneys Using Ultra-short Echo-time (UTE) MRI
Participants
El-Sayed H. Ibrahim, PhD, MSc, Ann Arbor, MI (Presenter) Nothing to Disclose
Robert A. Pooley, PhD, Jacksonville, FL (Abstract Co-Author) Nothing to Disclose
Joseph G. Cernigliaro, MD, Jacksonville, FL (Abstract Co-Author) Nothing to Disclose
Mellena D. Bridges, MD, Jacksonville, FL (Abstract Co-Author) Nothing to Disclose
Jamie G. Giesbrandt, MD, Jacksonville, FL (Abstract Co-Author) Nothing to Disclose
James C. Williams, PhD, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
William E. Haley, MD, Jacksonville, FL (Abstract Co-Author) Nothing to Disclose
PURPOSE
Ultra-short echo-time (UTE) MRI provides echo times (TE) in the range of tens of microseconds, which allows for effective imaging
of tissues that have rapid signal decay, e.g., kidney stones. In this study, we investigate the imaging performance of UTE MRI for
stones embedded within their usual milieu, the kidney, thus mimicking the in vivo situation.
24 kidney stones passed/extracted from patients were obtained. The stones represented 8 different types (confirmed by micro CT):
calcium oxalate monohydrate (COM), calcium oxalate dehydrate (COD), brushite, apatite, uric acid (UA), struvite, cystine, and
mixed-composition. Each stone type was represented by 3 stones in a range of sizes: small (2-3 mm), medium (4-6 mm), and large
(7-10 mm). A total of 8 pig kidneys, purchased from a local meat store, were used in the experiments. Using small cuts, three
stones (large, medium, and small) of the same type were inserted into each kidney, each into a different calyx (Fig 1a). The
kidneys were arranged in a small plastic container filled with water and covered with a sealed lid (Fig 1b), and then imaged on a
Siemens 3T MRI scanner using an 18-channel body surface coil and an optimized 3D UTE pulse sequence.
RESULTS
All stones were successfully visualized. The resulting images clearly showed the stones' shapes with high resolution (Fig 1c).
Although efforts were made to expunge air bubbles throughout the pre-scan process, air gaps still existed inside some of the
kidneys, which resulted in some artifacts. Using the body surface coil and large FOV did not adversely affect stone visualization,
which is promising for future in vivo imaging.
CONCLUSION
This study confirms the potential of MRI for in vitro imaging of stones in kidneys using the body surface coil, which is one step
closer to in vivo imaging than phantom experiments with head or knee coils. If successful for true in vivo imaging, the UTE
technique could serve as an alternative to CT for imaging patients for whom minimization of radiation exposure is desirable. The
sequence could be also added to abdominal MRI protocols for comprehensive evaluation of the genitourinary system.
Although CT is the modality of choice for imaging kidney stones, UTE MRI may provide an effective alternative when there are
concerns about radiation exposure.
SSE11-02
Low-dose Abdominal Computed Tomography for Urinary Stone Disease - Impact of Additional
Spectral Shaping on Image Quality and Dosage
Participants
Patricia Dewes, MD, Frankfurt, Germany (Presenter) Nothing to Disclose
Claudia Frellesen, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Jan-Erik Scholtz, MD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Sebastian Fischer, MD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Thomas J. Vogl, MD, PhD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Ralf W. Bauer, MD, Frankfurt, Germany (Abstract Co-Author) Research Consultant, Siemens AG Speakers Bureau, Siemens AG
Boris Schulz, MD, Frankfurt Am Main, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate a novel tin filter based abdominal CT technique for urolithiasis in terms of image quality and radiation exposure.
130 consecutive patients with suspected urolithiasis underwent non-enhanced CT in our department with various techniques: 48
patients were examined with a novel tin filtration (150kV Sn) method (group 1) on a third-generation dual-source-CT, 33 patients
were examined with automated kV-selection (80-140kV) based on the scout view with the same CT-device (group 2) and 49
patients were examined on a second-generation dual-source-CT (group 3) also with automated kV-selection (80-140kV) based on
the scout view. Automated exposure control was active in all groups. Image quality was subjectively evaluated on a 5-point-likertscale by two radiologists and interobserver agreement as well as signal-to-noise-ratio (SNR) was calculated. Dose-Length-Product
(DLP) and volume based CT weighted Dose Index (CTDIvol) were used to analyze radiation exposure.
RESULTS
Image quality was rated in favour for the tin filter protocol with an excellent interobserver agreement (ICC=0.86-0.91). SNR was
significantly better in group 1 and 2 compared to second-generation DSCT (p<0.001). On third-generation dual-source CT, there
was no significant difference in SNR between the 150 kV Sn and the CAREkV protocol (p=0.5). DLP of group 1 was significantly
lower in comparison to group 2 and 3 by 23% and 27% (93 vs. 122 vs. 127mGycm; p<0.002). CTDIvol of group 1 was significant
lower compared to group 2 (-36%) and 3 (-32%) (1.95 vs. 3.09 vs. 2.87 mGy; p<0.001).
CONCLUSION
Additional shaping of a 150kV spectrum by a tin filter substantially lowers patient exposure while improving image quality on
abdominal Computed Tomography for urinary stone disease.
The novel tin filtered technique reduces radiation exposure and improves image quality in comparison to standard low- dose
abdominal CT, thus serving to benefit the patient.
SSE11-03
Predictive Value of Low Dose and Dual-Energy CT for Successful Stone Disintegration in Shock Wave
Lithotripsy: An in-Vitro Study
Participants
Sebastian Winklhofer, MD, San Francisco, CA (Presenter) Nothing to Disclose
Largo Remo, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Christian Fankhauser, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Cedric Poyet, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Pirmin Wolfsgruber, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Tullio Sulser, MD, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Hatem Alkadhi, MD, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Paul Stolzmann, MD, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
PURPOSE
Shock wave lithotripsy (SWL) represents the golden treatment for urinary stone disease. Failure of stone disintegration results in
repeated treatments or alternative procedures, thereby not only increasing medical costs. The ability to predict successful SWL will
improve the selection of patients suitable for SWL. This study investigates single energy computed tomography (SECT) and dualenergy computed tomography (DECT) to predict numbers of shock waves to stone disintegration in an in-vitro setting.
A total of 33 human urinary calculi (10 uric acid, 8 hydroxyapatite, 6 calcium oxalate monohydrate, 5 cysteine, 3 struvite, 1
brushite stones, mean size 6±3 mm) were scanned using a 128-slice DECT machine (Somatom Force, Siemens Healthcare,
Forchheim, Germany) with single- (120kVp) and dual-energy settings (80/150, 100/150kVp) resulting in 6 different SECT and DECT
data sets. Calculi were disintegrated using an electromagnetic Dornier DL50 lithotrypter (Dornier MedTech, Wessling, Germany) over
a 2-mm mesh until succesful disintegration.
RESULTS
All stones were successfully disintegrated by applying a median of 72 shock waves (interquartile range 343). Regarding logistic
regression analysis, CT numbers significantly (p<0.01) predicted fewer or more than median shock waves to successful
disintegration and differed among data sets (p<0.05), both adjusted for stone composition (p<0.001) and size (p<0.001).
Correlation coefficients ranged from rho=0.36 to 0.68 with best correlation for CT numbers and shock waves at 80 kVp (p<0.001).
CONCLUSION
Lower CT numbers are significantly associated with fewer shockwaves needed which is independent of stone composition and size.
Optimal prediction of SWL success may be fascilated on the basis low-dose CT data which is paralleled by a low radiation dose.
Being able to predict the success of shock wave lithotripsy with low-dose computed tomography would be helpful to determine the
optimal management in patients with urinary calculi.
SSE11-04
Feasibility of Split-filter Dual-energy CT for in-Vitro Differentiation of Urinary Stones by Using Doseneutral (Compared with Single-energy CT) Protocol
Participants
Anushri Parakh, MBBS,MD, Basel, Switzerland (Presenter) Nothing to Disclose
Daniel Boll, Basel, Switzerland (Abstract Co-Author) Nothing to Disclose
Andre Euler, MD, Basel, Switzerland (Abstract Co-Author) Nothing to Disclose
Caroline Zahringer, Basel, Switzerland (Abstract Co-Author) Nothing to Disclose
Fabian Morsbach, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Daniel Mueller, Zurich, Switzerland (Abstract Co-Author) Nothing to Disclose
Geraldine Stadelmann, Basel, Switzerland (Abstract Co-Author) Nothing to Disclose
Sebastian T. Schindera, MD, Basel, Switzerland (Abstract Co-Author) Research Grant, Siemens AG; Research Grant, Ulrich GmbH &
Co KG; Research Grant, Bayer AG
PURPOSE
The study aimed to examine the efficacy of a novel split-filter (using gold and tin filters) single-source dual-energy CT (sf-DECT) in
characterizing renal stones as compared to second-generation dual-source dual-energy CT (ds-DECT) in intermediate-sized
phantoms using vendor-suggested and dose-neutral (to single-energy CT) protocols.
Urinary stones (n=65, size: 2.1-6.4mm) of known chemical composition (15 calcium, 15 struvite, 15 cystine and 20 urate) were
embedded in a custom-made kidney model and placed in a 30-cm cylindrical water-containing phantom simulating a medium-sized
patient. Scans with vendor-recommended and dose-neutral protocols were performed on ds-DECT (SOMATOM Definition Flash,
Siemens; protocol A (vendor-suggested) tube A, 100kVp, 210 reference mAs; tube B, Sn140kVp, 162 reference mAs; protocol B
(dose-neutral) tube A, 100kVp, 65 reference mAs; tube B, Sn140kVp, 50 reference mAs) and sf-DECT (SOMATOM Definition Edge,
Siemens; protocol C (vendor-suggested) AuSn 120kVp, 640 reference mAs; protocol D (dose-neutral) AuSn 120kVp, 235 reference
mAs). Stones were assessed by a dedicated post-processing software. Positive (PPV) and negative (NPV) predictive values were
calculated. A comparison of radiation doses between both dual-energy techniques was made using CTDIvol parameter.
RESULTS
The CTDIvol (in mGy) for protocols A to D measured 13.7, 4.3, 11.2 and 4.4 respectively. Presence of all stones was detected by
the four protocols. The PPV of protocols A-D to characterize urate stones were 95.2, 95.2, 94.1 and 58.6 and for non-urate stones
were 100, 100, 93.6 and 96.9, respectively. For clinically significant stones (>4 mm), the PPV for characterizing urate or non-urate
stones (100 for both) by protocols A and B was not affected. For the same stone size, PPV of protocols C vs. D were 100 vs 76.9
for urate and 96.4 vs. 96.0 for non urate stones. Dose-neutral sf-DECT was particularly inferior to ds-DECT in characterizing urate
stones and stones which were less than 4 mm.
CONCLUSION
While dose-optimization is feasible in differentiation of urate from non-urate stones by ds-DECT for smaller stones, it is accurate for
sf-DECT if they are greater than 4 mm in size.
Sf-DECT is a promising new tool for dual-energy evaluation with a benefit of reduced radiation dose as compared to secondgeneration dual-energy technique.
SSE11-05
Virtual Non-enhanced Images Generated from Spectral CT: Determinants of Detection of Urinary
Calculi in the Renal Collecting System
Participants
Yan Chen, Zhengzhou, China (Presenter) Nothing to Disclose
Peijie Lv, MMed, Zhengzhou, China (Abstract Co-Author) Nothing to Disclose
Jianbo Gao, MD, Zhengzhou, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To determine which features of urinary calculi are associated with their detection on VNE images generated from Spectral computed
tomograpic(CT) urography.
This retrospective study was approved by the insititutional ethics committee with waiver of informer consent.A total of53 patients
were examined with true nonenhanced (TNE) CT and Spectral CT urography in the excretory phase. Thecontrast medium was
virtually removed from excretory-phase images by using material suppressed iodine(MSI),water-based (WB) and calcium-based
(CaB) material decomposition (MD) analysis in the spectral imaging viewer.Thesensitivity regarding the detection of calculi on these
three groups and the subjective scoring were determined byusing true non-enhanced (TNE) images as the reference standard , and
interrater agreement was evaluated byusing the Cohen k test.By using logistic regression, the influences of image noise,
attenuation, and stone size, as well as attenuation of the contrast medium, on the stone detection rate were assessed on VNE
images.
RESULTS
169 stones were detected on the TNE images;149 stones were identified on CaB images (sensitivity,88.2%),145 stoneson WB
images(sensitivity, 85.7%),whlie 160 stones on MSI images(sensitivity,94.6%) with significant difference.Compared with the TNE
images,the relatively lower subjective scoring of the VNE images (P>0.05) and higher SNR,CNR(P<0.05)were identified. Size (longaxis diameter and short-axis diameter), and attenuation of the calculi,except for the image noise were significantly associated with
the detection rate on VNE images (P<0.05). As thresholdvalues on CaB, WB, MSI images, size larger than 2.68 mm , 3.01mm ,
2.03mm,maximum attenuation of the calculigreater than 223 HU, 312HU and 203HU respectively were found.
CONCLUSION
After virtual elimination of contrast medium with material decomposition and MSI, large and high-attenuation calculi can be
detected with high reliability.
VNE images generated at excretory-phase Spectral CT can depict calculi larger than 2.03mm in the presence ofcontrast medium;
however, small and hypoattenuating calculi may be missed.
SSE11-06
Improved Differentiation between Uric Acid and Non-uric Acid Renal Stones Using DECT
Monoenergetic Imaging
Participants
Fabio Lombardo, MD, Verona, Italy (Presenter) Nothing to Disclose
Matteo Bonatti, MD, Bolzano, Italy (Abstract Co-Author) Nothing to Disclose
Giulia A. Zamboni, MD, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Federica Ferro, Bolzano, Italy (Abstract Co-Author) Nothing to Disclose
Roberto Pozzi Mucelli, Verona, Italy (Abstract Co-Author) Nothing to Disclose
Giampietro Bonatti, Bolzano, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate monoenergetic attenuation values of renal stones for discriminating between uric acid and non-uric acid stones.
IRB-approved retrospective study; need for informed consent was waived. We included in our study 37 patients (23M, 14F; mean
age 54y) who underwent CT for symptomatic urolithiasis on our second-generation dual-source scanner. We performed a 120kV
single-energy low-dose acquisition of the whole abdomen followed by one or more 100/140kV dual-energy acquisitions limited to the
regions in which one or more stones were detected. All patients subsequently underwent stone extraction or they spontaneously
expelled the stone within 1 month from the examination; all the obtained stones were analyzed by means of infrared spectroscopy
and classified, according to their prevalent composition, as uric acid or non-uric acid stones. When patients had >1 stone, their
composition was considered the same for all the stones. Stones largest diameter was noted. One radiologist in training evaluated by
means of a round ROI the monoenergetic attenuation values of the stones from 40 to 190 kV. 40/190kV monoenergetic attenuation
ratios were calculated. A qualitative analysis on the monoenergetic curves was also performed.
RESULTS
75 stones were detected in 37 patients; 36 stones were located in the urinary calices, 13 in the renal pelvis, 25 in the ureters and
1 in the urinary bladder. Mean diameter was 6.1 mm (range 2-28 mm). At spectroscopy, 16/75 stones were prevalently composed
by uric acid and 59/75 by cysteine or calcium oxalates/phosphates. Mean 40/190kV monoenergetic attenuation ratios were 0.82 for
uric-acid stones (range 0.30-1.34) and 3.82 for non-uric acid stones (range 2.18-7.35)(p<0.0001). All uric-acid stones were
correctly characterized using a cut-off of 1.5. Qualitative analysis of monoenergetic curves showed a different and easily
recognizable shape both for uric acid and non-uric acid stones.
CONCLUSION
40/190 kV attenuation ratios accurately differentiate uric acid from non-uric acid stones. Furthermore, qualitative analysis of
monoenergetic curves can be an easy method to rapidly assess stone composition.
40/190 kV monoenergetic attenuation ratio accurately predicts renal stone composition, even in small calculi, leading to a more
accurate treatment planning.
ED006-TU
Genitourinary Tuesday Case of the Day
Tuesday, Dec. 1 7:00AM - 11:59PM Location: Case of Day, Learning Center
GU
Participants
Akira Kawashima, MD, PhD, Phoenix, AZ (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Honored Educators
SPSC30
Controversy Session: Gadolinium Contrast Agents and Adverse Effects: Too Much Attention or Too Little?
Tuesday, Dec. 1 7:15AM - 8:15AM Location: E451A
GU
MR
SQ
FDA
Participants
Hero K. Hussain, MD, Ann Arbor, MI (Moderator) Nothing to Disclose
Emanuel Kanal, MD, Pittsburgh, PA (Presenter) Consultant, Boston Scientific Corporation; Consultant, Medtronic, Inc; Consultant,
St. Jude Medical, Inc; Consultant, Bayer AG; Investigator, Bracco Group; Royalties, Guerbet SA;
Martin R. Prince, MD, PhD, New York, NY, (map2008@med.cornell.edu) (Presenter) Patent agreement, General Electric Company;
Patent agreement, Hitachi, Ltd; Patent agreement, Siemens AG; Patent agreement, Toshiba Corporation; Patent agreement,
Koninklijke Philips NV; Patent agreement, Nemoto Kyorindo Co, Ltd; Patent agreement, Bayer AG; Patent agreement, Lantheus
Medical Imaging, Inc; Patent agreement, Bracco Group; Patent agreement, Medtronic, Inc; Patent agreement, Topspins, Inc;
Stockholder, Topspins, Inc
Richard H. Cohan, MD, Ann Arbor, MI, (rcohan@umich.edu) (Presenter) Consultant, General Electric Company; ; ;
Matthew S. Davenport, MD, Cincinnati, OH, (matdaven@med.umich.edu) (Presenter) Book contract, Wolters Kluwer nv; Book
contract, Reed Elsevier;
LEARNING OBJECTIVES
1) To discuss associations of gadolinium based contrast agents (GBCA) and Nephrogenic Systemic Fibrosis (NSF). 2) To review
rates and types of acute adverse reactions in patients receiving GBCA, and to place those in perspective with respect to the risk of
NSF. 3) To discuss several other potential safety factors about GBCA, and to compare and contrast incidence of new potential
safety factors among the various CNS-approved GBCA. 4) To explain the current thinking regarding imaging patients with renal
impairment, and to define renal function thresholds that might be useful for operationalizing imaging in this patient population.
ABSTRACT
To review associations of gadolinium based contrast agents (GBCA) and Nephrogenic Systemic Fibrosis (NSF), and discuss current
practice patterns that led to almost complete elimination of NSF. Speaker: Martin Prince.To review rates and types of acute
adverse reactions in patients receiving GBCA, discuss principles of premedication and treatment, and place the acute adverse
reaction rate in perspective with respect to the risk of NSF. Speaker: Richard Cohan. To list and integrate several other potential
safety factors about GBCA, other than NSF and acute allergic type, into the clinical decision making process about whether or not
to administer GBCA, and to compare and contrast incidence of new potential safety factors among the various CNS-approved GBCA
available today. Speaker: Emanuel Kanal. To explain the current thinking regarding imaging patients with renal impairment, to
highlight the differences that exist between serum creatinine-based and eGFR-based screening, and to define the ranges of renal
function thresholds for which caution might be advised to avoid potential harm that might result from the administration of iodinated
and gadolinium-based contrast media. Speaker: Matthew Davenport.
URL
RC307
GU Incidental Findings 2015 - What Is New and Helpful in Managing Them? (An Interactive Session)
Tuesday, Dec. 1 8:30AM - 10:00AM Location: E450B
GU
Participants
Lincoln L. Berland, MD, Birmingham, AL, (lberland@uabmc.edu) (Coordinator) Consultant, Nuance Communications, Inc; Stockholder,
Nuance Communications, Inc;
Stuart G. Silverman, MD, Brookline, MA, (sgsilverman@partners.org) (Presenter) Author, Wolters Kluwer nv
Elaine M. Caoili, MD, MS, Ann Arbor, MI (Presenter) Nothing to Disclose
Susan M. Ascher, MD, Washington, DC (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Appreciate the need for and value of recommendations for managing incidental findings. The participants should also be able to
choose from a variety of methods to bring these recommendations to the point of interpretation. 2) Identify incidental adnexal
cystic lesions that require further evaluation to include the type and timing of follow up examinations. 3) Apply appropriate imaging
criteria and thresholds to better distinguish benign adrenal adenomas from more clinically important lesions. 4) Manage incidental
renal masses, even when they are incompletely characterized, such as when they are too small to characterize or detected on an
examination that is not designed to evaluate them fully. Please bring your charged mobile wireless device (phone, tablet or laptop)
to participate.
RC310
First Trimester Ultrasound (An Interactive Session)
Tuesday, Dec. 1 8:30AM - 10:00AM Location: S402AB
GU
OB
US
Participants
Active Handout:Carol Beer Benson
http://abstract.rsna.org/uploads/2015/15001996/Active RC310.pdf
Sub-Events
RC310A
Ectopic Pregnancy
Participants
Anne M. Kennedy, MD, Salt Lake City, UT (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Diagnose tubal ectopic. 2) Differentiate Cesarean scar implantation from a normal, low-lying pregnancy. 3) Recognize the more
unusual sites of ectopic pregnancy (cervical, interstitial, abdominal). 4) Understand the indications for expectant vs. medical vs.
surgical management .
ABSTRACT
Ectopic pregnancy can be a life-threatening condition for young, healthy women. The availability of senstive urine pregnancy tests
means that we are seeing patients at a time when It may be very difficult to see any sonographic findings of pregnancy. The
session will review and illustrate examples of the recommended descriptive terms 'pregnancy of unknown location',' probable
ectopic' and 'definite ectopic' both of which refer to tubal ectopics.We will also review the appearance of heterotopic pregnancy
and non-tubal ectopics including Cesarean scar implantation, interstitial and cervical implantation, and abdominal and ovarian
ectopic with demonstration of the role of color Doppler, 3D ultrasound and other imaging modalities.Modern management of ectopic
pregnacy has become much less aggressive, in part because the diagnosis is made so much earlier. The indications for the various
treatment options will be outlined with illustrative case of local injection as well as intraoperative photos during laparoscopy.
Active Handout:Anne M. Kennedy
http://abstract.rsna.org/uploads/2015/15001997/RC310A.pdf
RC310B
Diagnosis of Miscarriage
Participants
Peter M. Doubilet, MD, PhD, Boston, MA, (pdoubilet@partners.org) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Know the sonographic criteria for definite miscarriage and probable miscarriage in the early first trimester. 2) Understand that
any saclike intrauterine structure (rounded edges, no yolk sac or embryo) in a woman with a positive pregnancy test is highly likely
to be a gestational sac. 3) Understand that nonvisualization of an intrauterine gestational sac in a woman with hCG above the
'discriminatory' level (2000 mIU/ml) does not exclude the possibility of a normal pregnancy.
ABSTRACT
This lecture will cover the diagnosis of early first trimester miscarriage in two settings: (i) ultrasound demonstrates no intrauterine
gestational sac ('pregnancy of unknown location'); (ii) ultrasound demonstrates an intrauterine gestational sac but no embryo or
heartbeat. In the first of these settings, the role of the quantitative hCG level will be discussed, including whether a single
measurement can be used to rule out a normal intrauterine pregnancy. In the second setting, the currently accepted criteria for
definite miscarriage and for probable miscarriage will be presented. The lecture will also address findings that indicate a high
likelihood of impending pregnancy failure when an embryo with heartbeat is seen on ultrasound.
Active Handout:Peter Michael Doubilet
http://abstract.rsna.org/uploads/2015/15001998/RC310B Early1stTriMiscarriage--RSNA2015.pdf
RC310C
Mid-late First Trimester
Participants
Carol B. Benson, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Recognize the importance of evaluating the developing fetal head during the late first trimester for early detection of large neural
tube defects. 2) Incorporate measurement of the nuchal translucency into their assessment of the fetuses of gestational age 1114 weeks. 3) Recognize sonographic abnormalities of the ventral wall to distinguish normal physiologic bowel herniation from defects
including omphalocele and gastroschisis.
ABSTRACT
This lecture will discuss the sonographic appearance of fetal anatomy in the latter part of the third trimester in order to help
participants recognize abnormalities of the fetus at this early gestational age. While many anomalies cannot be detected until later
in pregnancy, the discussion will focus on those anomalies that can be detected in the first trimester. Specific topics covered will
be central nervous system anomalies, including anencephaly, encephalocele and holoprosencephaly, ventral wall defects including
omphalocele and gastroschisis, bladder outlet obstruction, and skeletal anomalies including skeletal dysplasias. Detection of
anomalies early in gestation, before the second trimester, permits time to assess the fetus for other anomalies, syndromes, and
aneuploidy.
RC329
Characterization of Complex and Sonographically Indeterminate Adnexal Masses (An Interactive Session)
Tuesday, Dec. 1 8:30AM - 10:00AM Location: E353B
GU
MR
US
Participants
Sub-Events
RC329A
Overview of the Clinical Indications for Using MRI
Participants
Andrea G. Rockall, MRCP, FRCR, London, United Kingdom (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To be familiar with the typical clinical presentation of adnexal masses. 2) To understand the role role of ultrasound in the initial
evaluation and diagnosis of adnexal masses. 3) To know the current indications for MRI in the characterisation of adnexal masses.
ABSTRACT
Clinical presentation of adnexal masses can be due to symptoms (such as acute or chronic pelvic pain or sepsis) or may be
incidental. Ultrasound is the initial investigation in almost every case, although CT may be used initially in patients presenting with
an acute abdomen. Ultrasound features that can differentiate benign from malignant adnexal masses are well defined and over 80%
of cases can be confidently characterised on the basis of ultrasound findings. However, when the nature of a mass is indeterminate
on ultrasound, MRI can be useful in further characterisation of the mass. This can be particularly useful in cases where fertility
preservation is of paramount importance or where the risks of surgery are high due to other co-morbidities. This lecture will include
a full discussion of the current indications for MRI in characterisation of adnexal masses.
RC329B
Review of Scoring System for Complex and Sonographically Indeterminate Adnexal Masses (The
RULES)
Participants
Isabelle Thomassin-Naggara, MD, Paris, France (Presenter) Speakers Bureau, General Electric Company; Research Consultant, Olea
Medical
LEARNING OBJECTIVES
1) To learn how to optimise the MRI protocol and how to improve the characterisation of indeterminate complex adnexal masses. 2)
To understand the added value of functional sequences (DCE MRI and DWI) in diagnosing adnexal masses. 3) To present a novel
diagnostic score named ADNEX MR score for classified adnexal masses using MR imaging according to their positive predictive value.
ABSTRACT
For complex adnexal masses, MR imaging add to conventional criteria of malignancy common to all imaging modalities (bilaterality,
tumor diameter larger than 4 cm, predominantly solid mass, cystic tumor with vegetations, and secondary malignant features, such
as ascites, peritoneal involvement, and enlarged lymph nodes) specific features based on the characterization of the solid tissue
(including vegetation, thickened irregular septa and solid portion) of the adnexal tumor. Using ADNEX MR-SCORING system for
adnexal masses, areas under the curve for diagnosis of malignancy is high both for experienced and junior reader
(AUCR1/R2=0.980/0.961). A score is 4 or greater is associated with malignancy with a sensitivity of 93.5% (58/62) and specificity
of 96.6% (258/267), the risk of malignancy is high, and the patient should be referred to a cancer center. When the diagnostic
score is 3 or less, the association with malignancy is minimal and the patient may benefit from more imaging follow-up or
conservative treatment. Finally, if the diagnostic score is 2, the mass has a very low risk to be malignant (<2%). This new MR
diagnosis classification will be detailed with interactive clinical cases during this session
RC329C
Interactive Cases
Participants
Elizabeth A. Sadowski, MD, Madison, WI (Presenter) Nothing to Disclose
Medical
LEARNING OBJECTIVES
1) Develop a method for classifying adnexal masses on MRI by assessing their signal characteristics and enhancement patterns. 2)
Assess the risk of ovarian cancer based on the MRI appearance of an adnexal lesion and clinical information. 3) Emphasize the role
of MRI in the evaluation of adnexal lesions.
ABSTRACT
ABSTRACT There is a spectrum of ovarian neoplasms ranging from benign to malignant. Identifying the MR imaging features
suggestive of benign versus worrisome lesions can help appropriately triage adnexal lesions into follow up versus surgical
consultation. The purpose of the interactive session is to review the imaging features of benign and worrisome adnexal lesions on
MRI and to discuss the appropriate follow up in each case.
RC351
Pelvic MRI in Oncology: Pearls for Practice
Tuesday, Dec. 1 8:30AM - 10:00AM Location: E350
GU
MR
OI
RO
Participants
Sub-Events
RC351A
Practical Approach to Understanding Gene Mutations with Interpretation of Imaging in Gynecologic
Malignancy
Participants
Priya R. Bhosale, MD, Houston, TX (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To learn the gentic mutations present in Endomtrial and Ovarian Cancer. 2) Pathogenesis of Ovarian Cancer. 3) Implications on
image interpretation.
ABSTRACT
Endometrial cancer is teh most common female gynecologic malignancy.Epithelial ovarian cancer is the most common cause of
gynecological cancer death in the United States. More recently epithelial ovarian tumors have been broadly classified into two
distinct groups. The type I tumors have low grade serous, clear cell, endometrioid, and mucinous histological features. Typically,
these tumors are slow growing and confined to the ovary, and are less sensitive to standard chemotherapy. BRAF and KRAS
somatic mutations are relatively common in these tumors, which may have important therapeutic implications. Type II tumors are
high grade serous cancers of the ovary, peritoneum, and fallopian tube. These tumors are clinically aggressive and are often widely
metastatic at the time of presentation. We will discuss the gene mutations associated with different endometrial and epithelial
ovarian cancer, pathogenesis, implications on therapy and imaging.
Honored Educators
Priya R. Bhosale, MD - 2012 Honored Educator
RC351B
Pearls and Pitfalls in Prostate MRI
Participants
Aradhana M. Venkatesan, MD, Houston, TX, (avenkatesan@mdanderson.org) (Presenter) Institutional research agreement,
LEARNING OBJECTIVES
1) List the elements of common prostate MRI acquisition protocols, defining the roles for each pulse sequence in prostate cancer
detection. 2) List imaging findings critical to accurate prostate cancer detection and staging. 3) Identify imaging pitfalls in the
detection and staging of prostate cancer. 4) Describe common MRI findings of treated prostate cancer. 4) List the elements of the
Prostate Imaging-Reporting and Data System (PI-RADS) structured reporting scheme. 5) List the updated changes reflected in the
most recent PI-RADSv2 structured reporting scheme.
ABSTRACT
Prostate cancer is one of the most frequently diagnosed cancers in the male population. It is the second most common type of
cancer detected in American men and their second leading cause of cancer death. The proposed refresher course will provide an
overview of MRI for prostate cancer imaging, including a discussion of salient imaging findings on multi-parametric MRI, pitfalls in
imaging interpretation, and an overview of existing standardized reporting templates for prostate MR interpretation.
RC351C
How to Perform and Interpret MRI of the Bladder and Urethra: Anatomy, Technique, and
Applications
Participants
Mukesh G. Harisinghani, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) MR techniques to image the bladder and urethra will be discussed. 2) Pointers for optimal MR evaluation will be discussed. 3)
Pointers for accurate diagnosis on MRI will be discussed.
ABSTRACT
The propsed course will be provide an overview of applying MR for imaging the bladder and uretheral region
RC352
Carotid and Renal Doppler (Hands-on)
Tuesday, Dec. 1 8:30AM - 10:00AM Location: E264
GU
VA
US
FDA
Participants
Gowthaman Gunabushanam, MD, New Haven, CT, (gowthaman.gunabushanam@yale.edu) (Moderator) Editor, WebMD Health Corp ;
Gowthaman Gunabushanam, MD, New Haven, CT, (gowthaman.gunabushanam@yale.edu) (Presenter) Editor, WebMD Health Corp ;
Mark E. Lockhart, MD, Birmingham, AL, (mlockhart@uabmc.edu ) (Presenter) Nothing to Disclose
Shweta Bhatt, MD, MBBS, Rochester, NY (Presenter) Nothing to Disclose
Wui K. Chong, MD, Chapel Hill, NC, (wk_chong@med.unc.edu) (Presenter) Nothing to Disclose
Corinne Deurdulian, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Vikram S. Dogra, MD, Rochester, NY (Presenter) Editor, Reed Elsevier
Edward G. Grant, MD, Los Angeles, CA (Presenter) Research Grant, General Electric Company ; Medical Advisory Board, Nuance
Communications, Inc
Ulrike M. Hamper, MD, MBA, Baltimore, MD (Presenter) Nothing to Disclose
Felix A. Hester, Helena, AL (Presenter) Nothing to Disclose
Michelle L. Robbin, MD, Birmingham, AL, (mrobbin@uabmc.edu) (Presenter) Consultant, Koninklijke Philips NV;
Leslie M. Scoutt, MD, New Haven, CT (Presenter) Consultant, Koninklijke Philips NV
Ravinder Sidhu, MD, Rochester, NY, (ravinder_sidhu@urmc.rochester.edu) (Presenter) Nothing to Disclose
Margarita V. Revzin, MD, Wilton, CT, (margarita.revzin@yale.edu) (Presenter) Nothing to Disclose
Davida Jones-Manns, Hampstead, MD (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe the technique and optimally perform carotid Doppler ultrasound. 2) Describe the technique and optimally perform renal
Doppler ultrasound. 3) Review qualitative and quantitative criteria for diagnosing abnormalities in carotid and renal ultrasound
Doppler examinations.
ABSTRACT
This hands-on course will provide participants with a combination of didactic lectures and an extended 'live' scanning opportunity
on normal human volunteers, as follows: Didactic lectures (30 minutes): 1. Carotid Doppler Ultrasound: scanning technique,
diagnostic criteria and interesting teaching cases. 2. Renal Doppler Ultrasound: scanning technique, diagnostic criteria and
interesting teaching cases. Mentored scanning (60 minutes): Following the didactic lectures, the participants will proceed to a
scanning area with normal human volunteers and ultrasound machines from different manufacturers. Participants will be able to
perform live scanning with direct assistance (if needed) by faculty. Faculty will be able to offer feedback, help participants improve
their scanning technique as well as answer any questions. Faculty will also be available to answer general questions relating to all
aspects of vascular Doppler, not limited to carotid and renal Doppler studies.
Honored Educators
Leslie M. Scoutt, MD - 2014 Honored Educator
SSG06
ISP: Genitourinary (Imaging Gynecological Malignancy)
Tuesday, Dec. 1 10:30AM - 12:00PM Location: N229
GU
MR
OI
BQ
Participants
Susanna I. Lee, MD, PhD, Boston, MA (Moderator) Nothing to Disclose
Andrea G. Rockall, MRCP, FRCR, London, United Kingdom (Moderator) Nothing to Disclose
Sub-Events
SSG06-01
Genitourinary Keynote Speaker: Gynecologic Cancer Imaging-Present and Future
Tuesday, Dec. 1 10:30AM - 10:40AM Location: N229
Participants
Susanna I. Lee, MD, PhD, Boston, MA (Presenter) Nothing to Disclose
ABSTRACT
The past decade has seen the development of MRI and FDG PET-CT, both of which now play central and complementary roles in
treatment planning and followup of women with uterine, ovarian and vulvar cancer. Ongoing investigations of novel techniques such
as diffusion and perfusion imaging, and of PET tracers capable of targeting hypoxia and hormone receptors, will push cancer
radiology firmly into the realm of the molecular, quantitative and predictive in the coming decade. PET-MRI, capable of concurrent
multi-modality functional imaging, will likely prove to be a mainstay in personalized gynecologic cancer care.
Honored Educators
Susanna I. Lee, MD, PhD - 2013 Honored Educator
SSG06-02
High Grade Serous Ovarian Cancer: BRCA Mutation Status and CT Imaging Phenotypes
Participants
Stephanie Nougaret, MD, New York, NY (Presenter) Nothing to Disclose
Yuliya Lakhman, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Hebert Alberto Vargas, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Maura Micco, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Melvin D'Anastasi, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Sarah A. Johnson, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Ramon E. Sosa, BA, New York, NY (Abstract Co-Author) Nothing to Disclose
Krishna Juluru, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Noah Kauff, New York, NY (Abstract Co-Author) Nothing to Disclose
Hedvig Hricak, MD, PhD, New York, NY (Abstract Co-Author) Nothing to Disclose
Evis Sala, MD, PhD, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the associations between BRCA mutation status and preoperative CT imaging phenotypes in women with high-grade
serous ovarian cancer (HGSOC).
115 patients with HGSOC (76 BRCA mutation-positive and 39 BRCA mutation-negative) and CT scans prior to the primary
cytoreductive surgery were included in this retrospective HIPAA-compliant study. Two radiologists (R1 and R2) independently
reviewed all CT scans and R1 determined total measurable peritoneal tumor volume (TPTV) for each patient. Associations between
BRCA mutation status, CT imaging features, and TPTV were analyzed using Fisher exact test and Mann Whitney test. Inter-reader
agreement was assessed with the Cohen's kappa. Kaplan-Meier and Cox proportional hazards regression survival analyses were
performed.
RESULTS
BRCA mutation-positive HGSOC had less frequent peritoneal disease, mesenteric infiltration, and lymphadenopathy at CT (p =
0.0002, < 0.0001-0.03, 0.03 for both readers, respectively). Furthermore, the pattern of peritoneal implants was correlated with
the BRCA mutation status: nodular pattern was more common in BRCA-associated tumors whereas infiltrative pattern was more
frequent in sporadic tumors (p = 0.0009 and p = 0.0005 for R1 and R2, respectively). BRCA mutation-positive HGSOC had higher
mean TPTV (125 cm3 ± 171) than sporadic tumors (56 cm3 ± 95) (p<0.001). Irrespective of BRCA mutation status, mesenteric
involvement by tumor was associated with shorter progression-free survival (p <0.0001 for both readers) and overall survival
(p<0.0002 and p<0.0001 for R1 and R2, respectively).
CONCLUSION
BRCA mutation status in HGSOC was linked to the distinct CT imaging phenotypes. Mesenteric disease at CT was an independent
predictor of reduced survival in both BRCA mutation-positive and sporadic tumors.
BRCA-associated HGSOC have characteristic prognostically significant morphology on CT.
Honored Educators
Stephanie Nougaret, MD - 2013 Honored Educator
Evis Sala, MD, PhD - 2013 Honored Educator
SSG06-03
Advanced Cervical Cancer: Quantitative Assessment of Early Response to Neoadjuvant Chemotherapy
with Intravoxel Incoherent Motion Diffusion-weighted Magnetic Resonance Imaging
Participants
Yanchun Wang, Wuhan, China (Presenter) Nothing to Disclose
Dao Y. Hu, MD, PhD, Wuhan, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the utility of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) for predicting
and monitoring the response of cervical cancer to neoadjuvant chemotherapy (NACT).
This prospective study was approved by an institutional review board, and informed consent was obtained from all patients. A total
of 42 patients with primary cervical cancer were recruited into this study. IVIM diffusion-weighted MRI was performed on all
patients at three time points (prior to NACT, 3 weeks after the first NACT, and 3 weeks after the second NACT).The response to
treatment was determined according to the Responded Evaluation Criteria in Solid Tumors (RECIST) three weeks after the second
NACT treatment, and the subjects were categorized into responders and non-responders. The standard ADC, true diffusion
coefficient (D), perfusion-related pseudo-diffusion coefficient (D*), and perfusion fraction (f) values were determined.
RESULTS
Patients were divided into responders (n=24) and non-responders (n=18) according to the RECIST guidelines. Before treatment, the
D and standard ADC values were significantly higher in responders than in non-responders (both p<0.01). No significant differences
were observed in D* and f . Analysis of the receiver operating characteristic (ROC) curves indicated that the threshold of
D<0.93×10-3mm2/s and the standard ADC<1.11×10-3mm2/s could be used to differentiate responders from non-responders,
yielding area under curve (AUC) values of 0.804 and 0.768, respectively. Three weeks after both the first and second NACT
treatments, the D and standard ADC values in the responders were still significantly higher than those in the non-responders.D*
and f values still showed no significant differences.The ROC curve analysis indicated that the AUC values for D and standard ADC
were 0.823 and 0.763 for the second time point and 0.787 and 0.794 for the last time point.
CONCLUSION
IVIM may be useful for predicting and monitoring the efficacy of NACT in cervical cancer. D and standard ADC values could
represent reliable early predictors of the NACT response prior to treatment. Furthermore, these parameters can be used to monitor
NACT responses during and after therapy.
These results should be useful for both patients and clinical doctors. Patients who are unsuitable for NACT could be given radiation
or surgical treatment in a more timely manner.
SSG06-04
Prognostic Value of Diffusion-weighted MRI and PET/CT During Concurrent Chemoradiotherapy in
Uterine Cervical Cancer
Participants
Jung Jae Park, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
PURPOSE
To evaluate the prognostic value of diffusion-weighted MRI (DWI) and PET/CT during concurrent chemoradiotherapy (CCRT) of
cervical cancer for predicting disease progression.
This retrospective study included 67 consecutive patients (median age, 55 years; range, 28-78 years) who received CCRT for
locally advanced cervical cancer. All patients underwent both 3T-DWI and PET/CT before and during (at 4 weeks) treatment. The
mean apparent diffusion coefficient (ADC) and maximum standardized uptake value (SUVmax) were measured on the tumors and the
percentage changes of each parameter between the two time points (ΔADC and ΔSUVmax) were calculated. In the prediction of
disease progression, the diagnostic performance of tumor ΔADC and ΔSUVmax was evaluated using the time-dependent receiver
operating characteristics (ROC) curve analysis. The relationship between disease progression and clinical and imaging parameters
was investigated using univariate and multivariate Cox regression analyses.
RESULTS
During a mean follow-up of 2.7 years, disease progression was identified in 16 patients (23.9%): local recurrence (n= 7), distant
metastasis (n= 8) and both local recurrence and distance metastasis (n= 1). During treatment, the mean ADC and SUVmax
significantly increased and decreased, respectively (both P < 0.001). The mean ΔADC and ΔSUVmax were 42.6 ± 17% and 67.6 ±
16.5%, respectively. In the prediction of disease progression, the integrated area under the curve of ΔADC (0.791) and ΔSUVmax
(0.781) were not significantly different ( P = 0.88) and the optimal cut-offs of ΔADC and ΔSUVmax were 35.1% and 60.7%,
respectively. On multivariate Cox regression analysis, the ΔADC (< 35.1%) and ΔSUVmax (< 60.7%) were the only independent
predictors of disease progression after treatment (hazard ratio, 4.1 and 4.5; P , 0.04 and 0.03, respectively).
CONCLUSION
The percentage changes of DWI and PET/CT parameters during CCRT offer similar prognostic value for the prediction of posttreatment disease progression in patients with cervical cancer.
DWI, as a noninvasive tool, can be used in the prediction of therapeutic outcomes following concurrent chemoradiotherapy in
patients with cervical cancer, instead of PET/CT with the risk of ionizing radiation exposure.
SSG06-05
Application of Non-Gaussian Water Diffusional Kurtosis Imaging in the Assessment of Uterine
Tumors: A Preliminary Study
Participants
Aliou A. Dia, MD, Suita, Japan (Presenter) Nothing to Disclose
Masatoshi Hori, MD, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Hiromitsu Onishi, MD, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Makoto Sakane, MD, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Takahiro Tsuboyama, MD, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Noriyuki Tomiyama, MD, PhD, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Mitsuaki Tatsumi, MD, PhD, Suita, Japan (Abstract Co-Author) Nothing to Disclose
Tomoyuki Okuaki, RT, Chuo-Ku, Japan (Abstract Co-Author) Employee, Koninklijke Philips NV
PURPOSE
To retrospectively evaluate the feasibility and the value of diffusional kurtosis imaging (DKI) in the assessment of uterine tumors
compared with that of conventional diffusion weighted imaging (DWI) and with pathological findings as gold-standard.
Sixty-one women (mean age: 54.85 years ±14.09, range 26-89 years) with histopathologically proven uterine cancers (51 cervical
cancers and 10 corpus cancers) underwent 3-T MR imaging using DKI with high b values (b=700, 1000, 1700 and 2500 s/mm2) and
DWI (b=0 s/mm2, b=700 s/mm2). Thirteen of the 61 patients (21.3 %) had coexisting leiomyomas.ROI-based measurements of
diffusivity (D), kurtosis (K) and ADC of the uterine cancers, leiomyomas, healthy myometrium and endometrium were performed.The
areas under the ROC curve (AUC) in differentiating malignant from benign lesions were also compared.
RESULTS
Mean D of uterine cancers (0.879 mm/s2 ± 0.30) was significantly lower than that of the leiomyomas (1.174 mm/s2±0.43)
(P=0.006), the healthy myometrium (1.178 mm/s2± 0.27) (P=0.000) and the healthy endometrium (1.308 mm/s2±0.5) (P=0.013).
Mean K of uterine cancers (0.754 mm/s2± 0.22) was moderately higher than that of leiomyomas (0.686 mm/s2± 0.24), the healthy
myometrium (0.708 mm/s2± 0.19) and the healthy endometrium (0.568mm/s2± 0.25).No significant difference was found between
the mean K of the uterine cancers, the leiomyomas, the healthy myometrium and endometrium (P=0.33, 0.27 and 0.23).There was
no significant difference in AUC between D and ADC.
CONCLUSION
D is not superior or inferior to the conventional ADC in the differentiation between benign and malignant uterine lesions. The K that
is related to the microstructural complexity was higher in uterine cancers than that of leiomyomas but without any significant
difference, opposite to K values in white matter tissue of the brain, in breast or prostate cancers where the mean K of malignant
lesions was significantly higher than of the benign lesions.
The D, in non-Gaussian DKI, is equal to the conventional ADC in differentiating benign from malignant uterine lesions. The K of
uterine malignant tumors was not significantly higher than that of the benign lesions, unlike in breast or prostate cancers.
SSG06-06
Clinical Value of Proton (1H-) Magnetic Resonance Spectroscopy (MRS) Using Body-phased Array
Coil at 3.0 T in Pretreatment Assessment for Cervical Cancer Patients
Participants
Gigin Lin, MD, Guishan, Taiwan (Presenter) Nothing to Disclose
Yu-Ting Huang, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Koon-Kwan Ng, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Yu-Chun Lin, MSC, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Tzu-Chen Yen, MD, PHD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Hung-Hsueh Chou, MD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Angel Chao, MD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Chiun-Chieh Wang, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Chyong-Huey Lai, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Pen-An Liao, MD, Taipei City, Taiwan (Abstract Co-Author) Nothing to Disclose
PURPOSE
To determine the clinical value of proton (1H-) magnetic resonance spectroscopy (MRS) using body-phased array coil at 3.0 T, in
pretreatment assessment for cervical cancer patients.
We prospectively enrolled 52 histology proven cervical cancer patients (age 27-80 years) and 30 age-matched surgical candidates
for benign uterine myoma without evidence of cervical cancer. Pretreatment MR study plus MRS and diffusion weighted imaging
(DWI) sequences were carried out at a 3.0 T system using body-phased array coil for the pelvis. PRESS localized 1H-MRS was
applied to cervical tumor or normal tissue, with resonances analyzed by using the LC-Model algorithm. Cramer-Rao lower bound
(CRLB) threshold of 20% was used as quality control. We compared resonances based on: (1) tumor vs normal cervical tissue, (2)
histopathology type (squamous vs adenocarcinoma) (3) T stage = IIb (4) nodal metastasis (5) distant metastasis using MannWhitney test.
RESULTS
Cervical tumor showed a lower 1.3-ppm lipid level (0.30 vs 1.01μM, P < .05), as compared with normal cervical tissue. Squamous
cell carcinoma demonstrated lower levels in 1.3-ppm lipid (0.17μM vs 0.59μM, P < .05) and 0.9-ppm lipid (0.04μM vs 0.16μM, P <
.05), as compared with adenocarcinoma. Tumor with T stage >= IIb had lower levels in 1.3-ppm lipid (0.15μM vs 0.53μM, P < .05),
0.9-ppm lipid (0.04μM vs 0.15μM, P < .05) and total choline (0.04μM vs 0.16μM, P < .05). Tumors with nodal metastasis contained
lower levels of 1.3-ppm lipid (0.16μM vs 0.44μM, P < .05) and glutamine (0.01μM vs 0.02μM, P < .005), whereas tumors with
distant metastasis contained a lower level of 1.3-ppm lipid (0.12μM vs 0.50μM, P < .05). However, resonances from cervical tumor
were independent to maximal tumor size or ADC value on MRI.
CONCLUSION
1H-MRS using body-phased array coil at 3.0 T in cervical cancer patients is useful in differentiating tumor, histopathology type, T
stage >= IIb, nodal or distant metastasis, and is independent to maximal tumor size or ADC value on MRI.
1H-MRS using body-phased array coil at 3.0 T added additional dimensions for pretreatment assessment in cervical cancer patients.
SSG06-07
Impact of Multiparametric MRI (mMRI) on the Therapeutic Management of Suspicious Adnexal
Masses Detected by Transvaginal Ultrasound (TVUS)
Participants
Simone Schrading, MD, Aachen, Germany (Presenter) Nothing to Disclose
Sabine M. Detering, Aachen, Germany (Abstract Co-Author) Nothing to Disclose
Dirk Bauerschlag, Aachen, Germany (Abstract Co-Author) Nothing to Disclose
Christiane K. Kuhl, MD, Bonn, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Incidental adnexal masses at TVUS are common and diagnostically challenging. The primary goal of imaging is accurate tissue
characterization to guide further management, i.e. the choice between plain follow-up vs laparoscopic surgery vs. open surgery.
Aim of this study was to evaluate the diagnostic utility of mMRI for further management stratification in patients with such adnexal
masses
Prospective IRB-approved trial on 126 women (mean age 54.6 years) with inconclusive adnexal masses at TVUS. All women
underwent conventional work up, including pelvic examination, TVUS, and CA-125 levels. In addition, all women underwent mMRI at
3T with high resolution T2-TSE in three planes, DWI (max. b-800) and DCE. Likelihood of malignancy and appropriate management
(i.e. follow-up vs. laparoscopic vs. open surgery) was first determined based on results of conventional methods, and then,
independently, based on mMRI. Then, all methods were reviewed in synopsis. Final surgical pathology served as standard-ofreference or clinical and imaging follow-up of at least 24 months
RESULTS
In 65% (82/126) of patients the adnexal mass finally classified as benign, in 29% (36/126) as malignant and in 6% (8/126) as
borderline. The diagnostic indices for TVUS+CA-125 alone vs. MRI alone vs. all methods combined were as follows: Sensitivity: 86%
(31/36) vs. 97% (35/36) vs. 100% (36/36); Specificity: 32% (29/90) vs. 83% (75/90) vs. 80% (68/90); PPV: 34% (31/91) vs. 70%
(35/50) vs. 74% (40/54), NPV: 65% (29/44) vs. 98% (75/76) vs. 100% (72/72). After mMRI, the therapeutic management was
changed in 41/126 (34%) of patients. In 30 patients in whom surgery had been recommended based on conventional assessment,
mMRI correctly diagnosed typical benign findings; these patients underwent follow-up instead of surgery. None of these women
developed malignancy during follow-up. In another 11 patients, mMRI results correctly suggested malignancy such that open
surgery was performed instead of laparoscopic surgery
CONCLUSION
Compared with conventional assessment (pelvic exam, TVUS, CA-125), mMRI correctly changed the management in one-third of
women with incidental adnexal masses. It helps avoid unnecessary surgery, or unnecessary surgical steps (conversion from
laparoscopic to open surgery)
Pelvic mMRI helps to significantly improve clinical management of asymptomatic women with incidental adnexal masses identified on
TVUS
SSG06-08
Preoperative Tumor Texture Analysis from MRI Predicts Deep Myometrial Invasion and High Risk
Histology in Endometrial Carcinomas
Participants
Sigmund Ytre-Hauge, MD, Bergen, Norway (Presenter) Nothing to Disclose
Erik Hanson, PhD, Bergen, Norway (Abstract Co-Author) Nothing to Disclose
Arvid Lundervold, MD, PhD, Bergen, Norway (Abstract Co-Author) Nothing to Disclose
Jone Trovik, MD, Bergen, Norway (Abstract Co-Author) Nothing to Disclose
Helga Salvesen, MD, PhD, Bergen, Norway (Abstract Co-Author) Nothing to Disclose
Ingfrid S. Haldorsen, MD, PhD, Bergen, Norway (Abstract Co-Author) Nothing to Disclose
PURPOSE
Tumor heterogeneity is a key feature of malignant disease. Heterogeneity in MR images can be quantified by texture analysis. We
aimed to explore whether high risk histological features are reflected in texture parameters derived from preoperative MRI in
endometrial carcinomas.
Preoperative pelvic contrast-enhanced MRI (1.5T) including diffusion-weighted imaging (DWI) was prospectively performed in 99
patients with histologically confirmed endometrial carcinomas. Tumor region of interest (ROI) was manually drawn encircling the
uterine tumor on axial T1-weighted contrast-enhanced (CE) series on the slice displaying the largest cross-section tumor area.
Histogram based texture features (standard deviation, skewness and kurtosis) were calculated from these tumor ROIs. Texture
parameters were analyzed in relation to established histological subtype and grade, surgicopathological staging parameters (deep
myometrial and cervical stroma invasion and lymph node metastases) and MRI based tumor volume and tumor apparent diffusion
coefficient (ADC) value using Mann-Whitney U test, Jonckheere-Terpsta trend test and Pearson's bivariate correlation test.
RESULTS
Large standard deviation (SD) in the tumor ROIs was significantly associated with presence of deep myometrial invasion (p=0.009).
Lower values for skewness were observed in the tumor ROIs from endometrioid high grade tumors (p=0.012) and from nonendometrioid tumors (by definition always high grade lesions, p=0.020). Kurtosis was positively correlated to tumor volume (r= 0.27;
p=0.006) and negatively correlated to tumor ADC value (r=-0.28; p=0.006).
CONCLUSION
MRI derived tumor texture features reflecting tumor heterogeneity are significantly related to high risk histology and predict deep
myometrial invasion in endometrial carcinomas. Thus, tumor texture features based on MRI represent promising biomarkers to aid
preoperative tumor characterization for risk stratified surgical treatment.
Tumor texture features derived from MRI reflect high risk endometrial carcinoma and may aid preoperative risk classification for
stratified surgery.
SSG06-09
Endometrial Cancer MR Staging Accuracy in a Large Multi-site UK Cancer Network Over Three Years:
Can the Reported Single Centre Staging Accuracies be Met in Clinical Practice?
Tuesday, Dec. 1 11:50AM - 12:00PM Location: N229
Participants
Neil Soneji, BSC, MBBS, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Annarita Ferri, MD, Chieti, Italy (Presenter) Nothing to Disclose
Victoria Stewart, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Roberto Dina, MD, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Nishat Bharwani, MBBS, FRCR, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Andrea G. Rockall, MRCP, FRCR, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
PURPOSE
To determine the radiological staging accuracy of endometrial cancer (EC) from images acquired from multiple MR scanners across a
10 centre UK cancer network over three years.
Retrospective study of 382 consecutive patients with EC imaged in 9 external hospitals and 3 internal hospital sites discussed at
our tertiary gyne-oncology centre between October 2011-October 2014. All patients with tertiary centre reports for both final
histology and MRI were included (n=270). The radiological stage provided at MDT discussion was compared to the 'gold standard'
histological report. Parameters assessed included depth of myometrial invasion, cervical and nodal stage. The use of DWI or DCE
and the site for incorrect staging were recorded. MedCalc statistical software version 15.2.2 was used.
RESULTS
242 of 270 MRI reports (90%) included a final FIGO stage; of these 147 scans were performed internally and 95 at an external
hospital. Accuracy of the reported depth of invasion was 72.7% for all cases (72.8% for internal and 72.6% for external scans).
Sensitivity, specificity, positive and negative predictive values & accuracy with DWI (n=204) were 67%, 77%, 64%, 79%, 73% and
without DWI (n=38) were 75%, 69%, 53%, 86%, 71% (p>.05). Accuracy with DCE (n=109) was 72% and without (n=130) was
73%. For cervical stromal invasion, sensitivity, specificity, PPV, NPV and accuracy for all scans were 59%, 94%, 64%, 93% and
89%. As a percentage of all causes of staging error, depth of invasion accounted for 41-52%, cervix stromal invasion 20-32% and
nodal stage 8-16% depending on whether the patient was scanned internally or externally, or whether DWI or DCE were included
(p>.05).
CONCLUSION
Staging accuracy in a large multi-site cancer network over three years does not meet the reported staging accuracies in metaanalyses of smaller single centre published research (pooled sensitivity/specificity of 86-90%). DWI and DCE did not affect staging
accuracy, although only a small number of cases did not have these. The underlying causes for the reduction in sensitivity and
specificity need to be evaluated in order to translate the highest achievable MR staging accuracy to long term routine practice.
Accuracy of MR staging of endometrial cancer in a multi-site cancer network over three years does not reach single centre study
results. The causes for staging inaccuracies need to be understood.
SSG09
Molecular Imaging (Gynecologic Oncology)
Tuesday, Dec. 1 10:30AM - 12:00PM Location: S504CD
BR
GU
MI
MR
RO
FDA
Participants
Kathryn A. Morton, MD, Salt Lake City, UT (Moderator) Nothing to Disclose
Zaver M. Bhujwalla, PhD, Baltimore, MD (Moderator) Nothing to Disclose
Sub-Events
SSG09-01
First Clinical Trial on Ultrasound Molecular Imaging Using KDR-Targeted Microbubbles in Patients with
Breast and Ovarian Lesions
Tuesday, Dec. 1 10:30AM - 10:40AM Location: S504CD
Participants
Juergen K. Willmann, MD, Stanford, CA (Presenter) Research Consultant, Bracco Group; Research Consultant, Triple Ring
Technologies, Inc; Research Grant, Siemens AG; Research Grant, Bracco Group; Research Grant, Koninklijke Philips NV; Research
Grant, General Electric Company
Lorenzo Bonomo, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Antonia Testa, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Pierluigi Rinaldi, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Guido Rindi, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Sanjiv S. Gambhir, MD, PhD, Stanford, CA (Abstract Co-Author) Board Member, Enlight Biosciences; Board Member, ImaginAb, Inc;
Board Member, FUJIFILM Holdings Corporation; Board Member, ClickDiagnostics, Inc; Consultant, FUJIFILM Holdings Corporation;
Consultant, Gamma Medica, Inc; Speaker, ImaginAb, Inc; Stock, Enlight Biosciences; Stock options, Enlight Biosciences; Travel
support, Gamma Medica, Inc
PURPOSE
To assess if clinical ultrasound molecular imaging (USMI) using a novel clinical grade human kinase domain receptor (KDR)-targeted
microbubble (BR55, Bracco) is safe and allows assessment of KDR expression in patients with breast and ovarian lesions, using
immunohistochemistry (IHC) as gold standard.
21 women (34-66 yrs) with focal breast lesions and 24 women (48-79 yrs) with focal ovarian lesions were injected IV with BR55
(0.03-0.08 mL/kg bw) and 2D USMI of the target lesions was performed dynamically every 2 min starting 5 min after injection up to
29 min, using the linear 15L8 probe (Siemens) or the endocavitary 1123 probe (Esaote). Normal breast tissues surrounding the
lesion or the contralateral presumed normal ovary served as intra-patient controls. Blood pressure, EKG, oxygen levels, heart rate,
CBC, and metabolic panel were obtained before, and 30 min, 1h, 24h after BR55 administration. Persistent focal BR55 binding on
USMI was visually assessed in consensus by 2 blinded offsite radiologists as none, possibly or definitely. Patients underwent surgical
resection of the target lesions and tissues were stained for CD31 and KDR. A pathologist assessed vascular KDR expression using a
4-point scale (none, weak, intermediate, high). Adjudication was performed in consensus (offsite radiologists and pathologist) to
match clinically.
RESULTS
USMI with BR55 was well tolerated by all patients at all doses, without safety concerns. Among the 40 patients included in the
analysis, KDR expression was higher in malignant breast and ovarian lesions (score 2.40±0.63 and 2.08±0.64, respectively)
compared to benign breast and ovarian lesions (2.08±0.64 and 1.33±0.50). KDR expression matched well with presence of focal
BR55 binding on USMI in malignant breast (13/15; 86.7%) and ovarian (11/13; 84.6%) lesions, as well as benign breast (2/3;
66.7%) and ovarian (8/9; 88.9%) lesions. Focal USMI signal could be detected up to 29 min after injection.
CONCLUSION
Use of BR55 in USMI of breast and ovarian lesions is safe and effective and preliminary data indicate that KDR-targeted USMI signal
matches well with vascular KDR expression on IHC.
This study provides proof of principle on feasibility and safety of KDR-targeted USMI in patients with breast and ovarian lesions and
lays the foundation for further clinical trials.
SSG09-02
Imaged EGFR Expression Level Reflects Inhibited Growth-Pathway Node in Model of Triple-Negative
Breast Cancer
Participants
Eric Wehrenberg-Klee, MD, Boston, MA (Presenter) Nothing to Disclose
Nafize S. Turker, PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Pedram Heidari, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Mauri Scaltriti, PhD, New York, NY (Abstract Co-Author) Nothing to Disclose
Umar Mahmood, MD, PhD, Charlestown, MA (Abstract Co-Author) Research Grant, Sabik Medical Inc; Advisory Board, Blue Earth
Diagnostics Limited;
PURPOSE
Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype for which targeted inhibitors of the
RTK/PI3K/AKT/mTOR growth pathway have demonstrated early treatment success. The surface receptor EGFR is one of the
dominant RTKs mediating downstream growth signals along this pathway and changes in EGFR expression may be predictive of
therapeutic inhibition. We sought to demonstrate that the changes in EGFR expression predictive of treatment response could be
non-invasively assessed.
64Cu-DOTA-cetuximab F(ab´)2 was prepared from cetuximab monoclonal antibody and probe affinity for EGFR assessed. A panel of
TNBC cell lines (MDMBA468, MDMBA231, HCC70) was treated with the AKT inhibitor GDC-0068 or the PI3K inhibitor GDC-0941 for
one day at a range of concentrations. Following treatment, we assessed in vitro EGFR probe uptake. In vitro uptake study results
were compared to protein quantification as assessed by Western blot. After treatment of HCC70 mouse xenografts with control,
GDC-0068, or GDC-0941 for two days, PET-CT imaging of HCC-70 tumors with 64Cu-DOTA-EGFR F(ab´)2 was performed.
RESULTS
In vitro treatment with GDC-0068 resulted in increased EGFR Probe uptake of 25%, 139%, and 16% for MDAMB468, MDMBA231, and
HCC70, respectively. In vitro treatment with GDC-0941 resulted in increased EGFR uptake of 6%, 87%, and 88%, for the same
panel of cell lines. In vitro uptake studies demonstrate close correlation with changes in EGFR expression as assessed by Western
blot. In vivo imaging of HCC70 mouse xenografts with EGFR PET Probe after treatment with control, GDC-0068, or GDC-0941
demonstrate SUVmean of 0.32 (±0.03), 0.50 (±0.01), 0.62 (±0.01), with all comparisons significant (p<0.01).
CONCLUSION
We demonstrate in a murine model of triple-negative breast cancer that changes in EGFR expression induced by targeted
therapeutics can be non-invasively assessed using a 64Cu-DOTA-EGFR F(ab´)2 PET imaging probe. We demonstrate that changes
in the level of EGFR expression, potentially indicative of therapeutic response, differ depending on the growth-pathway inhibited.
Noninvasive assessment of changes in EGFR expression could be a valuable clinical tool for rapid assessment of therapeutic efficacy
of targeted growth pathway inhibitors in TNBC, allowing for dynamic clinical decision making in response to imaged resistance
profiles.
SSG09-03
FACBC PET/CT Before and After Neoadjuvant Therapy in Locally Advanced Breast Cancer: A
Prospective Pilot Clinical Trial
Participants
Gary A. Ulaner, MD, PhD, New York, NY (Presenter) Research support, General Electric Company; Research support, F. Hoffmann-La
Roche Ltd
Serge Lyashchenko, New York, NY (Abstract Co-Author) Nothing to Disclose
Hanh Pham, New York, NY (Abstract Co-Author) Nothing to Disclose
Jason S. Lewis, PhD, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
Genes for amino acid transport proteins are highly upregulated in both invasive ductal carcinoma (IDC) and ILC, as compared to
normal breast epithelium. This molecular phenotype may allow for the development of imaging agents based on amino acid
metabolism. We evaluated whether Fluorine-18 labeled 1-amino-3-fluorocyclobutane-1-carboxylic acid (FACBC), an amino acid
analog labelled with fluorine-18, could be used as an imaging agent for local staging of locally advanced breast cancer before and
after neoadjuvant therapy.
This prospective clinical trial is being performed under IRB approval. In this trial, newly diagnosed breast cancer patients that are
planned for neoadjuvant systemic therapy followed by surgical resection undergo FACBC PET/CT prior to systemic therapy and then
again following completion of systemic therapy. Maximum Standardized Uptake Values (SUVmax) and other quantitative measures of
FACBC-avidity are measured for the primary breast tumor and nodal metastases before and after systemic therapy. Following
surgery, FACBC results are correlated with postoperative histopathologic results.
RESULTS
Of 28 planned patients, we have currently accrued 23. All 23 accrued patients have undergone the pre-neoadjuvant therapy FACBC
PET/CT. All 23 primary breast lesions were FACBC avid with SUVmax values of 2.3 to 17.5. 18 of 23 patients (78%) had FACBC avid
axillary nodes with SUVmax values of 1.2 to 14.6. In 2 of 23 patients (9%), an unsuspected extra-axillary local nodal metastasis
was detected on the pre neoadjuvant therapy FACBC PET/CT. SUVmax of these nodes was 2.1 and 2.2, and both were
pathologically proven to be metastases. 15 of 23 patients (65%) have completed both pre- and post-neoadjuvant PET/CT scans
and histological analysis following surgical resection. In 13 of these 15 patients (87%), a reduction of SUVmax in the primary breast
cancer of greater than 90% could accurately identify the presence or absence of complete response/near complete response as
defined by post surgical histologic analysis.
CONCLUSION
This pilot trial of FACBC PET/CT in locally advanced breast cancer demonstrates potential uses of FACBC PET/CT before and after
neoadjuvant therapy.
Further work on FACBC as a radiotracer in locally advanced breast cancer is warranted.
SSG09-04
Operation-naive Invasive Ductal Carcinoma of the Breast. Comparison of Staging Performed with
Whole Body DWI, PET, PET-CT, and PET-MR
Participants
Onofrio A. Catalano, MD, Napoli, Italy (Presenter) Nothing to Disclose
Bruce R. Rosen, MD, PhD, Charlestown, MA (Abstract Co-Author) Research Consultant, Siemens AG
Angelo Luongo, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
Mark Vangel, PhD, Charlestown, MA (Abstract Co-Author) Nothing to Disclose
Marco Catalano, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
Emanuele Nicolai, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
Andrea Soricelli, MD, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
Marco Salvatore, MD, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To compare the performance of whole body (WB) DW, WB-PET, WB-PETCT, and WB-PETMR in patients with newly diagnosed
invasive ductal breast cancer, before undergoing treatment.
49 consecutive women with newly diagnosed invasive ductal carcinoma of the breast underwent WB-DWI, WB-PET, WB-contrast
enhanced (CE) PETCT and WB-CE-PETMR before treatment. A radiologist and a nuclear medicine physician evaluated in consensus
the studies and searched for occurrence, number, and location of metastases. Final staging and number of lesions, according to
each technique, were compared. Pathology and imaging follow up were used as the ground truth reference.
RESULTS
All the techniques correctly staged 32/49 patients: stage2b in 8, 2c in 7, 3c in 4, 4 in 13. They provided discordant stages in 17/49
patients: 1 (stage 2a): staged-4 by WB-PET; 4 (stage 2b): 3/4 staged-2a by WB-PET and WB-PETCT, 1/4 staged-4 by WB-DWI;3
(stage 3a): 2/3 staged-2b by WB-PET and WB-PETCT, 1/3 staged-4 by WB-DWI;3(stage 3c): 2/3 staged-2a by WB-PET and WBPETCT, 1/3 staged-4 by WB-PET and WB-PETCT;6 (stage 4): 1/6 staged-3a by WB-PET, WB-DWI, and WB-PETCT, 1/6 staged-2b
by WB-PET and WB-PETCT, 1/6 staged-2b by WB-PET, WB-DWI, and WB-PETCT, 1/6 staged-3a by WB-DWI, 1/6 staged-3c by
WB-DWI, and 1/6 staged-3a by WB-PET, WB-PETCT and 3c by WB-DWI. Staging performance of WB-PETMR (49 correctly staged)
was significantly better than WB-PETCT (38 correctly staged) (P=0.001, chi square-test).The best performing modality for
malignant lymph-node detection was WB-PETMR (47 of 49 patients), followed by WB-DWI (37/49), followed by WB-PET and WBPETCT (15 patients each). Significantly more malignant nodes were detected by WB-PETMR (P<0.0001, paired t-tests). At least as
many true-positive lesions were detected by WB-PETMR than by any of the other three modalities for 46 patients. The
corresponding number of patients for WB-PET, WB-PETCT, and WB-DWI were 40, 39 and 34, respectively.
CONCLUSION
PETMR allows a better accuracy in initial staging of surgical-naive ductal invasive breast cancer. The higher performance is likely
related to the additive information of PET, DWI, as well as of the other sequences (STIR, T1-weighted Dixon, HASTE, ADC maps,
and CE-T1-weighed images) of WB-PETMR
When available WB-PETMR should be considered for proper staging of naive ductal invasive breast cancer.
SSG09-05
Multiparametric 18F-FMISO PET/MRI for Assessment of Treatment Response to Chemo-radiation and
Hypoxia Monitoring in Cervix Cancer Patients: A Feasibility Study
Participants
Petra Georg, MD,PhD, Wiener Neustadt, Austria (Abstract Co-Author) Nothing to Disclose
Piotr Andrzejewski, MA, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Pascal A. Baltzer, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Stephan H. Polanec, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Wolfgang Wadsak, Vienna, Austria (Abstract Co-Author) Speaker, General Electric Company; Consultant, THP Medical; Research
Grant, ABX GmbH; Research Grant, Rotem GmbH
Alina Sturdza, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Georgios Karanikas, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Stephan Polterauer, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Richard Poetter, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Thomas H. Helbich, MD, Vienna, Austria (Abstract Co-Author) Research Grant, Medicor, Inc; Research Grant, Siemens AG; Research
Grant, C. R. Bard, Inc
Dietmar Georg, PhD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Katja Pinker, MD, New York, NY (Presenter) Nothing to Disclose
PURPOSE
To demonstrate feasibility of combined multiparametric positron emission tomography/magnetic resonance imaging at 3T (3T MP
PET/MRI) and to assess treatment response and hypoxia monitoring in cervix cancer patients undergoing chemo-radiation therapy.
In this IRB-approved prospective study 7 patients underwent sequential 3T MP 18F-FMISO PET/MRI at baseline; 2 and 5 weeks (w)
after start and 3 months (FU) after treatment. MRI protocol consisted of a high-resolution isotropic T2-w SPACE, a DWI EPI
(b=50/850 sec/mm²) and a high-resolution contrast-enhanced (CE) T1-w VIBE sequence. Patients were injected with 330 MBq
18F-FMISO and scanning was started 240 min after injection. CT data was used for attenuation correction. PET and MR image
registrations were performed using Mirada RTx (Mirada Medical, Oxford, UK , ver. 1.4.0.23) software. Gross tumour volume (GTV)
was contoured by an experienced radiation oncologist on PET/MRI data sets. The volume of GTV was assessed for tumor size, CEkinetics, restricted diffusivity and 18F-FMISO-avidity using SUVmax and SUV (SUVnorm ) normalized to gluteal muscle uptake. At
follow up, cervix was contoured, since all patients showed clinically complete remission.
RESULTS
3T MP 18F-FMISO PET/MRI was successfully performed in all patients at every time-point. Median GTV volume was 43.9cc at
baseline, 22.4cc after 2w (20-25Gy) and 7.7cc after 5w (40-45Gy). Mean ADC values were 1.02x10-3mm2/sec increasing to
1.18x10-3mm2/sec after 2w and to 1.27x10-3mm2/sec after 5w and to 1.37x10-3mm2/sec at FU. All GTVs showed mean initialenhancement (IE) followed by a plateau with an increasing IE at 2w and 5w and wash-out at 5w. At FU, there was a persistent
enhancement. The mean 18F-FMISO SUVnorm was 3.1 at baseline and decreased to 2.3 at 2w and 2.0 at 5w and follow-up. In all
patients there was never the whole tumor 18F-FMISO-avid, but 18F-FMISO-avid spots within the tumor indicative of hypoxia could
be identified before and during the course of therapy.
CONCLUSION
MP 18F-FMISO PET/MRI in cervix cancer patients at 3T is feasible and enables non-invasive monitoring of morphological and
functional changes during treatment.
3T MP 18F-FMISO PET/MRI can depict areas of tumor hypoxia during therapy and thus identify patients at risk who need an
aggressive treatment approach.
SSG09-06
Correlation of PET-MR Biomarkers with Breast Cancer Molecular Subtypes, Grading and Presence of
Distant Metastases at Time of Presentation
Participants
Onofrio A. Catalano, MD, Napoli, Italy (Presenter) Nothing to Disclose
Bruce R. Rosen, MD, PhD, Charlestown, MA (Abstract Co-Author) Research Consultant, Siemens AG
Carlo Iannace, MD, San Leucio del Sannio, Italy (Abstract Co-Author) Nothing to Disclose
Angelo Luongo, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
Marco Catalano, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
Mark Vangel, PhD, Charlestown, MA (Abstract Co-Author) Nothing to Disclose
Maria Lepore, MD, Avellino, Italy (Abstract Co-Author) Nothing to Disclose
Bethany L. Niell, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Emanuele Nicolai, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
Andrea Soricelli, MD, Napoli, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate if PET-MR biomarkers correlate with molecular genetic subtypes, grading, and presence of distant metastases at time
of presentation in naïve ductal invasive breast cancers.
21 consecutive patients with naïve ductal invasive breast cancer and genetic molecular subtype profiling underwent whole-body
contrast enhanced FDG-PET-MR (Biograph mMR, Siemens). Two readers, using commercially available software, measured the
following PET-MR biomarkers: ADC, Ktrans, Ve, Kep, IAUC, SUVmax, SUVmean, and MTV. They were correlated with genetic
molecular subtypes, grading and occurrence of distant metastases.
RESULTS
Genetic molecular subtypes were as follows: ER-7, ER+14; PR-8, PR+13; HER2-11, HER2+10; Ki67-low (<=35%), Ki67 medium/high
(>35%). Grading was G2 in 14 and G3 in 7. Six patients had distant metastases. The following biomarkers were higher in the ERand PR- compared to ER+ and PR+ patients: Kep (9234±1320 versus 6492 ±2358, p0.01), SUVmax (14.19±7.17 versus 6.17±4.24,
p0.004), and SUVmean (8.44±4.01, p0.004). ADC directly correlated with the degree of Ki67 expression (1019±256 for Ki67<=35%,
1338±105 forKi67>35%, p0.002). The following biomarkers were lower in HER2- patients compared to HER2+ cases: ADC (1050±280
versus 1306±122, p0.009), Kep (6726±2240 versus 8599±2122, p0.028), SUVmax (6.29±4 versus 11.8±7.65, p0.046), and
SUVmean (3.72±2.28 versus 7.03±4.43, p0.04).G2 patients experienced lower Kep (6638±2391 versus 8944±1764, p0.04) and lower
SUVmax (6.83±4.73 versus 12.89±8.07, p 0.04) than G3 patients.No biomarkers correlated with presence of distant metastases.
CONCLUSION
In naïve ductal invasive breast cancers, PET-MR biomarkers correlate with molecular genetic subtypes and with grading, but not
with the presence of distant metastases.
PET-MR biomarkers might have prognostic and therapeutic implications on patients' management.
SSG09-07
Impact of Estrogen Receptor Gene Mutations on [18F]-Fluoroestradiol Uptake in Breast Cancer
Participants
Manoj Kumar, MS, Madison, WI (Abstract Co-Author) Nothing to Disclose
Ginny L. Powers, PhD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Justin Jeffery, Madison, WI (Abstract Co-Author) Nothing to Disclose
Yongjun Yan, PhD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Amy M. Fowler, MD, PhD, Saint Louis, MO (Presenter) Nothing to Disclose
PURPOSE
Accurately predicting therapeutic responsiveness in women with breast cancer remains challenging. Positron emission tomography
(PET) imaging using [18F]-16alpha-17beta-fluoroestradiol (FES) provides a way to non-invasively and longitudinally examine the
subset of tumors expressing estrogen receptor alpha (ERα) which comprise approximately 70% of all breast cancers. However, the
effect of mutations in the gene encoding ERα, recently identified in patients with endocrine-resistant, metastatic breast cancer, on
FES uptake is unknown. We developed a model system to test how mutations in ERα influence the uptake of FES.
Stable cell lines expressing either wild-type ERα (231-ER) or a point mutation in the ligand-binding pocket, G521R (231-G521R),
were created in the ERα-negative human breast cancer cell line MDA-MB-231. ERα-positive MCF7 human breast cancer cells were
used as a positive control and parental MDA-MB-231 cells were used as a negative control. Cell uptake of FES was measured in
vitro with microPET/CT imaging and gamma counting. In addition, in vivo FES uptake was measured in MCF7 and 231-ER tumors
grown as xenografts in athymic nude mice.
RESULTS
FES uptake was observed both in vitro and in vivo in the MCF7 and 231-ER cells/tumors. However, there was no significant FES
uptake in the 231-G521R cells or parental MDA-MB-231 cells. The 231-ER cells had a similar dose response curve to MCF7 in
competition assays using increasing doses of cold estradiol, and as consistent with the uptake data, 231-G521R binding was not
altered by cold competition.
CONCLUSION
These data support the use of stable cell lines expressing variant forms of ERα as models for demonstrating the effects of ERα gene
mutations on FES uptake. Ongoing studies are focusing on the effects of recently identified clinically-relevant ERα mutations on FES
uptake and on the prediction of response to ER-targeted therapies.
FES-PET imaging provides a non-invasive way to probe ERα function and may prove useful in identifying the development of ERα
gene mutations and thus predicting endocrine resistance in ERα-positive breast cancer patients.
SSG09-08
Imaging Patients with Breast and Prostate Cancers Using Combined 18F NaF/18F FDG and TOF
simultaneous PET/ MRI
Participants
Ryogo Minamimoto, MD, PhD, Stanford, CA (Presenter) Nothing to Disclose
Andreas M. Loening, MD, PhD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Valentina Taviani, PhD, Stanford, CA (Abstract Co-Author) Nothing to Disclose
Sanjiv S. Gambhir, MD, PhD, Stanford, CA (Abstract Co-Author) Board Member, Enlight Biosciences; Board Member, ImaginAb, Inc;
Board Member, FUJIFILM Holdings Corporation; Board Member, ClickDiagnostics, Inc; Consultant, FUJIFILM Holdings Corporation;
Consultant, Gamma Medica, Inc; Speaker, ImaginAb, Inc; Stock, Enlight Biosciences; Stock options, Enlight Biosciences; Travel
support, Gamma Medica, Inc
Shreyas S. Vasanawala, MD, PhD, Palo Alto, CA (Abstract Co-Author) Research collaboration, General Electric Company;
Consultant, Arterys; Research Grant, Bayer AG;
Andrei Iagaru, MD, Stanford, CA (Abstract Co-Author) Research Grant, General Electric Company; Research Grant, Bayer AG
PURPOSE
We previously reported the pilot evaluation of a simultaneous PET/MRI scanner with TOF capability, as well as the use of combined
18F NaF/18F FDG PET/CT in cancer patients. Here we prospectively compared the combined 18F NaF/18F FDG PET/ MRI against
99mTc-MDP in patients with breast and prostate cancers for the detection of metastatic disease.
Fifteen patients referred for 99mTc-MDP bone scans were prospectively enrolled from Oct 14 - Mar 15. The cohort included 7 men
with prostate cancer and 8 women with breast cancer, 41 - 85 year-old (average 61 ± 13). 18F NaF (0.7-2.2 mCi, mean: 1.2 mCi)
and 18F FDG (3.8-5.2 mCi, mean: 4.2 mCi) were subsequently injected from separate syringes. The PET/MRI was done 6-30 days
(average 9.3 ± 3.2) after bone scan. The whole body MRI protocol consisted of T2-weighted, DWI, and contrast-enhanced T1weighted imaging. Lesions detected with each test were tabulated and the results were compared.
RESULTS
All patients tolerated the PET/MRI exam, and PET image quality was diagnostic despite the marked reduction in the administered
dosage of radiopharmaceuticals (80% less for 18F NaF and 67% less for 18F FDG compared to standard protocols). Five patients
had no bone metastases identified on either scans. Bone scintigraphy and PET/MRI showed osseous metastases in 9 patients, but
more numerous bone findings were noted on PET/MRI than on bone scintigraphy in 3 patients. One patient had negative bone scan,
but bone metastases were seen on PET/MRI. Lesions outside the skeleton were identified by PET/MRI in 3 patients.
CONCLUSION
The combined 18F NaF/18F FDG PET/MRI is superior to 99mTc-MDP scintigraphy for evaluation of skeletal disease extent. Further, it
detected extra-skeletal disease that may change the management of these patients, while allowing a significant reduction in
radiation exposure from lower dosages of PET radiopharmaceuticals administered. A combination of 18F NaF/18F FDG PET/MRI may
provide the most accurate staging of patients with breast and prostate cancers prior to the start of treatment.
The combined 18F NaF/18F FDG PET/MRI is superior to 99mTc-MDP scintigraphy for evaluation of skeletal disease extent.
SSG09-09
In Vivo Assessment of Ovarian Tumor Response to Tyrosine Kinase Inhibitor Pazopanib using
Hyperpolarized 13C-Pyruvate MRS and 18F-FDG PET/CT Imaging in a Mouse Model
Tuesday, Dec. 1 11:50AM - 12:00PM Location: S504CD
Participants
Murali Ravoori, Houston, TX (Abstract Co-Author) Nothing to Disclose
Sheela Singh, Houston, TX (Abstract Co-Author) Nothing to Disclose
Jaehyuk Lee, Houston, TX (Abstract Co-Author) Nothing to Disclose
James Bankson, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Vikas Kundra, MD, PhD, Houston, TX (Presenter) License agreement, Introgen Therapeutics, Inc
PURPOSE
Early response measures for ovarian cancer are needed to common targets such as tyrosine kinases. Via effects on signaling within
tumor cells or via effects on angiogenesis, such inhibitory drugs have the potential to alter tumor metabolism. 18Fluorodeoxyglucose
(18F-FDG) mimics glucose and can be used to evaluate early glycolysis. Hyperpolarization magnetic resonance spectroscopy (MRS)
imaging can be used to study pyruvate, which can be produced by glycolysis and other pathways and sits at a decision point for
aerobic versus anaerobic metabolism. Our purpose was to assess whether either early or late components of metabolism can serve
as indicators of response of ovarian cancer to tyrosine kinase inhibitor (including angiogenesis inhibitor via VEGF receptor inhibition)
Pazopanib.
Seventeen days after injection of 2 x 106 human ovarian SKOV3 tumors cells into female nude mice, treatment with vehicle or
Pazopanib (2.5 mg/mouse po) was initiated. Longitudinal T2-weighted MR, hyperpolarized pyruvate MRS, and 18F-FDG PET/CT
imaging were performed pre-treatment as well as 2 days and 2 weeks after treatment.
RESULTS
Pazopanib was effective in inhibiting ovarian tumor growth compared to control (p<0.05). Significantly higher pyruvate to lactate
conversion (lactate/pyruvate+lactate ratio) was found 2 days after treatment with pazopanib compared to pre-therapy (p<0.005,
n=8). This was not seen with control or with 18F-FDG PET/CT imaging.
CONCLUSION
Findings suggest that later metabolic events (pyruvate to lactate conversion) may serve as as an early indicator of response of
ovarian cancer to tyrosine kinase (angiogenesis) inhibitor pazopanib in mouse models, even when early glycolytic events do not.
Hyperpolarized 13C-Pyruvate MRS may serve as an early indicator of response to tyrosine kinase (angiogenesis) inhibitors such as
pazopanib in ovarian cancer even when 18F-FDG PET/CT does not.
GUS-TUA
Genitourinary Tuesday Poster Discussions
Tuesday, Dec. 1 12:15PM - 12:45PM Location: GU/UR Community, Learning Center
GU
FDA
Participants
Antonio C. Westphalen, MD, Mill Valley, CA (Moderator) Nothing to Disclose
Sub-Events
GU223-SDTUA2
NSsaFe study: An Observational Study on the Incidence of Nephrogenic Systemic Fibrosis in Renal
Impaired Patients Following Gadoterate Meglumine Administration
Station #2
Participants
Jennifer V. Frabizzio, MD, Abington, PA (Presenter) Consultant, Guerbet SA
PURPOSE
: To determine the incidence of nephrogenic systemic fibrosis (NSF) in patients with renal impairment after administration of
gadoterate meglumine (DOTAREM®) and to collect data on the safety profile of gadoterate meglumine in a post-marketing
observational study.
: Safety data are being collected worldwide for hundreds of patients with moderate to severe renal impairment undergoing
contrast-enhanced magnetic resonance with gadoterate meglumine. At inclusion, clinical history, indication for MR imaging and renal
function are recorded, and patients are followed up for over 2 years with 3 visits separated by at least 3 months. During follow-up
visits, adverse events (AEs) are recorded with particular focus on any symptoms related to NSF. If NSF is suspected then biopsy is
performed for confirmation.
RESULTS
As of February 10, 2015, the safety data of 512 patients (mean age: 69.5 years (range: 21-95); male: 59.8%) were available for
review. The mean eGFR was 37.3 ±15.9 ml/min/1.73m2 (range: 4.0-74.2) including 68.4% of moderate, 16.2% of severe, 12.7% of
end-stage renal insufficiency and 2.7% of kidney transplanted patients. To date, 288 patients attended the first follow-up visit
(between 3 and 12 months after MRI), 176 patients attended the second follow-up visit (between 13 and 21 months after MRI) and
114 patients the third follow-up visit (between 22 and 27 months after MRI). No AEs related to DOTAREM® were reported. Seven
patients (1.4%) had serious adverse events due to underlying disease that were not related to gadoterate meglumine. Not a single
case of NSF has been observed.
CONCLUSION
: This interim analysis of the NSsaFe study records no cases of NSF in patients with moderate to severe renal impairment after the
administration of gadoterate meglumine.
A gadolinium agent with no incidence of NSF could allow for patients with renal impairment to obtain constast could provide more
accurate diagnosis and potentially eliminate the need to obtaining GFR laboratory values pre MRI.
GU224-SDTUA3
Quantitative Enhancement Analysis in Small Renal Mass: Differentiation of Clear Cell Carcinoma from
Other Subtypes and Angiomyolipoma with Minimal Fat at Three-phase Multi-detector CT
Station #3
Participants
See Hyung Kim, Daegu, Korea, Republic Of (Presenter) Nothing to Disclose
Jung Hee Hong, Daegu, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To quantitatively assess whether enhancement characteristics at three-phase MDCT can help differentiate clear cell RCCs from
papillary, chromophobe RCCs and AMLs with minimal fat.
IRB approved this retrospective study. A total of 409 clear cell, 62 papillary, 41 chromophobe RCCs and 51 AMLs with minimal fat
were included. Mean attenuations between clear cell RCC and the other three groups in each phase were compared using t-test.
Enhancement values, such as percentage enhancement ratio (PER), enhancement change (EC) and absolute washout ratio (AWR),
were calculated and compared using cutoff analysis with optimal threshold level among four groups.
RESULTS
Mean attenuation of clear cell RCCs was significantly greater than papillary and chromophobe RCCs in corticomedullary and early
nephrographic phases, and AMLs with minimal fat in corticomedullary phase. AMLs with minimal fat were significantly great in nonenhanced phase. There were significant differences in PER, EC and AWR of clear cell RCC, compared with those of papillary (148.8
vs. 262.5, P=0.002, 0.581 vs. 1.285, P=0.001, and 37.1 vs. -70.5, P=0.001), chromophobe RCCs (148.8 vs. 169.8, P=0.02, 0.581
vs. 0.751, P=0.02, and 37.1 vs. 28.8, P=0.03) and AMLs with minimal fat (148.8 vs. 194.2, P=0.01, 0.581 vs. 0.981, P=0.02, and
37.1 vs. 13.4, P=0.008). Diagnostic performances to differentiate clear cell RCCs from papillary, chromophobe RCCs and AMLs with
minimal fat had accuracies, ranging 80.9% (399/471) to 88.5% (417/471), 70.2% (321/457) to 74.1% (339/457) and 80.6%
(371/460) to 85.0% (391/460).
CONCLUSION
Enhancement values may help differentiate clear cell RCCs from papillary RCCs, chromophobe RCCs and AMLs with minimal fat.
Enhancement characteristics of three phase MDCT are helpful for differentiating clear cell RCCs from other subtypes and AMLs with
minimal fat.
GU225-SDTUA4
Clinical Value of Proton (1H-) Magnetic Resonance Spectroscopy (MRS) using Body-phased Array
Coil at 3.0 T in Pretreatment Assessment for Cervical Cancer Patients
Station #4
Participants
Gigin Lin, MD, Guishan, Taiwan (Presenter) Nothing to Disclose
Yu-Ting Huang, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Koon-Kwan Ng, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Yu-Chun Lin, MSC, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Tzu-Chen Yen, MD, PHD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Hung-Hsueh Chou, MD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Angel Chao, MD, Taoyuan, Taiwan (Abstract Co-Author) Nothing to Disclose
Chiun-Chieh Wang, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
Chyong-Huey Lai, Guishan, Taiwan (Abstract Co-Author) Nothing to Disclose
PURPOSE
pretreatment assessment for cervical cancer patients.
We prospectively enrolled 52 histology proven cervical cancer patients (age 27-80 years) and 30 age-matched surgical candidates
for benign uterine myoma without evidence of cervical cancer. Pretreatment MR study plus MRS and diffusion weighted imaging
(DWI) sequences were carried out at a 3.0 T system using body-phased array coil for the pelvis. PRESS localized 1H-MRS was
applied to cervical tumor or normal tissue, with resonances analyzed by using the LC-Model algorithm. Cramer-Rao lower bound
(CRLB) threshold of 20% was used as quality control. We compared resonances based on: (1) tumor vs normal cervical tissue, (2)
histopathology type (squamous vs adenocarcinoma) (3) T stage = IIb (4) nodal metastasis (5) distant metastasis using MannWhitney test.
RESULTS
Cervical tumor showed a lower 1.3-ppm lipid level (0.30 vs 1.01μM, P < .05), as compared with normal cervical tissue. Squamous
cell carcinoma demonstrated lower levels in 1.3-ppm lipid (0.17μM vs 0.59μM, P < .05) and 0.9-ppm lipid (0.04μM vs 0.16μM, P <
.05), as compared with adenocarcinoma. Tumor with T stage >= IIb had lower levels in 1.3-ppm lipid (0.15μM vs 0.53μM, P < .05),
0.9-ppm lipid (0.04μM vs 0.15μM, P < .05) and total choline (0.04μM vs 0.16μM, P < .05). Tumors with nodal metastasis contained
lower levels of 1.3-ppm lipid (0.16μM vs 0.44μM, P < .05) and glutamine (0.01μM vs 0.02μM, P < .005), whereas tumors with
distant metastasis contained a lower level of 1.3-ppm lipid (0.12μM vs 0.50μM, P < .05). However, resonances from cervical tumor
were independent to maximal tumor size or ADC value on MRI.
CONCLUSION
1H-MRS using body-phased array coil at 3.0 T in cervical cancer patients is useful in differentiating tumor, histopathology type, T
stage >= IIb, nodal or distant metastasis, and is independent to maximal tumor size or ADC value on MRI.
1H-MRS using body-phased array coil at 3.0 T added additional dimensions for pretreatment assessment in cervical cancer patients.
GU226-SDTUA5
Post Ablation MRI Evaluation of the Prostate and Predictors of Local Tumour Recurrence
Station #5
Participants
Tristan Barrett, MBBS, BSc, Guildford, United Kingdom (Presenter) Nothing to Disclose
Masoom A. Haider, MD, Toronto, ON (Abstract Co-Author) Consultant, Bayer AG
John Trachtenberg, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
Sangeet Ghai, MD, Toronto, ON (Abstract Co-Author) Nothing to Disclose
PURPOSE
To determine the morphologic changes in the prostate gland after focal laser ablation therapy for prostate cancer and to assess
the value of different MRI sequences for the detection of recurrent/residual disease
Nineteen patients undergoing focal ablation therapy for prostate cancer were followed up clinically and with MRI at 3-7 months post
therapy, with findings correlated to subsequent biopsy. The overall gland volume was compared to baseline size and morphological
features were assessed on anatomical T2 imaging including signal intensity, atrophy, capsular retraction, and loss of zonal anatomy.
Diffusion-weighted imaging was quantitatively assessed using apparent diffusion co-efficient (ADC) maps and dynamic-contrastenhanced (DCE) MRI uptake curves were calculated for treatment regions.
RESULTS
At follow-up biopsy, 8 patients (42.1%) had no evidence of prostate cancer in the region of the gland treated, and 11 (57.9%)
demonstrated recurrent/residual disease. Prostate gland volume reduced in 17/19, with a median decrease of 11.6% and a
statistically significant correlation between the size of ablation zone decrease in volume. There was no significant difference in ADC
values, nor in any of the T2-weighted imaging signs assessed between the groups. 7/8 patients with no disease demonstrated type
I enhancement curves on DCE-MRI, and none had a type III curve. 4/11 patients with recurrent/residual disease demonstrated a
type III enhancement curve; 3 of these patients had Gleason 3+4 disease on biopsy and there was a significant correlation
between the type of enhancement curve and post-treatment Gleason score.
CONCLUSION
The prostate gland undergoes expected atrophy following focal ablation therapy. Diffusion-weighted imaging and T2-weighted
imaging do not accurately distinguish residual disease. DCE-MRI enhancement curves show promise for differentiating residual
disease from fibrosis, making it the optimal sequence for follow-up assessment in this patient cohort.
Multi-parametric MRI of the prostate and DCE in particular are helpful in evaluating presence of residual disease post focal ablation
for PCa and may be used for follow up of pateints to detect recurrence of significant disease, rather than subjecting the patients
to repeated biopsies.
GU227-SDTUA6
Incidental Ovarian Lesions on CT in Post-menopausal Women with a History of Non-ovarian
Malignancy: Can We Tell Benign from Malignant?
Station #6
Participants
Akshay D. Baheti, MBBS, Seattle, WA (Presenter) Nothing to Disclose
Kiran Gangadhar, MD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Daniel S. Hippe, MS, Seattle, WA (Abstract Co-Author) Research Grant, Koninklijke Philips NV; Research Grant, General Electric
Company
Ryan O'Malley, MD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
Carolyn L. Wang, MD, Seattle, WA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Determine whether the ACR white paper on managing incidental adnexal lesions seen on CT (based on SRU guidelines)can be used in
a high-risk population of late postmenopausal women (>55 years)with known non-ovarian cancer and whether CT morphology of the
lesions can be used to discriminate benign from malignant
IRB and HIPAA compliant retrospective review was performed of 140 patients with 158 adnexal lesions,classified as simple
cystic,complex cystic,solid-cystic and solid based on CT morphology and features described in the ACR paper. Lesions were
categorized as benign,indeterminate or malignant based on pathology,imaging stability(median f/u 34 months)or response to
therapy.Intergroup comparison was done based on patient and lesion features with Fisher's exact test and permutation tests to
account for dependence between bilateral lesions in same patient.
RESULTS
20/158(13%) malignant, 44/158(28%) indeterminate and 94/158(59%) benign lesions were noted.19/20 malignant lesions were
metastases while 1 was indeterminate for colorectal metastasis vs ovarian primary. 0/105 simple cysts,2/27 complex cysts,15/21
solid-cystic and 3/5 solid lesions were malignant.Cysts classified complex due to high HU(>20) without septations or
calcifications(16/27) were all benign.Compared to benign lesions, malignant ones were more likely to have a solid component
(M:18/20 vs B:4/94,OR=202,p<0.001) rather than purely cystic features.Enhancing components and septae were more common in
malignant lesions(p<0.001). Overall, 61/140(44%)patients had metastases.Presence of peritoneal metastases significantly
correlated with ovarian involvement by malignancy(OR=30.9,p<0.001). Malignancy in adnexal lesions was significantly associated
with primary tumor type(p=0.02),with breast and colorectal cancers most common to metastasize to ovaries(5 each).
CONCLUSION
Our study supports the ACR recommendations on incidental adnexal lesions even in patients with known non-ovarian
neoplasm.Simple adnexal cysts are highly unlikely to be malignant,while lesions that are not simple cystic should be viewed with
suspicion.Peritoneal metastases have a significant correlation with ovarian involvement.
The current ACR white paper on managing incidental adnexal lesions on CT extrapolates US-based criteria.We endorse the same
using a high-risk cohort.We also evaluate them further based on CT morphology,primary tumor and metastatic pattern.
UR120-EDTUA7
Decoding MR Defecography: A Case-Based Approach
Station #7
Participants
Guangzu Gao, MD, New Haven, CT (Presenter) Nothing to Disclose
Samira Rathnayake, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Steffen Huber, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Magnestic resonance (MR) defecography can pose a challenge to the uninitiated for a variety of reasons, often related to
unfamiliarity with the relevant pelvic anatomy, confusion regarding the parameters used to measure organ descent and/or limited
knowledge of the pathologic entities themselves. The purpose of this exhibit is to help the viewer master these concepts, providing
the relevant information in a simple, yet comprehensive, quiz-based approach.
Cases will be presented in a quiz format followed by a brief explanation of the answer, highlighting the relevant concepts. We will
present a summary slide at the end of all the cases which will provide the relevant information in a tabulated form. The following
are the list of cases that will be presented/discussed: Normal anatomy Example of normal images at different phases rest, squeeze,
evacuation). Normal parameters (PCL line, H line, M line, anorectal angle) will also be showcased Abnormal entities: Anterior
compartment (cystocele, urethral hypermobility)- Middle compartment (uretrovaginal prolapse, enterocele, sigmoidocele,
peritoneocele) Posterior comparemtent (anterior and posterior rectocele, rectal intussusceptions, rectal prolapse) Descending
perineal syndrome Spastic pelvic floor syndrome (dyssynergic defecation) Summary tables
UR185-EDTUA8
Neoplastic and Non-neoplastic Proliferative Diseases of the Perinephric Space
Station #8
Participants
Morooj Al Subhi, MD, Montreal, QC (Presenter) Nothing to Disclose
Maria Tsatoumas, MD, Outremont, QC (Abstract Co-Author) Nothing to Disclose
Vipul Bist, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Amer Alaref, MD, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Benoit P. Gallix, MD, PhD, Montpellier, France (Abstract Co-Author) Nothing to Disclose
Caroline Reinhold, MD, MSc, Montreal, QC (Abstract Co-Author) Consultant, GlaxoSmithKline plc
TEACHING POINTS
1. To review the cross-sectional anatomy of the perirenal space. 2. To describe the interlacing network through which various
pathologic processes infiltrate and spread within the perirenal space.3. To illustrate the specific imaging findings of neoplastic and
non-neoplastic processes of the perirenal space.
OUTLINE• Cross-sectional anatomy of perirenal space Anatomic borders Pathways of spread via interlacing network• Neoplastic
conditionso Lymphomao Plasma-cell neoplasmo Metastaseso Primary renal cell carcinomao Retroperitoneal malignancies• Nonneoplastic conditionso Fluid (hematoma, urinoma, abcess, cysts, lymphangioma)o Inflammatory (pancreatitis, xanthogranulomatous
pyelonephritis)o Proliferative (retroperitoneal fibrosis, amyloid, extramedullary hematopoisis, rosai-dorfman and erdheim-chester
disease)CONCLUSION1. Cross-sectional imaging is crucial in diagnosing pathologic processes of the perirenal space. 2. Although
considerable overlap of the imaging findings exist, specific imaging features in combination with clinical history, can help suggest
the correct diagnosis. 3. Imaging-guided percutaneous biopsy can be performed to establish the diagnosis in indeterminate cases
allowing for accurate patient management.
Honored Educators
Caroline Reinhold, MD, MSc - 2013 Honored Educator
Caroline Reinhold, MD, MSc - 2014 Honored Educator
GUS-TUB
Genitourinary Tuesday Poster Discussions
Tuesday, Dec. 1 12:45PM - 1:15PM Location: GU/UR Community, Learning Center
GU
FDA
Participants
Sub-Events
GU228-SDTUB1
Incidence of Contrast-Induced Nephropathy, Dialysis, and Renal Graft Loss after Transplant Renal
Angiography
Station #1
Participants
Ghaneh Fananapazir, MD, Sacramento, CA (Presenter) Nothing to Disclose
Behrad Golshani, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Michael T. Corwin, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Sima Naderi, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Chris Bent, MD, SACRAMENTO, CA (Abstract Co-Author) Nothing to Disclose
Ramit Lamba, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To report the incidence of contrast-induced nephropathy (CIN), dialysis, and renal graft loss attributable to direct intraarterial
injection of the transplanted renal artery in renal allograft recipients.
Our institutional review board approved this retrospective health insurance portability and accountability act complaint study. Onehundred patients underwent conventional transplant renal arteriography. Serum creatinine levels were recorded at baseline, prior to
the arteriogram, and within the 24-72 hours after the angiogram. CIN was assessed on those patients who had a serum creatinine
within the 24-72 hour window. CIN was defined as an increase in serum creatinine of > 0.5 mg/dL and/or 1.5 times the prearteriogram creatinine. In those patients with CIN, as well as those who did not meet the criteria for assessing the creatinine in the
24-72 hour window, clinical outcomes of need for dialysis and renal allograft loss 30 days after angiography were evaluated.
RESULTS
Thirty-seven patients met the criteria for assessing for CIN, of which three patients (8%) demonstrated CIN after arteriogram.
None of the patients with CIN or those who did not meet the criteria to assess for CIN required dialysis or had graft failure at 30
days.
CONCLUSION
Even in patients with a single renal allograft, the risk of CIN appears to be low, with no subsequent need for dialysis or graft loss.
Caution regarding administration of iodinated contrast to renal transplant recipients may have been previously overstated and
administration may be performed safely.
Honored Educators
Ramit Lamba, MD - 2014 Honored Educator
GU252-SDTUB3
70 kV renal CT Angiography with 3rd Generation Dual-source CT for the Preoperative Assessment of
Robotic-assisted Laparoscopic Partial Nephrectomy: Preliminary Study
Station #3
Participants
PURPOSE
Robotic partial nephrectomy can minimalize the volume of ischemia during procedure with super-selective renal artery clumping at
Robotic partial nephrectomy can minimalize the volume of ischemia during procedure with super-selective renal artery clumping at
the distal arterial branches. Although meticulous evaluations of intra-renal arterial are warranted, the evaluation is challenging on
current renal CT angiography (CTA) because of limited contrast between the intra-renal arterial branches and the renal cortex.
Since low-energy CT radically improve contrast enhancement in CTA, we evaluated the ability of 70 kV renal CTA with 3rd
generation dual-source CT for depicting intra-renal arterial branches.
We retrospectively evaluated 23 patients who underwent renal CTA for suspicious renal neoplasm on 192-slice 3rd generation dualsource CT scanner at 70 kV. All patients were given 510 mgI/Kg of contrast media (CM) with an injection rate of 5 mL/s and CTA
was acquired using bolus-tracking technique. CT values of the abdominal aorta, the main trunk of the renal artery, and the renal
cortex were measured. The most distal artery detected on 0.6 mm slice images was recorded for each patient. The images were
evaluated using semi-automatic vessel tracking between the main trunk of the renal artery and the proximal interlobar artery.
Success rate of vessel tracking was recorded for each patient. These results were compared with historical control scanned in
conventional multi-slice CT at 120 kV.
RESULTS
CT values of the abdominal aorta, renal artery, and the renal cortex at 70 kV (793, 737, 326 HU respectively) were statistically
greater than those at 120 kV (330, 321, 154 HU; p<.0001). Although CT value differences between the artery and the renal cortex
were greater at 70 kV protocol, CT value ratio were not significantly different. 70 kV protocol could demonstrate the distal
interlobar artery in most of cases (86%), while the proximal part of interlobar artery were barely depicted at 120 kV. Consequently,
success rates of semi-automatic vessel tracking at 70 kV were greater than those at 120 kV (89 % vs. 30 %).
CONCLUSION
70 kV renal CTA with 3rd generation dual-source CT could successfully demonstrate the intra-renal branches of the renal artery,
leading to easy and reliable assessment of the tumor-supplying arterial branches.
70 kV renal CTA with 3rd generation dual-source CT is of great use for the preoperative assessment of robotic-assisted partial
nephrectomy by demonstrating the tumor supplying arteries.
GU231-SDTUB4
Diagnostic Accuracy of MRI and Diffusion-weighted Magnetic Resonance Imaging in Predicting
Response to Neo-adjuvant Chemo-radiotherapy (nCRT) in Patients with Locally Advanced Cervical
Carcinoma (LACC): Correlation with Pathological Response
Station #4
Participants
Ersilia Devicienti, Rome, Italy (Presenter) Nothing to Disclose
Anna Lia Valentini, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Benedetta Gui, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Elena Rodolfino, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Maura Micco, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Lorenzo Bonomo, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess diagnostic accuracy of MRI and diffusion-weighted magnetic resonance imaging (DWI) in predicting response to neoadjuvant chemo-radiotherapy (nCRT) in patients with locally advanced cervical carcinoma (LACC) and subsequently treated with
radical hysterectomy, in correlation with pathological response
70 women (mean age: 52.6 years) with histologically proven cervical cancer and stage FIGO>IB bulky underwent 1.5 T conventional
MRI and DWI, before (pre-nCRT MRI) and at the end of nCRT (post-nCRT MRI). Tumor volume and mADCs (calculated at b=0 and
800 s/mm2) were measured at each assessment in order to assess imaging-response to treatment. Radical hysterectomy was
performed 4 weeks after post-nCRT MRI. Treatment response was classified, according to histopathological results, as complete
response (CR), microscopical residual disease (microRD<3mm) and macroscopical residual disease (macroRD>3mm). Sensitivity,
specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI were calculated at first grouping
histopathology microRD as CR and also grouping histopathology microRD as macroRD
RESULTS
According to histopathology, 33/70 patients showed CR, 21/70 had microRD and 16/70 showed macroRD. At MRI 46 patients
showed complete response and 24 patients showed partial response to nCRT. Diagnostic accuracy, sensitivity, specificity, PPV and
NPV of MRI were respectively 82,86%, 87,50 %, 81,48%, 58,33 % and 95,65% when grouping histopathology microRD with CR and
70,00%, 54,05%, 87,88%, 83,33% and 63,04% when grouping histopathology microRD with macroRD
CONCLUSION
MRI and DWI imaging showed high diagnostic accuracy and in particular high VPN in evaluation of tumor response to nCRT in
patients with LACC. However its diagnostic accuracy is limited in patients with histopathological microRD (< 3mm) because of
intrinsic limit of MRI in spatial resolution
In this study, in which we enrolled a large number of patients with LACC proven by pathological results, MRI shows high diagnostic
accuracy in the evaluation of tumor response to nCRT and it is a reliable tool for surgery modulation
GU232-SDTUB5
Diagnostic Accuracy of PI-RADS v2: Validation with Targeted In-Bore MRI-Guided Prostate Biopsy
Station #5
Participants
Ely R. Felker, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Stephanie A. Lee-Felker, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Daniel J. Margolis, MD, Los Angeles, CA (Abstract Co-Author) Research Grant, Siemens AG
David S. Lu, MD, Los Angeles, CA (Abstract Co-Author) Consultant, Medtronic, Inc Speaker, Medtronic, Inc Consultant, Johnson &
Johnson Research Grant, Johnson & Johnson Consultant, Bayer AG Research Grant, Bayer AG Speaker, Bayer AG
Robert A. Princenthal, MD, Thousand Oaks, CA (Abstract Co-Author) Employee, Koninklijke Philips Electronics NV
John F. Feller, MD, Indian Wells, CA (Abstract Co-Author) Consultant, Koninklijke Philips NV Consultant, Visualase, Inc
Martin I. Cohen, MD, Thousand Oaks, CA (Abstract Co-Author) Nothing to Disclose
Bernadette M. Greenwood, BS, RT, Indian Wells, CA (Abstract Co-Author) Nothing to Disclose
Hyung J. Kim, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the diagnostic performance of the recently proposed PI-RADS v2 scoring system, using in-bore magnetic resonance
(MR) guided biopsy (MRGB), and to determine the correlation between PI-RADS v2 score and biopsy Gleason score (GS).
IRB-approved, HIPAA-compliant, retrospective study of 153 consecutive patients (102 men with elevated PSA and suspected PCa,
and 51 men on active surveillance; mean age 65.6 +/- 8.5 years, median PSA 7.8 ng/mL) with 191 lesions referred for mpMRI
(T2WI, DWI, DCE) at 3T followed by MRGB.Targets were originally selected by one of four experienced genitourinary radiologists and
then re-scored using PI-RADS v2 criteria by a fifth radiologist who was blinded to clinical information and biopsy histology. Test
characteristics, including sensitivity and specificity, were calculated. Clinically significant disease (CSD) was defined as GS 7 or
higher. PI-RADS v2 scores were compared among CSD, clinically insignificant PCa, and benign targets. Spearman Rank test was
used to assess correlation between PI-RADS v2 score and biopsy GS.
RESULTS
Biopsies were clinically significant PCa, insignificant PCa and benign in 63 (33%), 37 (19%) and 91 (48%) patients, respectively.
CSD had significantly higher mean PI-RADS v2 score (4.49 +/- 0.56) than insignificant PCa (3.97 +/- 0.79) and benign targets (2.96
+/- 0.73) (p < 0.0001). There was a positive correlation between PI-RADS v2 score and GS (r = 0.64, p < 0.0001). Sensitivity,
specificity, accuracy, PPV, and NPV of PI-RADS 5 for CSD were: 52%, 93%, 80%, 79%, and 80%; of PI-RADS 4 or higher for PCa
were: 90%, 75%, 83%, 80%, and 87%. The NPVs of PI-RADS < 4 for PCa and CSD were 88% and 97%, respectively.
CONCLUSION
PI-RADS v2 performs well as a predictor of MRGB outcome and has moderate to good correlation with biopsy GS.
MRGB is high-yield for detection of CSD in patients with PI-RADS v2 4 and 5 targets.The high NPV of PI-RADS v2 < 4 for CSD
suggests that monitoring of these lesions, rather than immediate targeted biopsy, may be a consideration for management.
GU233-SDTUB6
Evaluation for Reliability and Validity of Newly Developed MRI-based Radiological Scoring System for
Invasive Placenta Previa
Station #6
Participants
Yoshiko Ueno, MD, Kobe, Japan (Presenter) Nothing to Disclose
Tetsuo Maeda, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Kazuhiro Kitajima, MD, Nishinomiya, Japan (Abstract Co-Author) Nothing to Disclose
Satoru Takahashi, MD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
To examine the reliability and validity for a newly developed MRI-based radiological scoring system for invasive placenta previa
This study was based on the retrospective review of prenatal MR images of 70 patients (median age: 35 years) who underwent MR
examination at 1.5 T for the screening of invasive placenta previa. Eighteen out of 70 patients were pathologically diagnosed with
invasive placenta previa. MR imaging included axial, coronal and sagittal T2-weighted half-Fourier single-shot turbo spin echo
sequence and sagittal T1-weighted gradient echo sequence. Cumulative radiological score (CRS) was defined as a sum of Likert 5point agree/disagree scale for six MR features: T2 dark band, intraplacental abnormal vascularity, uterine bulging, heterogeneous
placenta, myometrial thinning and placental protrusion sign. Two expert radiologists (reader A and B) and two inexperienced
residents (reader C and D) who were blinded to the patient's outcome independently calculated their CRS (range 5-30). The interrater reliability of the CRS was assessed by intraclass correlation coefficient (ICC) measurement. The correlation between the CRS
and invasive placenta previa was assessed by logistic regression analysis. For evaluation of the diagnostic performance of the CRS
for invasive placenta previa, the receiver operating characteristic (ROC) analysis was performed.
RESULTS
The inter-rater reliability was excellent for the expert radiologists (ICC: 0.85), fair-to-good among all four readers (ICC: 0.72) and
the inexperienced residents (ICC: 0.66). In logistic regression analysis, there was a significant correlation between the CRS and
invasive placenta previa for all readers (R2, A: 0.57, B: 0.61, C: 0.45, D: 0.55, p<0.05). ROC analysis showed the cut off value was
17 (Sensitivity: 88.9%, Specificity: 92.3%, Accuracy: 91.4%; for reader A, Sensitivity: 83.3%, Specificity: 92.3%, Accuracy:
90.0%; for reader B, Sensitivity: 83.3%, Specificity: 92.3%, Accuracy: 90.0%; for reader C, Sensitivity: 50.0%, Specificity: 98.0%,
Accuracy: 85.7%; for reader D).
CONCLUSION
We have developed a new MRI-based radiological scoring system that demonstrates excellent or fair-to-good inter-rater reliability,
significant association, and high diagnostic performance with invasive placenta previa.
This new MRI-based radiological scoring system is suitable for the diagnosis of invasive placenta previa.
UR124-EDTUB7
Hypovascular Focal Lesions of the Kidney: Imaging Spectrum with CT, CEUS, MR and Pathology
Correlation
Station #7
Participants
Javier L. Moreno Negrete, MD, Barcelona, Spain (Presenter) Nothing to Disclose
Blanca Pano Brufau, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Laura Herrero, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Rafael Salvador Izquierdo, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Carmen Sebastia Cerqueda, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
Carlos Nicolau, MD, Barcelona, Spain (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
-Recognize the multiple differentials of a hypovascular renal focal lesion, point out the imaging features of the most frequent
etiologies and review the diagnostic keys of the least frequent causes.-Review the Bosniak classification (with particular emphasis
in CEUS and CT), the management of renal cysts and the correlation between the different imaging techniques.-Propose a
diagnostic approach for hypovascular renal lesions.
Introduction Introduction. CT, MR and CEUS protocols and technical issues. Avascular (Cystic) lesions. Review of Bosniak's
Classification by CT. Evaluation of CEUS and MR for Cyst Classification. Benign (Bosniak I-II) Indeterminate (Bosniak IIF) Malignant
(Bosniak III-IV) Hypovascular lesions. Benign. Infections, vascular causes, fatty AMLs, granulomatous diseases (Sarcoid) Malignant
UR002-EBTUB
Top Ten Pearls and Pitfalls of Magnetic Resonance Urography (MRU)
Hardcopy Backboard
Participants
Marc Dilauro, MD, MSc, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Nicola Schieda, MD, Ottawa, ON (Presenter) Nothing to Disclose
Najla Fasih, MBBS, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Krishna Prasad Shanbhogue, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Trevor A. Flood, MD, FRCPC, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Evan S. Siegelman, MD, Philadelphia, PA (Abstract Co-Author) Consultant, BioClinica, Inc; Consultant, ICON plc; Consultant, ACR
Image Metrix
TEACHING POINTS
1. Understand how to design and implement a comprehensive MRU protocol 2. Appreciate common technical pitfalls and how to
detect and avoid them 3. Develop an approach to the diagnosis of urothelial pathologies with MRU and understand common
interpretive pitfalls
Technical Pitfalls/Pearls1. Insufficient distention mimics/obscures pathology; Saline/Furosemide improves distention 2. Peristalsis
mimics strictures; Thick-slab heavily T2W TSE dynamic sequences capture peristalsis 3. TSE flow artifact mimics filling defects;
Acquire orthogonal TSE and balanced SSFP 4. T2* effects overwhelm T1 shortening; Dilute gadolinium concentration or use
Gadoxetic acid Interpretive Pitfalls/Pearls1. Hemorrhage may demonstrate restricted diffusion; Do not rely solely on DWI for
diagnosis2. Not all hilar masses are urothelial cell carcinoma (UCC); Hilar RCC mimics UCC 3. Infiltrative lesions are not always UCC;
Other malignancies (e.g. lymphoma) and benign (e.g. pyelonephritis, contusion) causes should be considered4. Not all bladder wall
thickening is malignant; Benign etiologies preserve the bladder wall layers5. Not all venous tumor thrombus is from RCC; UCC rarely
causes venous thrombosis6. Satisfaction of search is critical in MRU; UCC often demonstrates multifocality
Honored Educators
Evan S. Siegelman, MD - 2013 Honored Educator
Krishna Prasad Shanbhogue, MD - 2012 Honored Educator
Krishna Prasad Shanbhogue, MD - 2013 Honored Educator
MSCC33
Case-based Review of Nuclear Medicine: PET/CT Workshop-Cancers of the Abdomen and Pelvis (In
Conjunction with SNMMI) (An Interactive Session)
Tuesday, Dec. 1 1:30PM - 3:00PM Location: S406A
GI
GU
CT
NM
Participants
Janis P. O'Malley, MD, Birmingham, AL (Director) Nothing to Disclose
Ciaran J. Johnston, MD, Dublin, Ireland (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Identify the utility of PET CT in staging a wide variety of primary and recurrent GI, GU and gynecological cancers. 2)
Differentiate patterns of physiological FDG uptake from pathologic processes. 3) Expalin the importance of CT correlation for
selected cancer subgroups. 4) Describe the role of PET CT in assessing patient response to radiation therapy and chemotherapy,
including early assessment and PET influenced treatment strategies.
SSJ10
Genitourinary (Prostate Intervention)
Tuesday, Dec. 1 3:00PM - 4:00PM Location: E353C
GU
IR
MR
US
FDA
Participants
Aytekin Oto, MD, Chicago, IL (Moderator) Research Grant, Koninklijke Philips NV; ; ;
Temel Tirkes, MD, Indianapolis, IN (Moderator) Nothing to Disclose
Sub-Events
SSJ10-01
MR-guided In-bore versus MRI/Ultrasound Fusion Plus TRUS-guided Prostate Biopsy: A Prospective
Randomized Trial in Patients with Prior Negative Biopsies
Awards
Trainee Research Prize - Resident
Participants
Lars Schimmoeller, MD, Duesseldorf, Germany (Presenter) Nothing to Disclose
Michael Quentin, MD, Dusseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Christian Arsov, MD, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Dirk Blondin, MD, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Robert Rabenalt, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Gerald Antoch, MD, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Andreas Hiester, Dusseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Erhard Godehardt, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Helmut Erich Gabbert, D-40225 Dusseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Peter Albers, MD, PhD, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study prospectively compares the PCa detection rate (PCa-DR) of MR-guided in-bore biopsy (IB-GB) alone and MRI/ultrasound
fusion-guided biopsy combined with a systematic TRUS-GB (FUS+TRUS-GB) in patients with at least one negative TRUS-GB and PSA
level ≥4ng/ml.
253 patients were included in this study. After multiparametric prostate MRI (T2WI, DWI, DCE-MRI) at 3T patients with any PIRADS sum score ≥10 were prospectively randomized to IB-GB or FUS+TRUS-GB. Analysis of detection rates for PCa and significant
PCa (Gleason score ≥7), highest Gleason score, number of biopsy cores to detect one (significant) PCa, positivity rate of biopsy
cores, and tumor involvement per biopsy core were performed.
RESULTS
210 patients met all study requirements and were prospectively randomized, 106 patients receiving IB-GB and 104 patients
FUS+TRUS-GB (age 65.3±7.1 vs. 66.7±6.8 years; median PSA 10.0 vs. 10.8 ng/ml, IQR 7.8-14.9 vs. 7.4-15.5 ng/ml). Mean number
of cores was 5.61±0.80 vs. 17.38±1.17; p<0.001. PCa-DR for IB-GB was 36.8% (29.2% for significant PCa) and for FUS+TRUS-GB
39.4% (31.7%); p=0.776 and p=0.765. Mean highest Gleason score of 7.24±0.96 vs. 7.46±1.01; p=0.233. Positivity rate per biopsy
core was 20.7% (123/595) vs. 11.6% (210/1,808); p<0.001. Number of biopsy cores needed to detect one PCa or one significant
PCa was 15.3 vs. 44.1 and 19.2 vs. 54.8.
CONCLUSION
The combined biopsy approach did not significantly improve the overall PCa-DR compared to targeted IB-GB alone, but required
significantly more cores. A prospective comparison of MR-targeted biopsy alone to systematic TRUS-GB is justified.
We did not observe a difference between IB-GB and FUS+TRUS-GB to detect PCa.
SSJ10-02
Accuracy of Targeted Prostate Biopsy Using MR-ultrasound Fusion to Guide Biopsies Directed to Focal
Lesions Suspicious for Malignancy: A Retrospective Study of 286 Patients
Participants
Guilherme C. Mariotti, MD, Jundiai, Brazil (Presenter) Nothing to Disclose
Tatiana Martins, MD, Belo Horizonte, Brazil (Abstract Co-Author) Nothing to Disclose
Marcos R. Queiroz, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Thais Mussi, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Rodrigo Gobbo, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
PURPOSE
Demonstrate an increase in the accuracy of targeted prostate biopsy using MR-ultrasound fusion to guide biopsies directed to focal
Demonstrate an increase in the accuracy of targeted prostate biopsy using MR-ultrasound fusion to guide biopsies directed to focal
lesions suspicious for malignancy in a retrospective study of 286 patients.
A single-institutional, IRB approved retrospective analysis of 286 patients in our database, which underwent targeted prostate
biopsies using MR-ultrasound fusion from August 2013 to January 2015.We included all patients with suspected prostatic cancer
based on clinical or laboratory findings (positive digital rectal examination or high PSA) submitted to multiparametric MRI and US-MRI
fusion prostate biopsy.We excluded 7 patients with MRI-biopsy interval >= 6 months, 17 patients that underwent biopsy for staging
of known cancer or active surveillance and 1 patient for whom clinical data was unavailable.
RESULTS
A total of 261 patients were included. Of these, 45 patients (17%) underwent previous negative transrectal US-guided biopsies.
Table 1 summarizes demographic data of our casuistic.Pre-procedure MRI followed a Likert scale for suspition: Likert 1: 1 patient
(0,4%); Likert 2: 18 patients (6,9%); Likert 3: 100 patients (38,3%); Likert 4: 75 patients (28,7%); Likert 5: 67 patients
(25,7%).Overall positivity of the biopsies for tumors was 59% (154 cases), with 79% (123 cases) significant cancer (Gleason>=7),
19% (30 cases) non-significant cancer (Gleason 6) and 1 case of STUMP. Analyzing only the Likert 4 and 5 cases, in a total of 142
cases, the overall positivity was 76% (108 cases), with 90% (96 cases) significant cancer (Gleason>=7), 10% (11 cases) nonsignificant cancer (Gleason 6) and 1 leiomyoma. In our institution, the positivity of US-guided random biopsies, in a large sample of
other patients in the same period (331 patients), was around 52%.
CONCLUSION
Our study demonstrates a significant improvement in the performance of prostate biopsy with US- MRI fusion compared to random
US-guided biopsies, with potential clinical impact.
Random prostate biopsies performed on a sextant-basis have a high incidence of false-negative results, and often diagnose
microfocal lesions with low clinical significance. Targeted prostate biopsies using MR-ultrasound fusion have shown to detect
clinically significant lesions and increase the accuracy of the procedure, with better clinical outcomes.
SSJ10-03
Targeted MR-guided Prostate Biopsy: Are Two Biopsy Cores per MRI Lesion Required?
Participants
Lars Schimmoeller, MD, Duesseldorf, Germany (Presenter) Nothing to Disclose
Frederic Dietzel, Dusseldorf, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study evaluates the efficiency and potential benefit of taking two biopsy cores per MRI lesion when performing targeted MRguided prostate biopsy.
1545 biopsy cores of 774 intraprostatic lesions (two cores per lesion) in 290 patients (66.2±7.8 years; median PSA 8.2 ng/ml; IQR
6.0-12.0 ng/ml) were retrospectively evaluated regarding PCa detection, Gleason score, and tumor infiltration of the first (FBC)
compared to the second biopsy core (SBC). All patients received previously a multiparametric (mp)-MRI (T2WI, DWI, DCE) of the
prostate at 3T and all lesions were histologically verified by MR-guided in-bore biopsy.
RESULTS
491 biopsy cores were prostate cancer (PCa) positive, 239 of 774 (30.9%) FBC and 252 of 771 (32.7%) SBC (p=0.446). 61 FBC vs.
78 SBC detected significant PCa with a Gleason score ≥4+3=7 (25.5% vs. 31.0%; p=0.125). 687 SBC (89.1%) showed no histologic
difference to the FBC. 74 SBC resulted in a higher tumor involvement per core when detecting the same Gleason sore (38.1%). In
total 29.9% of the PCa lesions were Gleason-upgraded by SBC. 40 SBC detected PCA by negative FBC (5.2%). 43 SBC resulted in a
Gleason upgrade (5.6%). 20 SBC showed a Gleason upgrade from a Gleason score 3+3=6 to ≥3+4=7 (2.6%) and 4 SBC to a Gleason
score ≥4+3=7 (0.5%). 14 SBC showed a Gleason upgrade from 3+4=7 to ≥4+3=7 (1.8%).
CONCLUSION
The benefit of a second targeted biopsy core per suspicious MRI lesion is likely minor, especially regarding a significant Gleason
upgrade. Therefore a further reduction of biopsy cores is feasible when performing a targeted MR-guided in-bore prostate biopsy.
Provided a correct biopsy position was documented a second biopsy core per MRI lesion may be omitted for targeted MR-guided inbore biopsy.
SSJ10-04
Prostate Cancer Aggressiveness: Correlation Between Multiparametric MRI and Molecular Stagging
Using the CCP Score (Prolaris™ test)
Participants
Raphaele M. Renard-Penna, Paris, France (Presenter) Nothing to Disclose
Geraldine Cancel-Tassin, Paris, France (Abstract Co-Author) Nothing to Disclose
Eva M. Comperat, MD, Paris, France (Abstract Co-Author) Nothing to Disclose
Justine Varinot, Paris, France (Abstract Co-Author) Nothing to Disclose
Pierre Mozer, MD, PhD, Paris, France (Abstract Co-Author) Nothing to Disclose
Morgan Roupret, Paris, France (Abstract Co-Author) Nothing to Disclose
Marc O. Bitker, Paris, France (Abstract Co-Author) Nothing to Disclose
Olivier Lucidarme, MD, Paris, France (Abstract Co-Author) Consultant, Bracco Group Consultant, F. Hoffmann-La Roche Ltd
Consultant, Boehringer Ingelheim GmbH
Olivier Cussenot, Paris, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
To correlate the ESUR-PI-RADS components as prognostic imaging biomarkers in localized prostate cancer to the Gleason score and
the molecular CCP score (Prolaris™) .
107 patients who had a multiparametric (mp) MRI before (RP) were selected. The largest lesion (index lesion) was measured on T2MRI (Fig 1A) and ADC map and was classified with the ESUR-PI-RADS scoring system. A region of interest (ROI) was drown in the
center of each target, on the ADC map . A single ADC ROI was correlated to histologically index proven lesion. The index lesions
pointed out by mp MRI were matched on RP specimens and were run in Myriad's Research Laboratory in accordance with the
Prolaris™ protocol in order to perform CCP score
RESULTS
For each index lesion the Pearson's correlations between, pretherapeutic CAPRA score, compoments of the ESUR-PIRADS score,
including the maximal diameter (Tmax) and the topography of the index tumor were compared with the histo-pathological
observations on the RP specimen.ESUR-PI RADS score and its components were tested with logistic regression model in oreder to
assess their predictive value for Gleason's grade 4, CCP score value on the index lesion.On one hand, significant negative
correlation was found between mean ADCs and diameter of the index lesion with Gleason's grade 4 ( p=0.0078). The logistic
regression model including Tmax (over 10mm) and ADC (under 800) predict with confidence Gleason'grade 4 in the index lesion (Fig
3). On the other hand, The Tmax or ADC size of the index lesion, remains unable to point out the aggressiveness of 7 tumours
defined by CCP score. Among those, six were Gleason 6 (3+3) with a median Tmax of 8mm, and one of 8 mm was Gleason 7(3+4)
CONCLUSION
By mapping image features to gene expression data we were able to show that diffusion imaging and tumor size offer a potential for
in vivo non invasive assessment of prognostic cancer aggressiveness.However CCP score related to high risk of lethal cancer did
not, completely match with the mpMRI tumour map and Gleason score in 7% of patients. These results previosuly suggested by
large scale genomic analysis suggest that the further management of early stages PCa could strongly beneficed of targeted biopsy
with moelcular analysis
This radio genomic correlation suggest that management of PCa could strongly benefit from both MRI targeted biopsy and
subsequent molecular analysis.
SSJ10-05
Multi-parametric MRI (MpMRI) Findings after Focal Laser Ablation for Prostate Cancer (Pca)
Participants
Aytekin Oto, MD, Chicago, IL (Presenter) Research Grant, Koninklijke Philips NV; ; ;
Shiyang Wang, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Xiaobing Fan, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Stephen Thomas, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Ambereen Yousuf, MBBS, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Gregory S. Karczmar, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Tatjana Antic, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Scott Eggener, Chicago, IL (Abstract Co-Author) Research Grant, Visualase, Inc Speakers Bureau, Johnson & Johnson
PURPOSE
To describe the quantitative and qualitative MpMRI findings following focal laser ablation of Pca
27 patients with 36 cancer foci on baseline MRI, underwent MRI guided focal laser ablation were prospectively followed with,
immediate (36/36 sites), 3-month (36/36 sites) and 12-month (24/36 sites) post-procedure 3T MpMRI and TRUS guided biopsy at
12 months. Qualitative and quantitative MpMRI findings including size and appearance of ablation defect, ADC, K(trans) and Ve
were recorded and compared between the follow-up studies and between patients with and without residual disease.
RESULTS
36 cancer foci were ablated in 27 patients. Ablation defect was clearly visible on 36/36, 11/36 and 0/24 sites on the immediate, 3month and 12-month post-contrast DCE-MR images respectively, with a gradual decrease in size on 3 month MRI even in visible
cases. Focal atrophy/scarring was noted at the site of ablation in 10/36 and 20/24 sites on 3-month and 12-month MRI. Mean
K(trans) values were significantly lower on post-procedure MRI`s compared to baseline values (p<0.05). Mean ADC values on 3month MRI were significantly higher than the baseline ADC values (p<0.05). There was not significant change in Ve (p>0.05). In 2/4
cases with residual cancer, focal early enhancement was noted on 12-month DCE-MR Images. Other than 1 case with residual
cancer, no focal lesion (other than diffuse and ill-defined changes secondary to ablation) was noted at the ablation site on 12month T2 and ADC images.
CONCLUSION
Immediate post-contrast MR images are helpful for identification of the ablation defect. Quantitative MR parameters such as ADC
and K (trans) change significantly following ablation. Early focal enhancement on DCE-MR Images at the ablation zone at 12-month
MRI is a suspicious finding for residual tumor.
Follow-up MR images can be obtained at 12 months after laser ablation and early focal enhancement at the ablation zone can be
considered suspicious for residual cancer.
Honored Educators
SSJ10-06
Primary and Secondary Prostate Biopsy Settings: Differences When Performing Targeted MR-guided
Biopsies
Participants
Frederic Dietzel, Dusseldorf, Germany (Presenter) Nothing to Disclose
Lars Schimmoeller, MD, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
Erhard Godehardt, Duesseldorf, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study evaluates the MR-guided in-bore biopsy (IB-GB) in patients, who were either biopsy naive (primary biopsy) or who had
undergone at least one previous negative trans-rectal ultrasound-guided biopsy (secondary biopsy) with regard to cancer detection
rate, tumor localization and lesion size.
In total, 1,602 biopsy cores from 297 patients (66.1±7.8y; median PSA 8.2ng/ml; prostate volume 58±30ml) in primary (n=160) and
secondary (n=137) prostate biopsies settings were evaluated in this retrospective study. All patients received diagnostic prostate
MRI (T2WI, DWI, DCE) at 3T. All lesions described on MRI were biopsied with IB-GB and examined histologically.
RESULTS
In 148 patients 511 cores were positive for prostate cancer (PCa). Clinically significant PCa was found in 82.4% (any Gleason
pattern ≥4). PCa detection rate for patients with primary biopsies was 55.6% and 43.1% for secondary biopsies. In patients with
primary vs. secondary biopsies, PCa was located peripherally in 62.5% vs. 49.5% (p=0.04), in the transition zone in 27.3% vs.
27.5% (p=0.53), and in the anterior stroma in 10.2% vs. 22.9% (p<0.01). Higher grade PCa (Gleason score ≥4+3=7) occurred
apically in 38.5% (p=0.01). PCa detection rates for patients with smaller prostate volumes (<30ml vs. 30-50ml vs. >50ml; p<0.01)
or larger lesion sizes (>0.5cm3 vs. 0.5-0.25cm3 vs. <0.25cm3; p<0.01) were significantly higher.
CONCLUSION
In primary and secondary prostate biopsies PCa detection rates were significantly higher for larger lesions and smaller prostate
glands. In secondary biopsies, PCa was anteriorly located at a significantly more frequent rate. Higher grade PCa was detected in
both settings in an apical location more often.
MRI-guided in-bore biopsy led to high detection rates, especially of clinically significant PCa, in primary and secondary prostate
biopsies.
SSJ11
Genitourinary (Multimodality Imaging of Pregnancy and Pelvic Floor)
Tuesday, Dec. 1 3:00PM - 4:00PM Location: E353B
GU
MR
US
Participants
Elizabeth A. Sadowski, MD, Madison, WI (Moderator) Nothing to Disclose
Mary C. Frates, MD, Sharon, MA (Moderator) Nothing to Disclose
Sub-Events
SSJ11-01
Dynamic Contrast-enhanced MRI Combined with Diffusion Weighted Imaging in Differential Diagnosis
of Malignant Gestational Trophoblastic Neoplasia and Postpartum Retained Placental
Participants
Kangkang Xue, Zhengzhou, China (Presenter) Nothing to Disclose
Jingliang Cheng, MD, Zhengzhou, China (Abstract Co-Author) Nothing to Disclose
Yong Zhang, DO, Zhengzhou, China (Abstract Co-Author) Nothing to Disclose
Tianxia Bei, Zhengzhou, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To explore the application value of dynamic contrast-enhanced MRI (DCE-MRI) combined with diffusion weighted(DW-MRI) in the
differential diagnosis of malignant gestational trophoblastic neoplasia(MGTN) and postpartum retained placental tissue(RPT).
The institutional review board approved this retrospective stuty and waived the requirement for informed consent. 74 cases(median
age, 30.6 years; age range, 20-48 years) of MGTN and RPT confirmed clinically were retrospectively analyzed, all patients
underwent DCE-MRI and DW-MRI(500 and 1000 mm²/s) at 3.0T. Types of time signal-intensity curves(TIC) and quantitative
analysis of time to peak(TTP), maximum contrast enhancement ratio(MCER) and ADC values of each case were performed.
Differences in TTP, MCER, and ADC values between MGTN and RPT were evaluated using the independent samples t-test
respectively.The sensitivity, specificity and accuracy of dynamic contrast-MRI, DW-MRI and combination of the two methods in
diagnosing MGTN and RPT were calculated.
RESULTS
There were 39 MGTN, of which 13 lesions were invasive mole and 26 lesions were choriocarcinoma. There were 35 RPT, of which 14
lesions were normal retained placenta, 6 lesions were adherent placenta and 15 lesions were implanted placenta. The mean ADC
value and TTP of MGTN(1.38±0.11×10-3mm²/s, 37.84±3.73 s) were significantly different( p<0.01 ) from that of
RPT(2.03±0.56×10-3mm²/s, 102.11±9.14 s).The MECR of MGNT(248.58±19.28%) was not significantly different (P>0.05) from that
of RPT(236.45±16.77%) statistically. The sensitivity, specificity and accuracy in diagnosing MGTN and RPT was 84.62%, 85.71%,
85.13% for DCE-MRI; 89.74%, 88.57%, 89.19% for DW-MRI; 94.87%, 94.29%, 94.59% for combination of the two methods.
CONCLUSION
MGTN and RPT has different features in DCE-MRI and DW-MRI respectively, and the combination of the two methods can provide
high application value for the differential diagnosis of MGTN and RPT.
The clinical issues and standard imaging features of malignant gestational trophoblastic neoplasia and postpartum retained placental
tissue are similar, and the combination of DWI and dynamic-enhanced MRI can help clinician distinguish them, so as to decide
treatment plans.
SSJ11-02
Variable Sonographic Features and Imaging Underdiagnosis of Partial Molar Pregnancy
Participants
Julia Savage, MD, Ann Arbor, MI (Presenter) Nothing to Disclose
GlaxoSmithKline plc
Erika Mowers, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Katherine Pasque, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Ashish P. Wasnik, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Vanessa Dalton, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Jason Bell, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
PURPOSE
The goal of this study is to describe the ultrasound findings in histopathologically proven molar pregnancies and to correlate these
findings with clinical parameters including serum beta-hCG levels and partial vs. complete molar pregnancy.
Retrospective chart review revealed 72 women with failed pregnancy or elective termination with histopathologic diagnosis of molar
pregnancy and available ultrasound images between January 1, 2001 to December 31, 2011. Clinical data, ultrasound images and
reports were reviewed.
RESULTS
Mean age of women was 30.45 ± 6.97 years of age (range: 16-49), with 1.25 ± 1.49 prior pregnancies (range: 1-11). Mean
gestational age (GA) by last menstrual period was 74.45 ± 19.07 days (range: 39-138) and median serum beta-hCG was 64,400
(range: 447-662,000), with expected positive correlations between mean sac diameter (MSD) vs. beta-hCG (r=0.45, p=0.004) and
MSD vs. GA (r=0.54, p<.0001). Pathologic results showed 49 partial and 23 complete moles. By imaging, partial moles were more
commonly described as having a discrete gestational sac (85.7 vs 21.7%, p<.0001), yolk sac (48.9 vs. 4.6%, p=0.0003), or fetal
pole (57.1 vs. 0%, p<.0001), while complete moles were more likely to show clearly abnormal tissue in the uterus (82.6 vs. 20.8%,
p<.0001) and to be prospectively diagnosed as molar pregnancy by the dictating radiologist (86.9 vs. 40.82%, p=0.0002).
CONCLUSION
Partial molar pregnancy is associated with a highly variable sonographic appearance and frequent detection of recognizable
products of conception, which may contribute to its underdiagnosis by imaging. Complete molar pregnancy is more strikingly
abnormal and thus recognizable by imaging, and commonly diagnosed prospectively.
Suspicion of hydatidiform mole in failed pregnancy has impacts on clinical management including: need for uterine evacuation,
submission of products of conception to pathology, and serum b-hCG surveillance; failure to prospectively suggest or diagnose
molar pregnancy may negatively impact patient care.
Honored Educators
SSJ11-03
Performance of Translabial Ultrasound versus Pelvic Floor MRI in the Detection of Transvaginal Mesh
Implant Complications
Participants
Karoly Viragh, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Seth A. Cohen, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Shlomo Raz, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
The goal of the study was to determine the efficacy of 2D and 3D dynamic translabial ultrasound versus pelvic floor MRI in the
detection of transvaginal mesh implant complications.
With IRB approval and HIPAA compliance, a retrospective observational study was performed to correlate the intraoperative findings
of transvaginal mesh implant complications (perforation, extrusion, fluid collections) with the standard pre-operative translabial
ultrasound and pelvic floor MRI evaluations in women who were treated with suburethral transvaginal mesh implant for stress urinary
incontinence or pelvic organ prolapse. The pre-operative translabial ultrasound and MRI examinations were reviewed with attention
to technical details. The sensitivity of ultrasound in identifying complications was calculated. The location of the transvaginal mesh
with respect to the bladder and urethra was also evaluated (extraluminal, intramural, intraluminal). Factors for technical
improvement were identified.
RESULTS
The study cohort included 200 women (mean age 55 years) with transvaginal mesh implants for who underwent 2D and 3D dynamic
translabial ultrasound, pelvic floor MRI and mesh excision at our institution between 2007 and 2013. Descriptive statistics were
provided. 17 patients were found to have perforation into the urethra and/or bladder during surgery. None were found to have
extrusion or significant fluid collections. Translabial ultrasound had a sensitivity of (12/17) 70.5%, whereas detection of mesh
fragments by MRI was challenging even in retrospect. Limitations were due to suboptimal visualization of the mesh fragments, which
could be improved with pre-procedural hydration for bladder distention and the use of vaginal gel to better image the suburethral
space.
CONCLUSION
2D and 3D dynamic translabial ultrasound is a powerful real-time method for transvaginal mesh localization and for visualizing
complications, most importantly perforation into the urethra and/or bladder, which allows for better surgical planning and preoperative patient counseling.
Translabial ultrasonography is a powerful real-time diagnostic technique for the evaluation of female pelvic floor dysfunction and is
more sensitive than MR in detecting transvaginal mesh perforation.
SSJ11-04
To Determine the Ultrasound Predictors of Successful Treatment of Ectopic Pregnancy Using a Single
Dose Methotrexate Protocol: Preliminary Results
Participants
Margarita V. Revzin, MD, Wilton, CT (Presenter) Nothing to Disclose
Dennis Toy, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Regina J. Hooley, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Leslie M. Scoutt, MD, New Haven, CT (Abstract Co-Author) Consultant, Koninklijke Philips NV
PURPOSE
Uncomplicated ectopic pregnancy (EP) usually is managed with methotrexate (MTX) and other non-surgical interventions. There is
limited data on the expected US findings of MTX treated EPs. The aim of the present study is to identify US predictors of
successful treatment with MTX.
This is a retrospective IRB approved and HIPAA compliant cohort study, exempt from informed consent. The medical records of 121
women (mean age of 29 + 5.3 years) who were diagnosed with an EP and underwent a single dose treatment with MTX were
reviewed. Only those subjects who had a visible EP without heart activity on US prior to treatment and who had a follow up US
after treatment were included in the study (n=52). Post treatment EP were evaluated with respect to the change in size, shape,
echogenicity of the EP, presence of a gestational and yolk sac, fetal heart rate, vascularity, and hemoperitoneum after treatment.
Results were correlated with patient b-hCG levels, clinical symptoms and necessity for surgical intervention. Qualitative and
quantitative parameters were analyzed using parametric and nonparametric tests.
RESULTS
Separate assessment of the US findings with respect to their sensitivity(Ss), specificity (Sp), NPV and PPV respectively are as
follows: EP change in size 53%, 57%, 45%, 55%, shape 89%, 75%, 85%, 78%, echogenicity 87%, 78%, 85%, 90%, avascularity
79%, 90%, 85%, 88%; and absent or small hemoperitoneum 90%, 86%, 87%, 78% ; A combination of at least three of these
findings was most accurate with Ss 95%, Sp 96%, PPV 95%, NPV 90%.Presence of fetal heart activity, increased size of yolk sac
and gestational sac, large amount of hemoperitoneum were strong US predictors of failure of MTX treatment with Ss 100%, Sp
100%, PPV 100%, NPV 99%
CONCLUSION
A combination of at least three US findings including stable shape and echogenicity, avascularity and absence or small amount of
hemoperitoneum are best US predictors of successful MTX treatment of EPs. Detection of fetal heart activity, large
hemoperitoneum, and increase in size of gestational and yolk sac are strong US predictors of a failure of MTX treatment. Change in
size of the EP after MTX treatment is not a reliable predictor of either treatment success or failure.
US findings aid in prediction of successful treatment of ectopic pregnancy using a single dose methotrexate protocol
Honored Educators
SSJ11-05
Accuracy of MRI in the Prenatal Diagnosis of the Abnormally Adherent Placenta: Comparison with
Findings at the Time of Delivery
Participants
Sherelle L. Laifer-Narin, MD, Englewood, NJ (Presenter) Nothing to Disclose
Sidney Z. Brejt, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Sarah Goodman, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Jason Wright, New York, NY (Abstract Co-Author) Nothing to Disclose
Jeffrey H. Newhouse, MD, Bronxville, NY (Abstract Co-Author) Research Consultant, PAREXEL International Corporation
PURPOSE
To evaluate the accuracy of magnetic resonance imaging in diagnosing invasive placentation.
A retrospective review of all patients referred for MRI of the placenta from December 2004 to December 2014 was performed.
Indications for MRI included abnormal appearance of the placenta on ultrasound, history of prior cesarean delivery, and history of
prior uterine surgery. MRI reports were reviewed for placental location, presence or absence of abnormal placentation according to
established MRI findings, and suspicion for parametrial involvement. Criteria included the presence of dark intraplacental bands,
heterogeneous signal intensity, abnormal vascularization and thickened nodular contour along the urinary bladder surface, uterine
bulging into the bladder, and loss of the myometrial margin. MRI was considered positive even if only one of these criteria were
present. Comparison was made with findings at either delivery or operation, and pathology reports.
RESULTS
256 MRI exams were reviewed. 144 exams were negative both on MRI and delivery/pathology. 8 exams interpreted as normal on MRI
underwent hysterectomy with pathology demonstrating placenta accreta. 80 exams were interpreted as positive for abnormal
placentation, and were diagnosed as accreta, increta, or percreta on delivery/pathology. 24 cases interpreted as positive on MRI
had normal placental delivery and pathology. MR diagnosis of abnormal placentation had a sensitivity of 91%, specificity of 86%,
PPV of 77%, NPV of 95%, and an accuracy of 87.5%.
CONCLUSION
Placental adhesive disorder is a significant cause of maternal morbidity and mortality. Prenatal MRI is accurate in evaluating invasive
placentation in patients at high risk for this condition.
MRI can provide topographic information specifically in cases with lateral extension into the parametrical regions. Identification of
abnormal placentation assists the clinician in planning the mode of delivery, extent and location of surgical incision, and determining
the need for multidisciplinary involvement and assistance.
SSJ11-06
3T Pelvic MRI Thresholds for Pelvic Organ Prolapse before and after First Childbirth
Participants
Mark E. Lockhart, MD, Birmingham, AL (Presenter) Nothing to Disclose
Holly Richter, MD, Birmingham, AL (Abstract Co-Author) Research Grant, Pelvalon, Inc; Consultant, Pelvalon, Inc; Consultant,
Kimberly-Clark Corporation; Royalties, UpToDate, Inc
Gordon W. Bates, MD, Birmingham, AL (Abstract Co-Author) Nothing to Disclose
Timothy M. Beasley, PhD, Birmingham, AL (Abstract Co-Author) Nothing to Disclose
Desiree E. Morgan, MD, Birmingham, AL (Abstract Co-Author) Research support, General Electric Company
PURPOSE
To evaluate the usefulness of published 3T MRI parameters suggesting pelvic organ prolapse before and after first childbirth
In this IRB-approved HIPAA-compliant prospective cohort study, patients presenting for reproductive assistance were recruited to
complete validated questionnaires, clinical pelvic exams, baseline dynamic 3T MRI, and repeat MRI 6 months after delivery. Subjects
were nulliparous women, at least 19 years age, and asymptomatic by Pelvic Floor Distress Inventory-20. Predetermined published
thresholds or 2 SD beyond means in the literature for pelvic prolapse on MRI were evaluated. Also, a 10% change from baseline to
postpartum was considered a significant change. Using 120 cc rectal gel and pelvic phased array coil over the pelvis, static 3mm
axial and coronal T2 FSE sequences were followed by 10 mm thick dynamic sagittal HASTE at rest and during strain. The 10 mm
sagittal sequence then evaluated pelvic floor mobility during evacuation of the rectal gel. MRI parameters were measured by a
fellowship-trained radiologist, blinded to clinical data.
RESULTS
19 subjects (mean age 31 years) completed baseline clinical and MRI studies, and 10 (mean age 30.5 years) of them completed
postpartum clinical and MRI studies. None developed significant pelvic floor symptoms by the PFDI-7 and PISQ-12 questionnaires
after childbirth. None had levator tears at baseline; two subjects developed tears postpartum. Mean pelvic floor mobility was
increased in patients after childbirth and 17 pelvic soft tissue parameters increased by greater than 10% postpartum. At baseline
7/133 (5.3%), 8/209 (3.8%), and 79/209 (37.8%) of pelvic soft tissue measurements exceeded published thresholds (indicating
prolapse) at rest, strain, and evacuation, respectively, majority in the anterior compartment. After pregnancy and childbirth, 4/70
(5.7%), 6/110 (5.5%), and 51/110 (46.4%) exceeded thresholds at rest, strain, and evacuation, respectively, in this asymptomatic
population. Osseous parameters remained unchanged.
CONCLUSION
Although published soft tissue parameters work well for rest and strain MR imaging, their values in evacuatory series are frequently
exceeded, even in asymptomatic nulliparous and primiparous women.
In nulliparous and primiparous women, the evacuatory phase will commonly exceed published MRI thresholds for pelvic organ
prolapse and therefore results should be used with caution.
SSJ14
Molecular Imaging (Prostate/Neuroendocrine Tumors)
Tuesday, Dec. 1 3:00PM - 4:00PM Location: S504CD
GU
BQ
MI
MR
FDA
Participants
Peter L. Choyke, MD, Rockville, MD (Moderator) Researcher, Koninklijke Philips NV Researcher, General Electric Company Researcher,
Siemens AG Researcher, iCAD, Inc Researcher, Aspyrian Therapeutics, Inc Researcher, ImaginAb, Inc Researcher, Aura Biosciences,
Inc
Vikas Kundra, MD, PhD, Houston, TX (Moderator) License agreement, Introgen Therapeutics, Inc
Sub-Events
SSJ14-01
Promising Role of Ga-68 PSMA PET/CT over Conventional Imaging in Staging and Restaging of
Carcinoma Prostate
Participants
Venkatesh Rangarajan, MBBS, Mumbai, India (Presenter) Nothing to Disclose
Archi Agrawal, MBBS, Mumbai, India (Abstract Co-Author) Nothing to Disclose
Rasika Kabnurkar, MBBS, Mumbai, India (Abstract Co-Author) Nothing to Disclose
Nilendu C. Purandare, DMRD, Mumbai, India (Abstract Co-Author) Nothing to Disclose
Sneha A. Shah, Mumbai, India (Abstract Co-Author) Nothing to Disclose
PURPOSE
1) To study the utility of Ga-68 Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography
(PET/CT) for staging and restaging of Carcinoma Prostate (CaP).2) To compare the efficacy of Ga-68 PSMA PET/CT with Contrast
Enhanced Computed Tomography (CECT) and F18 Sodium Fluoride (NaF) PET/CT for lesion detection
Retrospective audit of prospectively maintained data of 25 patients of CaP (3 for staging and 22 with biochemical failure for
restaging) who underwent Ga-68 PSMA PET/CT, CECT and F18 NaF PET/CT scan. The imaging findings were analyzed on lesionlesion and patient-patient basis for concordance and discordance.
RESULTS
All the 3 cases imaged for staging evaluation demonstrated Ga-68 PSMA uptake at the site of primary while CECT demonstrated
lesion in only 1 patient. In cases with suspected biochemical failure, local recurrence was detected in 59% (13/22) patients on Ga68 PSMA PET/CT as against 9 % (2/22) detected on CECT. In 25 patients studied, Ga-68 PSMA PET/CT detected 43 metastatic
nodes compared to 29 detected on CECT. Ga-68 PSMA detected additional metastases in sub cm sized nodes in 24% (6/25)
patients. Ga-68 PSMA had incremental value in detecting occult extranodal metastases involving urinary bladder, pararectal nodule
and peritoneal deposit in 8% (2/25) patients .In 25 patients, 109 skeletal lesions were detected on Ga-68 PSMA while F18 NaF
PET/CT demonsrated147 lesions. Concordance in imaging findings of Ga-68 PSMA PET/CT and F 18 Fluoride PET/CT was noted in
68% (17/25) patients. Ga-68 PSMA PET/CT had an incremental value in staging of 1 patient where it detected lytic and marrow
metastases. In restaging group, 7 patients showed additional lesions on F18 NaF PET/CT.
CONCLUSION
Ga-68 PSMA PET/CT is superior in detection of primary, nodal and soft tissue metastases as compared to conventional imaging
techniques. However, F18 NaF PET/CT appears to detect more skeletal lesions in patients with biochemical failure in our study and
further prospective trials are warranted to confirm these findings.
Ga-68 PSMA PET/CT has an incremental value as a one stop shop in staging and restaging of carcinoma prostate
SSJ14-02
18F-fluoro-4-thia-palmitate (18F-FTP) PET Imaging for Evaluation of Exogenous Fatty Acid
Metabolism in Prostate Cancer: Implications for Treatment Optimization
Participants
Pedram Heidari, MD, Boston, MA (Presenter) Nothing to Disclose
Shadi A. Esfahani, MD, MPH, Boston, MA (Abstract Co-Author) Nothing to Disclose
Giorgia Zadra, PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Michael S. Placzek, PhD, Charlestown, MA (Abstract Co-Author) Nothing to Disclose
Benjamin Larimer, PhD, Charlestown, MA (Abstract Co-Author) Nothing to Disclose
Jacob M. Hooker, PhD, Charlestown, MA (Abstract Co-Author) Nothing to Disclose
Massimo Loda, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Upregulation of de novo lipogenesis is a major metabolic change in PCa development, and correlates with tumor progression and
Upregulation of de novo lipogenesis is a major metabolic change in PCa development, and correlates with tumor progression and
poor prognosis. Differentiation of diet-derived versus de novo fatty acid (FA) utilization in PCa is essential in designing anti-lipogenic
therapeutics. We aim to evaluate the use of 18F-fluoro-4-thia-palmitate (18F-FTP) PET for assessment of exogenous FA utilization
by PCa.
14C incorporation into lipids of LNCaP cells by a glucose donor (marker of de novo lipogenesis) was measured by a beta-counter
after treatment with vehicle, IPI-9119, or C75. Growth inhibition rescue of LNCaP cells was performed using Cell Titer Glo assay
after incubation with IPI-9119 alone or in the presence of BSA or of BSA-conjugated palmitate. For in-vitro 18F-FTP uptake study
LNCaP cells were incubated with IPI-9119, C75, Etomoxir, SSO, DMSO, and combination of IPI-9119 with Etomoxir or C75 for 24
hours. The cells were then incubated with 18F-FTP and harvested to measure retained activity corrected for cell count. IACUC
approval was obtained. Mice with subcutaneous LNCaP xenografts were fasted. PET data was acquired in list mode after injection
of 18F-FTP. The SUVmean and tracer influx constant were measured.
RESULTS
14C incorporation in lipids decreased to approximately 25% of control using both IPI-9119 and C75 indicating FASN inhibition. LNCaP
growth inhibition was aborted by BSA-conjugated palmitate. 18F-FTP uptake significantly increased with IPI-9119 treatment, while
C75, etomoxir, SSO treatment reduced 18F-FTP uptake. 18F-FTP PET demonstrated significantly decreased uptake in LNCaP tumors
following treatment with C75 and etomoxir compared to control (SUVmean=0.20±0.01, 0.25±0.2, and 0.40±0.02, respectively).
CONCLUSION
We demonstrated that metabolic imaging using 18F-FTP can be used to assess the exogenous FA utilization by PCa. As expected,
IPI-9119 (selective FASN inhibitor) increased the exogenous FA (18F-FTP) uptake while C75, which induces a host of metabolic
modulations other than FASN inhibition paradoxically reduces 18F-FTP uptake. Etomoxir (FAO inhibitor) and SSO (FA transporter
inhibitor) reduce 18F-FTP uptake as expected.
Understanding the effect of exogenous lipid availability on therapeutic potential of targeting de novo lipogenesis is critical in
prostate cancer treatment. This could lead to treatment strategies that result in maximal efficacy.
SSJ14-03
Feasibility of Hyperpolarized 13C-Pyruvate Magnetic Resonance Spectroscopy for Pancreatic Cancer
Diagnostic Imaging
Participants
Stephanie K. Carlson, MD, Rochester, MN (Presenter) Royalties, Medspira, LLC
Alan Penheiter, PhD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Prasanna K. Mishra, PhD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Fergus J. Couch, PhD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Slobodan I. Macura, PhD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
John D. Port, MD, PhD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Malgorzata Marjanska, PhD, Minneapolis, MN (Abstract Co-Author) Nothing to Disclose
Claire E. Bender, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
PURPOSE
Hyperpolarized (HP) 13C magnetic resonance spectroscopic imaging (MRSI) is a recently developed technique that allows the
detection of injected 13C-labeled agents and their metabolites in real-time. The purpose of this study was to identify and explore
potential metabolic pathways in pancreatic ductal adenocarcinoma (PDAC) that could be targeted with HP-13C MRSI to increase
the diagnostic accuracy of pancreatic cancer imaging.
We performed gene expression profiling using laser capture microdissection and RNAseq on histologically-confirmed primary PDAC
tumors and normal pancreas tissue from 21 patients. A promising, highly upregulated and imageable metabolic pathway (the
conversion of pyruvate to lactate) was identified. To further explore this pathway in vivo, mice bearing genetically-engineered
PDAC tumors were injected with 200 microliters of 80 mM [1-13C]-pyruvate. Tumors were quench-frozen and excised 30 s postinjection. Spectroscopic data on tumor lysates was obtained using 1H and 13C nuclear magnetic resonance. Studies were approved
by our IRB and IACUC.
RESULTS
Gene expression studies showed that transcripts encoding transporters and enzymes responsible for cellular import of pyruvate,
export of lactate, and conversion of pyruvate to lactate are almost universally upregulated in PDAC compared to normal pancreas,
while competing pathways of mitochondrial pyruvate metabolism and cytoplasmic pyruvate to alanine conversion are consistently
low. NMR analysis of PDAC tumors showed a tumor metabolic signature consistent with a very high lactate concentration and high
lactate-to-alanine ratio. Quantitative analysis after injection of [1-13C]-pyruvate showed a 4.8-fold enrichment of intratumoral [113C]-lactate over natural abundance, indicating that ~5% of the total lactate in the tumor at 30 s post-injection was derived from
the injected [1-13C]-pyruvate.
CONCLUSION
PDAC tumors have a pyruvate-lactate metabolic signature that can be quantitated with 13C-pyruvate NMR. Further exploration of
HP-13C-pyruvate MRSI for PDAC is warranted.
A new molecular imaging strategy for PDAC used in conjunction with existing morphological imaging could transform patient
management in clinically-challenging scenarios.
SSJ14-04
Evaluation of Fast Non-enhanced PET/MR Examination Protocols in a Fully Integrated PET/MR
System for Patients with Neuroendocrine Tumours: Direct Comparison to Multiphase Contrastenhanced PET/CT
Participants
Ferdinand F. Seith, BSC, Tuebingen, Germany (Presenter) Nothing to Disclose
Christian la Fougere, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Christina Pfannenberg, MD, Tuebingen, Germany (Abstract Co-Author) Nothing to Disclose
Konstantin Nikolaou, MD, Tuebingen, Germany (Abstract Co-Author) Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group
Speakers Bureau, Bayer AG
Nina Schwenzer, MD, Tuebingen, Germany (Abstract Co-Author) Nothing to Disclose
Cornelia Brendle, MD, Tubingen, Germany (Abstract Co-Author) Nothing to Disclose
Christina Schraml, MD, Tuebingen, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
In patients with neuroendocrine tumours (NET), kidney failure is a common complication of radionuclide therapy. It is known that
multiphase contrast-enhanced PET/CT is superior to non-enhanced PET/CT in diagnosing metastases with low or no tracer uptake
as well as small lesions especially in the liver. However, due to the superior soft tissue contrast of MRI it is possible that nonenhanced PET/MR offers the same information as contrast-enhanced PET/CT. The aim of the study was therefore to evaluate a
fast protocol in PET/MR without contrast agent in direct comparison to multiphase contrast-enhanced PET/CT as gold standard.
39 Patients (22 female, 58±13 years) were examined in multiphase contrast-enhanced 68Ga-DOMITATE-PET/CT in a clinical setup
and in PET/MR subsequently. 2 blinded readers investigated PET/MR examinations of the abdomen with 3 different setups:
T2HASTE+PET (30min), T2HASTE+TSET2+PET (35min) and T2HASTE+TSET2+DWI+PET (35min). The T2HASTE was acquired under
free breathing with continuous table move. DWI was acquired with two b-values (0, 800 s/mm2). Metastatic lesions were defined
as functional and/or morphological suspicious lesions or lymph nodes. The results were compared with the contrast-enhanced
PET/CT, follow-up examinations and histopathology, if available.
RESULTS
T2HASTE sequences were of diagnostic quality in all patients. DWI suffered from artefacts especially in the upper regions of the
liver. Compared with contrast-enhanced PET/CT high agreement was found with T2HASTE+TSET2+DWI+PET.
CONCLUSION
A protocol for PET/MR including T2HASTE, TSET2, DWI and PET seems to provide comparable results compared with multiphase
contrast-enhanced PET/CT. With an estimated time of 35 min for a whole body examination, this might serve as a legitimate
alternative to contrast-enhanced PET/CT for patients with kidney failure in the future.
In patients with neuroendocrine tumours (NET) and kidney failure, fast non-enhanced PET/MR protocols can serve as a legitimate
alternative to multiphase contrast-enhanced PET/CT examinations.
SSJ14-05
Qualitative and Quantitative Comparison of 68Ga-DOTATATE PET/CT and PET/ MRI in
Neuroendocrine Tumours
Participants
Francesco Fraioli, MD, London, United Kingdom (Presenter) Nothing to Disclose
Alshaima Alshammari, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Evangelia Skoura, Athens, Greece (Abstract Co-Author) Nothing to Disclose
Rizwan Syed, MBBS, FRCR, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Sofia Michopoulou, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Jamshed Bomanji, London, United Kingdom (Abstract Co-Author) Nothing to Disclose
Ashley M. Groves, MBBS, Hitchin, United Kingdom (Abstract Co-Author) Investigator, GlaxoSmithKline plc; Investigator, General
Electric Company; Investigator, Siemens AG; ; ;
PURPOSE
Many Neuroendocrine tumours (NET) show high somatostatin receptor avidity. The aim of this study is to compare 68Ga-DOTATATE
PET/CT with 68Ga-DOTATATE PET/MRI imaging in patients with known NET, and assess the confidence in anatomic lesion detection
and localization. Furthermore, the value of each sequence of MRI was separately evaluated.
We analysed the data of 38 NET patients. Cross over of both 68Ga-DOTATE PET/CT and PET/MRI scans were performed. MR
protocol was as follow: T1 MPR, pre and post gadolinium injection, T2 haste, DW1 (b0, 500, 1000). Two observers for 68GaDOTATATE PET/MRI and one observer for 68Ga-DOTATATE PET/CT, independently, reviewed the images and inter observer and
inter modality correlation was assessed by using interclass correlation.
RESULTS
Our initial data showed good inter modality correlation between 68Ga-PET/CT and PET/MRI. All lesions considered as malignant in
PET/CT were equally depicted in PET/MRI in the compared regions. Both modalities, revealed liver metastases in the same number
of patients (18 patients), and bone metastases in 7 patients. However, counting the number of liver lesions in each patient, 68GaDOTATATE PET/MRI was able to recognize more lesions in 3 patients. On the other hand, more lung lesions were detected in the
lung in the CT component compared to MRI component (7 lesions versus 4). The contrast and DWI sequence of PET/MRI did not
have a significant effect on final outcome, but in a selected number of cases these images confirmed and helped to further
characterize and detect more lesions. Inter observer reliability was equally very good in both modalities.
CONCLUSION
This study demonstrates the potential of 68Ga-DOTATOC PET/MRI in patients with NET, with special advantages in the
characterization of liver lesions.
68Ga-DOTATOC PET/MRI can help in diagnosis and staging of patients with NET, with special advantages in the characterization of
liver lesions.
SSJ14-06
68Ga-DOTATOC Uptake in Somatostatin Expressing Tumors is Directly Related to Specific Activity:
Implications for Receptor Quantitation Imaging
Participants
Pedram Heidari, MD, Boston, MA (Presenter) Nothing to Disclose
Dominik Berzaczy, MD, Vienna, Austria (Abstract Co-Author) Nothing to Disclose
Alicia Leece, Boston, MA (Abstract Co-Author) Nothing to Disclose
Shadi A. Esfahani, MD, MPH, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
The importance of specific activity (SA) has been previously shown in functional PET imaging studies. We hypothesized that tracer
uptake, measured using semiquantitative (SUV) or quantitative (Patlak plot) parameters, would vary considerably according to SA in
cancer receptor imaging. This study aims to evaluate the effect of SA on PET parameters used for quantitation of 68Ga-DOTATOC
uptake in somatostatin receptor (SSTR) tumor models.
In-vitro, SSTR2 expression level was assessed using Western blot across multiple cancer lines including IMR32, Capan1, A549 and
AR42J, and was normalized for Β-actin expression. The SSTR2/Β-actin ratio was correlated to in-vitro 68Ga-DOTATOC uptake
normalized for cell counts. AR42J and IMR32 normalized 68Ga-DOTATOC uptake was plotted against 68Ga-DOTATOC SA ranging
from 0.2 to 20 Ci/g and correlation was assessed. The in-vitro studies were performed in triplicate. For in-vivo studies Institutional
Animal Care and Use Committees approval was obtained. Subcutaneous AR42J xenografts were implanted in Nu/Nu mice. Dynamic
PET scans in list mode were acquired following injection of 68Ga-DOTATOC with a wide range of SAs (0.3 - 50 Ci/g). Net tracer
influx (Ki), SUVmax and SUVmean were plotted against the SA to establish the correlation between quantitative parameters and SA.
Patlak-plot was used to calculate the tracer influx constant for the tumor ((Ki= (k1 × k3 / k2 + k3)).
RESULTS
We observed a consistent ratio between 68Ga-DOTATOC uptake per cell and SSTR2/Β-actin level across the cell lines (R2=0.95,
p<0.024). In-vitro we demonstrated a linear correlation between SA and 68Ga-DOTATOC uptake per cell in IMR32 (R2=0.98,
P<0.015) and AR42J (R2=0.99, P<0.005). We found that Ki, SUVmax, and SUVmean decreased in a linear fashion with reduction in
SA. Quantitative 68Ga-DOTATOC PET parameters had a direct linear correlation with SA (R2=0.89, p<0001 for Ki, R2=0.66,
p<0.0001 for SUVmax and R2=0.82 and p<0.0001 for SUVmean).
CONCLUSION
68Ga-DOTATOC uptake is strongly correlated to SSTR2 expression for each given SA. However, 68Ga-DOTATOC uptake in SSTRexpressing tumors increases in a linear fashion with increase in SA, over the range studied.
68Ga-DOTATOC uptake by tumors can vary widely with change in specific activity. Quantitation for radiotherapy dosimetry and
response assessment is improved with correction for specific activity.
RC407
Quality and Safety in GU Radiology: Update on Best Practices, Contrast Material, and Radiation Dose
Tuesday, Dec. 1 4:30PM - 6:00PM Location: E350
GU
SQ
Participants
Giles W. Boland, MD, Boston, MA (Coordinator) Principal, Radiology Consulting Group; Royalties, Reed Elsevier
Richard H. Cohan, MD, Ann Arbor, MI, (rcohan@umich.edu) (Presenter) Consultant, General Electric Company; ; ;
James A. Brink, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Understand the background and current status of best practice clinical and workflow management and its imperitive for improving
patient outcomes. 2) To review indications for premedication prior to contrast material administration. To summarize the current
understanding of iodinated contrast media nephrotoxicity. To describe common errors made in treating contrast reactions. 3) To
understand the requirement to match radiation dose according to the individual patient, clinical question and modality used. To
outline meaningful radiation metrics including organ dosages and the overall radiation absorbed to estimate patient risk.
ABSTRACT
BEST PRACTICES: Increasingly medicine is being defined and evaluated based on patient outcomes rather than procedural events.
While best practices are evolving and sometimes incomplete, many do exist, yet there is marked departmental variation from one
organization to another. This session will outline why and how best practice implementation, particularly as it relates to IV contrast
use and radiation dose, is essential to achieve better patient outcomes. This will require evaluation of current practices and
comparison to nationally driven guidelines, with subsequent compliance to guidelines where they exist. CONTRAST SAFETY: Some
patients have contrast reactions despite premedication. Patients who have repeated reactions in this setting tend to have
reactions of similar severity. Studies performed with control groups suggest that there is minimal to no increased risk of contrastinduced renal failure in patients who receive iodinated contrast material; however, the control groups likely included patients at
increased risk of acute kidney injury. Some errors treating contrast reactions relate to failure to administer epinephrine or using the
wrong dose / wrong route. The act of administering this drug can also be problematic. RADIATION DOSE: In all radiological
examinations that utilize x-rays, there are always three important issues that must be taken into consideration. The first relates to
the appropriate amount of radiation to be used, which must always explicitly take into account the imaging task at hand as well as
the physical characteristics of the patient undergoing the CT examination. The second issue is how to transform the radiation
incident on the patient into the organ doses received which are essential to understanding (any) patient risks. The final
consideration is to understand the radiological significance of the radiation absorbed by the patient, and to estimate (any)
radiological risks, as well as the corresponding uncertainties.
RC410
Ultrasound Elastography
Tuesday, Dec. 1 4:30PM - 6:00PM Location: S406B
GI
GU
HN
NR
US
Participants
Sub-Events
RC410A
Thyroid Elastography
Participants
Richard G. Barr, MD, PhD, Campbell, OH (Presenter) Consultant, Siemens AG; Consultant, Koninklijke Philips NV; Research Grant,
Siemens AG; Research Grant, SuperSonic Imagine; Speakers Bureau, Koninklijke Philips NV; Research Grant, Bracco Group; Speakers
Bureau, Siemens AG; Consultant, Toshiba Corporation; Research Grant, Esaote SpA
LEARNING OBJECTIVES
1) Explain the difference between strain and shear wave elastography. 2) Understand the techniques to be able to perform thyroid
ultrasound elastography. 3) Apply ultrasound elastography into routine clinical practice of thyroid nodules.
ABSTRACT
Thyroid nodules are very common and work-up of these nodules remains challenging. Fine needle aspiration has been the method of
choice for diagnosing suspicious lesions with a sensitivity of 54%-90% and specificity of 60-96% for detection of malignant lesions.
Malignant thyroid lesions are statistically stiffer than benign lesions. Ultrasound elastography can assess the stiffness of thyroid
lesions. Several studies have been performed evaluating strain and shear wave elastography to characterize thyroid nodules. Strain
elastography is qualitative while shear wave elastography is quantitative. These studies suggest that ultrasound elastography may
improve sensitivity and specificity of characterizing thyroid lesions over B-mode imaging alone. There is a learning curve for
performing adequate thyroid ultrasound elastography. Both cystic lesions and calcified lesions are difficult to evaluate with
elastography. There is some overlap of stiffness values between benign and malignant thyroid nodules and elastography should not
eliminate biopsy of suspicious lesions based on B-mode imaging. Stiff lesions on elastography should increase the suspicion for
malignancy. This presentation will discuss the differences between strain and shear wave elastography, discuss technique and
pitfalls in performing the examination, review the literature, and discuss published guidelines.
RC410B
Renal Elastography: Where Are We?
Participants
Nicolas Grenier, MD, Bordeaux CEDEX, France, (nicolas.grenier@chu-bordeaux.fr) (Presenter) Advisory Board, Supersonic Imagine;
Travel support, Guerbet SA
LEARNING OBJECTIVES
1) To become familiar with the advantages and limits of the different elastography technologies applied to kidney. 2) To understand
the factors affecting reliability and reproducibility of elasticity measurement within the kidney. 3) To learn about the intrarenal
changes responsible for elasticity changes. 4) To learn about the clinical impact of elasticity measurement in renal parenchymal
diseases. 5) To learn about the clinical impact of elasticity measurement in renal tumors.
ABSTRACT
Ultrasound elastography is a new imaging technique under development that provides information about renal stiffness. Kidney
elasticity quantification with ultrasound should be better performed with a quantitative technique, based on shear wave velocity
measurements (ARFI or SSI methods). Kidney stiffness changes can be affected by mechanical factors such as external pressure
induced by the probe and intrarenal characteristics such as tissue anisotropy, which is high in renal medulla, vascularization, which
is high within the cortex, and hydronephrosis. Chronic kidney disease (CKD) incidence and prevalence are increasing in Western
countries, due particularly to diabetes mellitus and hypertension-related nephropathies. During progression of such renal
parenchymal diseases, cellular density may increase, mainly during acute inflammatory phases, and the interstitial matrix may be
invaded by fibrosis. All components of these tissue changes may induce an increase of renal elasticity which is not specifically
related to fibrosis. Tubular, glomerular, interstitial and vascular changes may also be responsible for an increase of stiffness. This is
why, further studies are now necessary before to understand the real impact of elastography measurement in clinical nephrology.
Considering characterization of renal tumors with elastography, clinical experience is still limited. Preliminary results show that
benign tumors seem to have lower values of elasticity than malignant ones, but, here too, more experience is also necessary.
RC410C
Liver Elastography
Participants
Paul S. Sidhu, MRCP, FRCR, London, United Kingdom, (paulsidhu@nhs.net) (Presenter) Speaker, Bracco Group; Speaker, General
Electric Company
LEARNING OBJECTIVES
1) To understand the concept of liver fibrosis grading and the implications for healthcare management. 2) To review the basis for
the assessment of liver fibrosis using elastography, with emphasis on the different techniques. 3) To understand the differences in
the techniques and the variability in measurement assessment. 4) To achieve an overview of the need and position of this
technique in clinical care.
ABSTRACT
Liver fibrosis and cirrhosis from many causes is an important cause of long term morbidity and mortlaity. Most cases are a
consequence of chronic viral disease (Hepatitis B and C) with alcoholic lever disease an important ethiological factor. The degree of
liver fibrosis, and the presence of established cirrhosis confer differnet mamangement stratergies, with imaging playing an important
role in the non-invasive assessment of patents with chronic liver disease. Fibrosis grading traditionally performed using the Metavir
or Ishak scoring system is essentially a hiistological grading system. Ultimately the possibility to avoid a liver biopsy is the aim, if a
non-invasive technique can stage the grade of fibrosis, establishing correct patient management. Liver ultrasound elastography is a
developing technique that offers this possibility, with varying methods of aassessment ranging form strain methods and shear wave
methods. These techniques will be explained, the status of the current standing of the techniques will be summarised, and the level
of technology offered by differnet machines will be reviewed. An overall summary of the current status and the implications for
clinical practice will be discussed.
ED006-W E
Genitourinary Wednesday Case of the Day
W ednesday, Dec. 2 7:00AM - 11:59PM Location: Case of Day, Learning Center
GU
Participants
TEACHING POINTS
Honored Educators
SPSH40
Hot Topic Session: Molecular Imaging and Radionuclide Therapy for Prostate Cancer
W ednesday, Dec. 2 7:15AM - 8:15AM Location: E451A
GU
MI
OI
RO
FDA
Participants
Uwe Haberkorn, MD, Heidelberg, Germany, (uwe.haberkorn@med.uni-heidelberg.de) (Moderator) Nothing to Disclose
Eric M. Rohren, MD, PhD, Houston, TX (Moderator) Nothing to Disclose
Alexander Drzezga, MD, Cologne, Germany (Moderator) Research Grant, Eli Lilly and Company; Speakers Bureau, Siemens AG;
Speakers Bureau, General Electric Company; Speakers Bureau, Piramal Enterprises Limited; Research Consultant, Eli Lilly and
Company; Research Consultant, Piramal Enterprises Limited; ; ; ; ; ;
ABSTRACT
Radium-223 is a recently approved therapy for treatment of bone metastases in patients with metastatic prostate carcinoma. As an
alpha-emitting radioisotope, radium has the potential to be a powerful therapy for treatment of a variety of skeletal malignancies.
In this presentation, the use of radium-223 in the treatment of prostate cancer will be reviewed through a case-based format.
Future directions in radium-223 therapy will be discussed.
URL
Sub-Events
SPSH40A
Ra-223 Therapy for Skeletal Metastases from Prostate Cancer
Participants
Eric M. Rohren, MD, PhD, Houston, TX (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Review the chemical and physical features of radium-223 dichloride. 2) Discuss the clinical utility of radium-223 therapy. 3)
Understand the technique for radium-223 administration. 4) Review the anticipated outcomes of radium-223 therapy through casebased review.
ABSTRACT
Radium-223 is a recently approved therapy for treatment of bone metastases in patients with metastatic prostate carcinoma. As an
alpha-emitting radioisotope, radium has the potential to be a powerful therapy for treatment of a variety of skeletal malignancies.
URL
Honored Educators
Eric M. Rohren, MD, PhD - 2015 Honored Educator
SPSH40B
Comparison of Ga-68 and F-18 Labeled Small Molecule PSMA Tracers for Prostate Cancer Imaging
Participants
Carsten Kobe, Cologne, Germany (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Understand the concept of PSMA PET-imaging in the diagnosis of prostate cancer in general and in comparison to conventional
methods. 2) Learn about the currently available alternatives for radiolableling of PSMA-tracers, e.g. 68-Gallium and 18F-Fluoride and
their characteristics. 3) Gain insights from first comparative studies about the clinical value of the availble tracers with regard to
their sensitivity, specificity and practicability.
SPSH40C
PSMA Ligands for Imaging and Therapy of Prostate Cancer
Participants
Uwe Haberkorn, MD, Heidelberg, Germany (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Understand the background and pharmacokinetics of PSMA ligands for PET/CT. 2) Estimate the value of PSMA-based imaging in
comparison to choline-based imaging. 3) Assess the value of PSMA-targeting for diagnosis and therapy. 4) Estimate the effects and
side effects of endoradiotherapy with PSMA ligands
ABSTRACT
The prostate-specific membrane antigen (PSMA) is frequently over-expressed in prostate cancer (PCa) which led to the
The prostate-specific membrane antigen (PSMA) is frequently over-expressed in prostate cancer (PCa) which led to the
development of several PSMA-targeting molecules are for the detection and therapy of metastatic castration resistant prostate
cancer (mCRPC).In a first diagnostic study 82.8% of 319 patients investigated with 68Ga-PSMAHBED-PET/CT at least one lesion
indicative for PCa was detected. Amongst lesions investigated by histology, 30 were false-negative in 68Ga-PSMAHBED-PET/CT, all
other lesions (n=416) were diagnosed true-positive or -negative. Fifty of 116 patients available for follow-up received a local
treatment after 68Ga-PSMAHBED-PET/CT. A comparison of the 68Ga-PSMA-ligand with 18F-fluoromethylcholine PET/CT revealed 78
PC-suspicious lesions in 32 patients using 68Ga-PSMA-PET/CT and 56 lesions in 26 patients using Choline-PET/CT (significant with
p=0.04). All lesions detected by 18F-fluoromethylcholine-PET/CT were also seen by 68Ga-PSMA-PET/CT. Since the ligand bound to
PSMA is internalized, the target may also be used for endoradiotherapy. We used a small molecule inhibitor of PSMA MIP-1095 for
therapy in 25 men with final stage mCRPC. PSA values decreased by >50% in 60.7% of the men treated. 84.6 % of men with bone
pain showed complete or moderate reduction in pain. Hematological toxicities were mild. 25% of men treated had a transient slight
to moderate dry mouth. No adverse effects on renal function were observed.In order to increase the therapeutic flexibilty a
theranostic PSMA ligand coupled to DOTA was synthesized which allows coupling to Ga-68 for diagnostic use or to Lu-177 or Ac225 for therapy. Initial experience in 30 patients shows promising results concerning antitumor activity with mild side effects.
URL
MSCP41
Case-based Review of Pediatric Radiology (An Interactive Session)
W ednesday, Dec. 2 8:30AM - 10:00AM Location: S406A
CH
GI
GU
OB
PD
Participants
Sudha A. Anupindi, MD, Philadelphia, PA (Director) Nothing to Disclose
LEARNING OBJECTIVES
1) To apply a systematic approach in the evaluation of pediatric diseases. 2) To identify essential imaging features of various
pediatric congenital, musculoskeletal, abdominal and neurological diseases using a multimodality approach. 3) To understand and
develop best imaging practice for various pediatric diseases.
ABSTRACT
To apply a systematic approach in the evaluation of pediatric diseases To identify essential imaging features of various pediatric
congenital, musculoskeletal, abdominal and neurological diseases using a multimodality approach To understand and develop best
imaging practice for various pediatric diseases
Sub-Events
MSCP41A
Fetal Thoracic and Abdominal Anomalies
Participants
Christopher I. Cassady, MD, Houston, TX (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
MSCP41B
Pediatric Abdominopelvic Tumors
Participants
M. Beth McCarville, MD, Memphis, TN (Presenter) Support, General Electric Company
LEARNING OBJECTIVES
MSCP41C
Congenital Disorders of the Genitourinary Tract
Participants
Tracy N. Kilborn, MBChB, Cape Town, South Africa (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
MSES41
Essentials of Genitourinary Imaging
W ednesday, Dec. 2 8:30AM - 10:00AM Location: S100AB
GU
MR
US
Participants
Sub-Events
MSES41A
Catching Ovarian Cancer
Participants
LEARNING OBJECTIVES
1) Review the types of ovarian epithelial neoplasm seen on imaging. 2) Assess the risk of ovarian cancer based on imaging
appearance of an adnexal lesion and clinical information. 3) Emphasize the role of MRI in further evaluation of adnexal lesions.
ABSTRACT
There is a spectrum of ovarian epithelial neoplasms ranging from benign to malignant. Current theories regarding the precursor
lesions are debated; however, the pathway from benign epithelial neoplasm to low grade carcinoma follows an indolent course and
is distinctly different from the aggressive evolution of high grade carcinoma. An understanding of the pathogenesis of low grade
versus high grade ovarian epithelial neoplasms can be helpful to radiologists, when they are faced with an adnexal lesion.
Identifying the imaging features suggestive of benign, intermediate and worrisome lesions can triage adnexal lesions into follow up
versus treatment. The purpose of this presentation is to review the imaging features of benign, indeterminate and worrisome
adnexal lesions and to discuss the appropriate follow up in each case.
MSES41B
US and MRI: Imaging of Chronic Pelvic Pain in Women
Participants
Mostafa Atri, MD, Toronto, ON (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To review MRI and US features of adenomyosis and their correlation with pathology. 2) To discuss staging and US and MRI
features of endometriosis and their role in the management of this condition. 3) To familiarize imagers with US features of
diverticulosis/diverticulitis and how to differentiate it from colitis.
ABSTRACT
Chronic pelvic pain constitutes 10-40% of gynecology visits at a total cost of 39 billion dollars/year in USA. The most common
etiologies are gynecological with GI, urology and MSK conditions being the other causes. During this presentation, imaging features
of adenomyosis, endometriosis, pelvic congestion, and US features of diverticulosis/diverticulitis are reviewed. Both adenomyosis
and endometriosis are common conditions affecting women. They are frequently seen as an incidental finding that can be
accurately evaluated by MRI and US in symptomatic patients. There is close correlation between pathology and imaging features of
adenomyosis. The main role of imaging in the evaluation of endometriosis is in the staging of the disease to plan for surgery. US
features of uncomplicated diverticulitis are discussed. Transvaginal US can accurately diagnose diverticulosis/diverticulitis that
should be sought for in women undergoing US to evaluate for chronic pelvic pain.
Handout:Mostafa Atri
http://abstract.rsna.org/uploads/2015/15001868/IMAGING CHRONIC PELVIC PAIN FINAL RSNA 2015 FINAL.pdf
MSES41C
Imaging of the Bladder and Ureters
Participants
Manjiri K. Dighe, MD, Seattle, WA (Presenter) Research Grant, General Electric Company
LEARNING OBJECTIVES
1) Review embryology and discuss congenital anomalies of the bladder and ureter. 2) Classify and discuss imaging appearance of
ureteric and bladder disease. 3) To discuss the protocols and imaging appearance of bladder and ureteric pathology on various
modalities. 4) Review the staging of bladder and ureteric malignancies. 5) Discuss the imaging appearance of various stages of
bladder and ureteric cancer. 6) Illustrate the newer techniques for imaging of bladder and ureter.
ABSTRACT
The ureter is an extra-peritoneal structure surrounded by fat.; The ureter is divided into three portions: the proximal ureter (upper)
is the segment that extends from the ureteropelvic junction to the area where the ureter crosses the sacroiliac joint, the middle
ureter courses over the bony pelvis and iliac vessels, and the pelvic or distal ureter (lower) extends from the iliac vessels to the
bladder. It is a dynamic organ and not a simple conduit through which urine flows. Benign and malignant lesions can affect the
ureter and these maybe due to contiguous involvement from the kidney or bladder. The ureter can be imaged by a variety of
modalities including computed tomography (CT), magnetic resonance imaging (MR), direct pyelography (DP) both antegrade (AP)
and retrograde (RP), nuclear medicine diuretic scan and voiding cystourethrography (VCUG). Benign lesions like endometriosis,
Ureteritis, Ureteritis cystica can affect the ureter as well. Transitional cell carcinoma in the ureter is usually diagnosed on imaging.
Bladder carcinoma is the fourth most common cancer in men and women. Knowledge of imaging options and appearance is
necessary for both radiologists and urologists. Transitional cell carcinoma (TCC) is the most common bladder neoplasm with
squamous cell and adenocarcinoma found in less than 10% of cases.; Benign lesions are uncommon but some can be suggested by
their imaging appearance. Cystoscopy allows tissue diagnosis and treatment of superficial lesions. Although magnetic resonance
imaging (MRI) and computed tomography (CT) both have limitations in detailing depth of muscle invasion, both have a prominent
role helping to define the lesion and in staging. This presentation illustrates the role of MR and CT in evaluating bladder and ureter
with a discussion of the newer techniques of MR Diffusion Weighted Imaging (DWI) and virtual cystoscopy by CT or MR.
MSRO41
BOOST: Genitourinary-Oncology Anatomy (An Interactive Session)
W ednesday, Dec. 2 8:30AM - 10:00AM Location: S103CD
GU
RO
FDA
Participants
Jelle O. Barentsz, MD, PhD, Nijmegen, Netherlands (Presenter) Nothing to Disclose
Albert J. Chang, MD, PhD, San Francisco, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Introduce imaging anatomy relevant to prostate cancer and review imaging issues for contouring primary tumors, nodal regions,
and adjacent critical structures. 2) Review how the integration of different imaging modalities can affect tumor delineation. 3) How
to choose appropriate imaging methods for specific purposes and to discuss the significance of certain imaging findings.
RC507
Bladder, the Forgotten Organ: Role of CT, MRI, and PET in Diagnosis, Staging, and Surveillance of Cancer
W ednesday, Dec. 2 8:30AM - 10:00AM Location: N229
GU
CT
MR
NM
Participants
Stuart G. Silverman, MD, Brookline, MA, (sgsilverman@partners.org) (Coordinator) Author, Wolters Kluwer nv
Andrew B. Rosenkrantz, MD, New York, NY (Presenter) Nothing to Disclose
Homer A. Macapinlac, MD, Houston, TX (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Learn the latest developments on the role of CT, MRI, and PET/CT in the detection, diagnosis, staging, and surveillance of
patients with bladder cancer. 2) Learn currently recommended CT, MRI, and PET/CT techniques and protocols and how to
implement them in clinical practice. 3) Learn how to interpret CT, MRI, and PET/CT scans of the bladder with an emphasis on case
review and diagnostic pitfalls.
ABSTRACT
The urinary bladder is the most common site of malignancy of the urinary tract and is imaged by radiologists on many abdominal
imaging exams. However, historically the bladder has been a 'forgotten' organ and thought to be largely the purview of the urologist
due to the central role that cystoscopy has played in both the diagnosis and local staging of bladder cancer. Recent advances in
CT, MRI, and PET have emerged that now allow radiologists to play an important role in the detection, diagnosis, staging, and
surveillance of patients with or suspected of having bladder cancer. This course will detail these advances and explain how, when,
and why radiologists should be using these three modalities in clinical practice today. Using illustrative case examples, advances in
knowledge such as how CT urography can be used to detect bladder cancer, how MR urography can be used to distinguish muscleinvasive from superficial tumors and evaluate the upper tracts, and how PET/CT (and the newly introduced PET/MRI) can be used
to stage and follow patients. With additional advances in low dose CT, emerging MRI techniques, and novel PET agents, radiology
will play an increasingly vital role in the care of patients with bladder cancer in the future.
RC510
Second and Third Trimester Obstetrical Ultrasound (An Interactive Session)
W ednesday, Dec. 2 8:30AM - 10:00AM Location: E450B
GU
OB
US
Participants
LEARNING OBJECTIVES
Please bring your charged mobile wireless device (phone, tablet or laptop) to participate.
Sub-Events
RC510A
3D Ultrasound in Obstetrics
Participants
Beryl R. Benacerraf, MD, Brookline, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To learn the principles of 3D sonography and the applications for fetal scanning. To evaluate clinical situations where 3D
scanning is helpful and where it is not useful beyond the 2D examination. 2) To see examples of fetal malformations scanned in 3D
using surface rendering and multiplanar reconstruction. 3) To learn how to use volume scanning to dramatically reduce scan time
and improve you scanning efficiency by rescanning stored volumes of complete fetal anatomy.
ABSTRACT
Three-dimensional (3D) ultrasound allows us to acquire a volume and display any plane of section within that volume regardless of
the scanning orientation. The ability to display a 3D image of any type or plane has been one of the most powerful recent advances
in sonography, particularly in the field of obstetrics and gynecology. In imaging of the fetus, 3D ultrasound is advantageous in
demonstrating many types of fetal defects and dysmorphologic facial features using surface rendering. The fetal brain is also one of
the areas where 3D ultrasound has been most helpful, since the reconstruction of the third non-scanning plane is crucial in
demonstrating planes of section not previously visible sonographically. The corpus callosum is an example of one area not readily
imaginable in standard imaging planes. The fetal sutures are also easy to image with 3D, which is particularly helpful in fetuses with
suspected craniosynostosis. 3D ultrasound is key for imaging fetal skeletal abnormalities, providing additional information on
affected fetuses as compared to 2D. Evaluation of the spine using 3D has been helpful to determine the level of spina bifida, thus
providing crucial information regarding prognosis. Evaluation of the fetal heart is an intense area of research interest, and the heart
can be imaged in realtime 3D (4D) using a method called STIC. This method provides the ability to obtain a full volume of the
beating heart to evaluate in detail off line with or without color Doppler and while it is beating.Volume imaging is also key in
improving efficiency of the ultrasound department. The entire fetus can be imaged easily by acquiring and archiving a few volumes.
This way, the patient can spend far less time in the ultrasound room and the entire scan can be done remotely and virtually using
the stored volumes. This techniques reduces operator dependency usually associated with 2D ultrasound.
RC510B
Fetal Genitourinary Anomalies
Participants
Roya Sohaey, MD, Portland, OR (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Apply the Urinary Tract Dilation classification system to fetal imaging practice. 2) Develop an anatomic approach for differential
diagnosis of urinary tract obstruction. 3) Develop an understanding of which cases would benefit from fetal MR.
ABSTRACT
By the conclusion of this course, the participant will be able to apply the prenatal UrinaryTract Dilation (UTD) classification system
for diagnosis and follow-up planning. The learner will develop an anatomic approach towards differential diagnosis for obstructive
causes of UTD, renal cystic dysplasia and complex genitourinary anomalies. In addition, a fetal sex-based approach for analysis of
complex lower tract anomalies will be discussed. The course will demonstrate how fetal MR is useful as a problem solving tool in
certain complex cases. The lecture is didactic and case-based in format.
RC510C
Placenta
Participants
Sara M. Durfee, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Identify the cause of vaginal bleeding in patients with placental abnormalities that include placenta previa and placental
abruption. 2) Describe the sonographic features of placenta accreta. 3) Define trophotropism and describe how this process leads
to both normal and abnormal placentation.
ABSTRACT
After this presentation, the participant will understand how the normal placenta develops and how factors such as trophotropism
lead to placental abnormalities. Specific abnormalities such as placenta previa, placental abruption and placenta accreta will be
addressed in detail. In addition, first trimester abnormalities such as the chorionic bump and subchorionic hematomas will be
discussed. The presenter will describe the sonographic appearance of succenturiate lobe, circumvallate placenta and sonolucencies
within the placenta and will comment on placental masses.
RC550
Fallopian Tube Catheterization (Hands-on)
W ednesday, Dec. 2 8:30AM - 10:00AM Location: E260
GU
OB
Participants
Amy S. Thurmond, MD, Portland, OR (Moderator) Nothing to Disclose
Ronald J. Zagoria, MD, San Francisco, CA, (ron.zagoria@ucsf.edu) (Presenter) Nothing to Disclose
Lindsay S. Machan, MD, Vancouver, BC (Presenter) Nothing to Disclose
A. Van Moore JR, MD, Charlotte, NC (Presenter) Nothing to Disclose
Anne C. Roberts, MD, La Jolla, CA (Presenter) Nothing to Disclose
David M. Hovsepian, MD, Stanford, CA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Obtain hands-on experience with fallopian tube catheterization using uterine models and commercially available catheters and
guidewires. 2) Review the evolution of interventions in the fallopian tubes. 3) Learn safe techniques for fallopian tube recanalization
for promoting fertility, and fallopian tube occlusion for preventing pregnancy. 4) Discuss the outcomes regarding pregnancy rate
and complications. 5) Appreciate ways to improve referrals from the fertility specialists and expand your practice.
ABSTRACT
Fallopian tube catheterization using fluoroscopic guidance is a relatively easy, inexpensive technique within the capabilities of
residency trained radiologists. Fallopian tube cathterization can be used to dislodge debris from the tube in women with infertility,or
to place FDA-approved tubal occlusion devices in women who do not desire fertility. The fallopian tube is the 1 mm gateway
between the egg and the sperm. Noninvasive access to this structure for promoting, and preventing, pregnancy has been sought
for over 160 years. This hands-on course allows participants use commercially available catheters and devices in plastic models for
fallopian tube catheterization, and to speak directly to world experts about this exciting procedure.
MSRO42
BOOST: Genitourinary-Integrated Science and Practice (ISP) Session
W ednesday, Dec. 2 10:30AM - 12:00PM Location: S103CD
GU
OI
RO
FDA
Participants
Stanley L. Liauw, MD, Chicago, IL (Moderator) Nothing to Disclose
George B. Rodrigues, MD, London, ON (Moderator) Nothing to Disclose
Sub-Events
MSRO42-01
Invited Speaker:
Participants
Rodney J. Ellis, MD, Pepper Pike, OH (Presenter) Nothing to Disclose
MSRO42-02
A Phase I Dose Escalation Study of Hypofractionated Radiation Therapy for Favorable Risk Prostate
Cancer: Acute Toxicity and Early Efficacy
Participants
Nicholas J. Sanfilippo, MD, New York, NY (Presenter) Nothing to Disclose
William C. Huang, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Herbert Lepor, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Silvia C. Formenti, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Benjamin Cooper, New York, NY (Abstract Co-Author) Nothing to Disclose
Smith Beverly, New York, NY (Abstract Co-Author) Nothing to Disclose
Barry Rosenstein, New York, NY (Abstract Co-Author) Nothing to Disclose
Samir S. Taneja, MD, New York, NY (Abstract Co-Author) Consultant, Eigen Consultant, GTx, Inc Consultant, Bayer AG Consultant,
Healthtronics, Inc Speaker, Johnson & Johnson Investigator, STEBA Biotech NV Royalties, Reed Elsevier
ABSTRACT
Purpose/Objective(s): The optimal radiation schedule for the curative treatment of prostate cancer remains unknown. Prostate
cancer patients receiving definitive external beam radiation therapy (EBRT) are typically treated 5 days per week for 7-9 weeks.
This prolongation of treatment time increases healthcare costs and is less convenient for patients. There is data supporting the
notion that the a/ß ratio for prostate cancer cells is between 1 and 3, suggesting a clinical benefit to hypofractionation. We
therefore conducted a Phase I dose escalation trial in men with low to low-intermediate risk prostate
adenocarcinoma.Materials/Methods: All men with clinical T1-2c, Gleason Score (GS) 6, prostate cancer with a prostatic specific
antigen (PSA) less than 10 ng/dL were eligible for this trial. Men with clinical T1-2c, GS 7 prostate cancer and/or PSA 10 - 20
ng/dL were included provided the biopsy demonstrated low volume disease (Results: From June, 2012 to December, 2014, 9
patients were accrued to the three dose cohorts with a median follow-up of 11 months (range: 2 – 30). Patients had a median age
of 63, pre-treatment PSA of 4.9 ng/dL, and pre-treatment AUA score of 10. Four patients had a GS of 7. The maximum tolerated
dose (MTD) was 57.6 Gy with all patients completing treatment with less than or equal to grade 2 maximum gastrointestinal,
genitourinary, dermatologic or fatigue related toxicity (Table 1). Six patients have at least 1 PSA post-treatment (3 months after
completion) with a median PSA decrease of 65%. One patient of the six with > 11 month follow-up had grade 2 rectal
telangiectasia requiring minor endoscopic cautery. The remaining 5 patients had no grade 2 toxicity thus far.Conclusion: All three
dose levels were well tolerated with no MTD identified. Further follow-up is warranted for long term toxicity and efficacy.Table 1:
Acute toxicity in patients undergoing hypofractionated radiation.Grade of ToxicityCTCAE v. 4.0Dose Level 154 Gy/ 18 Fxn = 3Dose
Level 255.8 Gy/ 18 Fxn = 3Dose Level 357.6 Gy/ 18 Fxn =
3Gastrointestinal023011032000Genitourinary000212312100Dermatitis0333Fatigue03111022
MSRO42-03
Robotic Stereotactic Body Radiation Therapy for Organ Confined Prostate Cancer
Participants
Jonathan A. Haas, MD, Mineola, NY (Presenter) Speaker, Accuray Incorporated
Aaron E. Katz, MD, Garden City, NY (Abstract Co-Author) Nothing to Disclose
Seth Blacksburg, MD, MBA, New York, NY (Abstract Co-Author) Speakers Bureau, Bayer AG;
Owen Clancey, PhD, Mineola, NY (Abstract Co-Author) Nothing to Disclose
Michael Santoro, MD, East Meadow, NY (Abstract Co-Author) Nothing to Disclose
Richard Ashley, MD, Garden City, NY (Abstract Co-Author) Nothing to Disclose
Dimitri Kessaris, MD, Manhasset, NY (Abstract Co-Author) Nothing to Disclose
Robert Mucciolo, MD, Massapequa, NY (Abstract Co-Author) Nothing to Disclose
Astrid Sanchez, Mineola, NY (Abstract Co-Author) Nothing to Disclose
Diane Accordino, RN, Mineola, NY (Abstract Co-Author) Nothing to Disclose
Susan Lowery, BA, Mineola, NY (Abstract Co-Author) Nothing to Disclose
William Macmelville, Mineola, NY (Abstract Co-Author) Nothing to Disclose
Christopher Mendez, BA, Mineola, NY (Abstract Co-Author) Nothing to Disclose
Matthew R. Witten, PhD, Mineola, NY (Abstract Co-Author) Nothing to Disclose
ABSTRACT
Purpose/Objective(s): The unique radiobiology of prostate cancer supports a hypofractionated as opposed to a conventionally
fractionated dose regimen with a potential for improved outcomes and reduced toxicities. We report on our continued experience
using a robotic linear accelerator to deliver stereotactic body radiation therapy for localized prostate cancer.Materials/Methods:
From April 2006 through December 2014, a total of 1207 patients with localized carcinoma of the prostate were treated with robotic
stereotactic body radiation therapy at a single institution. All patients had T1c to T2b disease. 493 patients had low risk disease.
548 patients had intermediate risk disease. 166 patients had high risk disease. Pretreatment PSAs ranged from .77 to 205. 126
patients received hormonal therapy prior to treatment at the discretion of their urologist. Treatment planning was done with CT
scans fused with an MRI scan except in 31 cases where an MRI scan could not be done for medical reasons such as a pacemaker.
Dose was prescribed to the 83% to 87% line, 5 mm beyond the capsule except posteriorly 3 mm. 1037 patients with low and
intermediate risk disease received CyberKnife only to a dose of 3500 to 3625 cGy over 5 fractions. All patients received 1500 mg of
amifostine intrarectally 50 minutes prior to each treatment fraction.Results: The median initial PSA was 6.2. The median follow-up
was 33 months. The median post treatment PSA is 0.35. At the time of last follow-up, 12 patients have had a PSA failure by
Phoenix biochemical definition. 1 patient with low risk disease failed. 7 patients with intermediate risk disease failed and 4 patients
with high risk disease failed. There were 136 patients with a minimum follow up of at least 36 months and 56 patients with a
minimum follow up of at least 48 months. There are 26 patients with a minimum follow up of 60 months. 272 patients achieved a
PSA below 0.2 and 413 patients reached a PSA below 0.4. The median treatment PSA at 12 months is 0.90. The median PSA at 24
months is 0.45. The median PSA at 36 months is 0.40. the median PSA at 48 months is 0.25. The median treatment PSA at 60
months is 0.20. With a median follow up of 33 months, the biochemical disease free survival for low risk, intermediate risk, and high
risk was 99.7%, 98.7%, and 97.5% respectively. 2 patients had symptomatic hematuria which resolved with hyperbaric oxygen. 2
patients required green light laser for urinary retention. 1 patient has required catheterization. 3 patients had rectal bleeding which
resolved with rowasa enemas and hyperbaric oxygen.Conclusion: Stereotactic body radiation therapy using a robotic linear
accelerator continues to be extremely well tolerated and efficacious in the management of localized prostate cancer. High rates of
local control can be achieved while also achieving low rates of bladder and rectal toxicity. This study confirms prior reported series
with a larger number of patients.
MSRO42-04
The Effect of Radiation Timing on PSA Reduction in High Risk Prostate Cancer Patients Treated with
Definitive Radiation Therapy
Participants
Apar Gupta, Boston, MA (Presenter) Nothing to Disclose
Steven Vernali, Boston, MA (Abstract Co-Author) Nothing to Disclose
Ankit Agarwal, BS, Boston, MA (Abstract Co-Author) Nothing to Disclose
Muhammad M. Qureshi, MBBS,MPH, Boston, MA (Abstract Co-Author) Nothing to Disclose
Alexander E. Rand, BA, Boston, MA (Abstract Co-Author) Nothing to Disclose
Ariel E. Hirsch, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
ABSTRACT
Purpose/Objective(s): We previously found that neither time to treatment (TTT) nor elapsed time of treatment (ETT) had any
effect on PSA velocity in patients with low- and intermediate-risk prostate cancer. In this analysis, we sought to examine the
effects of TTT and ETT on PSA change in patients with high-risk prostate cancer.Materials/Methods: We performed a retrospective
review of 1,584 patients who were diagnosed with prostate cancer at our institution between January 2005 and December 2013,
and found 412 patients with non-metastatic disease who completed treatment with definitive external beam radiation therapy
(EBRT). A total of 146 patients who also received concurrent androgen-deprivation therapy (ADT) were included in the analysis.
TTT was calculated as days between positive prostate biopsy and EBRT start date, and ETT was calculated as days between EBRT
start and stop date. Demographic data on race/ethnicity, primary language spoken, insurance status, marital status, and age were
also collected. Analysis of variance was performed to analyze the relationship of these factors with absolute and percentage
change in pre- and post-EBRT PSA levels. Data were analyzed using a 0.05 level of significance.Results: Median age at diagnosis
was 67 years (range 50-85 years); 11% had a Gleason score (GS) of 6, 49% GS 7, and 40% GS 8-10. Median TTT was 134 days
and median ETT was 62 days. No demographic variable was found to be significantly related to absolute or percentage change in
PSA. No optimal threshold of days from diagnosis to treatment (TTT) was identified to predict change in PSA level. ETT was
significantly related to PSA change, after adjusting for demographic variables. Those who fell in the upper quartile of ETT (>64
days) were found to have a 94.2% decline in PSA, compared to 98.0% for those who fell in the lower three quartiles
(p=0.03).Conclusion: A delay in treatment prior to starting EBRT did not have an effect on post-EBRT PSA level, relative to initial
PSA level. However, a delay during EBRT was related to a lesser reduction in PSA decline. Further research is warranted in this area
to elucidate the clinical significance of differences in PSA reduction.
MSRO42-05
Patient Inversion Therapy for Bowel (PITB) to Achieve Maximum Displacement in Radiotherapy for
Prostate Cancer
Participants
Gordon L. Grado, MD,PhD, Scottsdale, AZ (Abstract Co-Author) Nothing to Disclose
David Constantinescu, Charleston, IL (Presenter) Nothing to Disclose
Scott Thompson, CMD, Scottsdale, AZ (Abstract Co-Author) Nothing to Disclose
Carrie S. Petrone, RN, Scottsdale, AZ (Abstract Co-Author) Nothing to Disclose
Mary M. Grado, BSN,MS, Scottsdale, AZ (Abstract Co-Author) Nothing to Disclose
Michael C. Grado, BA, Scottsdale, AZ (Abstract Co-Author) Nothing to Disclose
Thayne Larson, MD, Scottsdale, AZ (Abstract Co-Author) Research Consultant, NxThera, Inc
PURPOSE
The purpose of this study was to evaluate a new and novel approach to the valuation and reduction of small bowel volume from the
irradiated fields in the treatment of prostate cancer. This technique utilizes inversion therapy to either completely displace small or
large bowel from the irradiated field or to significantly reduce the volume of bowel irradiated in the PTV. This procedure has
potential application in multiple areas of abdominal and pelvic radiation therapy.
Between January 2014 and March 2015, 14 consecutive patients were identified where small or large bowel was directly within the
irradiated PTV. Patients were evaluated with bladder distention, patient positioning, and inversion therapy to displace bowel from
the irradiated PTV. Inversion therapy had the greatest effect in displacing and maintaining displacement of bowel from the
irradiated volume. Several inversion tables were evaluated prior to the procedure and the two safest devices with the most clinical
experience for inversion therapy were selected for this trial. Dose volume histograms were compared with and without inversion.
RESULTS
Patients were identified with loops of bowel directly within the radiated field due to previous surgery or anatomy. Standard
techniques for bowel displacement (patient positioning, bladder distention, belly-board), were ineffective at displacing sufficient
bowel from the irradiated volume to affect greater radiation dose delivery. Inversion therapy was selected for bowel displacement
which when combined with bladder distention maintained the displacement during the course of radiation therapy. 13/14 patients
were found to have sufficient bowel displacement to allow greater radiation dose delivery to the PTV without compromising field
size or prescribed dose. 1/14 patients did not benefit from this technique.
CONCLUSION
Patient inversion therapy for bowel (PITB) achieved excellent bowel displacement for radiation therapy to the pelvis. In these
patients, neither the radiation therapy field nor the prescribed dose had to be compromised. Patients also had fewer bowel and
bladder symptoms during the pelvic radiation therapy. This technique is determined to be useful, easily applicable, and well
tolerated by patients.
This procedure permits higher radiation therapy dose delivery to the PTV with fewer side effects and morbidity due to less
small/large bowel volume irradiated.
MSRO42-06
Institutional Experience of Long-term (10-15 Years) Results with High Dose Rate (HDR) Salvage
Therapy for Recurrent Prostate Cancer
Participants
Nevine M. Hanna, MD, Sandy, UT (Presenter) Nothing to Disclose
ABSTRACT
Purpose/Objective(s): Limited treatments are available for recurrent prostate cancer patients. Modality selection can be challenging
for both the patient and their physicians. HDR brachytherapy has been used extensively as a boost after external beam radiation
therapy, but is increasingly being tested as salvage treated for locally recurrent prostate cancer. We report our long-term results
for HDR salvage brachytherapy in patients with initially low, intermediate, and high risk prostate cancer.Materials/Methods: Patients
(n=27) with a median age of 71 (57-84) years at recurrence with low- (n=10), intermediate- (n=8), and high-risk prostate cancer
(n=9) treated at the California Endocurietherapy (CET now at UCLA) between 1991 and 2009 were analyzed. Median HDR
brachytherapy dose prescription was 36 (22-46) Gy in 6 (3-8) fractions. Five patients did receive additional external beam radiation
therapy (EBRT) after HDR brachytherapy to an EBRT dose of 36 (36-50) Gy. Presenting disease characteristics were median
recurrent PSA 8.1 (1.4-86.7) ng/mL, Gleason Score 7 (5-10), median prostate volume 23.2 (0-80) cc. Androgen deprivation therapy
(ADT) was administered in 68% for a median of 6 (3-96) months. Risk groups were defined according to the NCCN guidelines.
Sustained PSA nadir+2 was used to define biochemical relapse. Statistical analyses being performed are to include Kaplan-Meier
analyses and univariate and multivariate Cox proportional analyses.Results: Preliminary analysis shows that the median overall
follow-up time was 6.90 (0.30-15.92) years. The 5, 10 and 15 year overall survival (OS) rates were 86%, 36% and 11%,
respectively. The 5, 10 and 15 year distant metastases-free survival (DMFS) rates were 68%, 29% and 11%, respectively.
Biochemical progression free survival (BPFS) for the initially presenting low, intermediate and high grade patients is 122, 59, and 41
months, respectively. On univariate analyses, BPFS after salvage HDR was most significantly impacted by PSA at recurrent
diagnosis (p=0.007) but not significantly affected by risk group at initial diagnosis (P>0.05). Univariate Cox analyses and
multivariate analyses are currently underway to determine the impact of ADT on these parameters.Conclusion: Our long-term data
validates HDR salvage brachytherapy in recurrent prostate cancer patients as a standard treatment option which offers excellent
rates of disease control.
MSRO42-07
Designing and Implementing an Innovative Phantom-Based Simulator Training Program for Prostate
Brachytherapy Using Advanced Magnetic Resonance Imaging
Awards
Participants
Nikhil G. Thaker, MD, Houston, TX (Presenter) Nothing to Disclose
Tze Yee Lim, Houston, TX (Abstract Co-Author) Nothing to Disclose
Rajat Kudchadker, Houston, TX (Abstract Co-Author) Nothing to Disclose
Tharakeswara K. Bathala, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Thomas Pugh, Houston, TX (Abstract Co-Author) Nothing to Disclose
Usama Mahmood, Houston, TX (Abstract Co-Author) Nothing to Disclose
Deborah A. Kuban, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Teresa Bruno, Houston, TX (Abstract Co-Author) Nothing to Disclose
Jihong Wang, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
R. Jason Stafford, PhD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Thomas A. Buchholz, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
S J. Frank, MD, Houston, TX (Abstract Co-Author) Board Member, C4 Imaging LLC; Stockholder, C4 Imaging LLC; Advisory Board,
Elekta AB
PURPOSE
Prostate brachytherapy (PB) is a well-established treatment for localized prostate cancer and has the potential to deliver excellent
outcomes at low cost. However, high-quality PB requires hands-on training and expertise in image-guidance, which is minimally
emphasized in current radiation oncology training. Additionally, MRI holds promise of improving target delineation over CT imaging.
Our objective was to design and implement a unique pilot training program that utilizes advanced MRI and a phantom simulator
approach to improve the quality of PB education.
Our existing PB phantom simulator program was adapted to introduce MRI treatment planning and post-implant evaluation. The
simulator program emphasized six core areas: patient selection, simulation, treatment planning, implantation, treatment evaluation,
and outcome assessment. Trainees in the simulator program were residents, fellows, or physicists. The program utilized the Iodine125 pre-operative planning technique and a transrectal ultrasound device to implant prostate phantoms. MRI markers were
substituted for spacers to allow for visualization.
RESULTS
Forty one trainees have completed the phantom simulator program to date. Ten implants were successfully conducted during the
MRI-phantom simulator pilot program. MRI 3DT2 CUBE sequence could adequately delineate the prostate, seminal vesicles, rectum
and bladder in the CIRS 053MM phantom. Dummy seeds could be well-visualized with post-implant CT scans. However, seed
identification on MRI required a learning curve due to the need to identify MRI markers, which flanked each dummy seed (Figure).
The MRI markers facilitated detection of up to 97% of seeds in implanted phantoms by identifying the signal voids between MRI
markers.
CONCLUSION
This proof-of-principle educational curriculum successfully adapted a phantom simulator training program to implement advanced
MRI simulation, treatment planning, and post-implant dosimetry. Analysis of implants showed that most organs could be adequately
visualized with MRI and that most seeds could be identified with the aid of MRI markers. Phantom-based simulator training programs
can provide a valuable educational opportunity to learn the PB process and to learn how to implement advanced image-guidance.
Phantom-based simulator training can enhance practical expertise with advanced imaging technology and image-guide therapies.
MSRO42-09
Stereotactic Body Radiation Therapy for Primary Lesion of Renal Cell Carcinoma
W ednesday, Dec. 2 11:50AM - 12:00PM Location: S103CD
Participants
Hotaka Nonaka, Chuo, Yamanashi, Japan (Presenter) Nothing to Disclose
ABSTRACT
Purpose/Objective(s): We assessed the efficacy and toxicity of stereotactic body radiation therapy (SBRT) for primary lesion of
renal cell carcinoma (RCC).Materials/Methods: We retrospectively reviewed 9 patients (7 male and 2 female) with stage I RCC
treated with SBRT between 2007 and 2014. The diagnosis of RCC was judged according to imaging. The median age was 73 years
old (range, 59-79). Three patients had high serum creatinine level before SBRT. Four patients had history of prior contralateral
nephrectomy. The median diameter of tumor was 18 mm (range, 9-26). A total dose of 60-70 Gy in 10 fractions was administered
at the 95% of planning target volume or internal target volume. Median biologically effective dose was 119 Gy (range 96-119),
using an a/ß value of 10 Gy. Overall survival (OS) and local progression-free survival (LPFS) were based on Kaplan Meier estimates.
Toxicity was scored according to NCI-CTCAE, version 4.0. Renal disorder was graded by referring to pretreatment renal
function.Results: The median follow-up duration after SBRT was 28 months (range, 11-89). Clinical response was partial response
(PR) in 5 tumors, stable disease (SD) in 4 tumors. Five tumors with PR has decreased gradually in size for 11-56 months (median,
42) after SBRT. Three patients developed distant metastases. The 2- and 3- year OS rate were 85.7% and 64.3%, respectively
(median survival time, 44 months). The 3- year LPFS rate was 100%. In a case of a patient with SD tumor, autopsy was performed
at 29 months after SBRT, and it showed almost complete necrosis of tumor tissues with a small amount of viable renal carcinoma
cells. Three patients developed Grade 3 chronic kidney disease (CKD), 1 had Grade 2 CKD. All patients with Grade 3 CKD had high
serum creatinine level before SBRT, and 2 of these patients had prior contralateral nephrectomy before SBRT. Severe toxicity for
other organs at risk was not observed.Conclusion: SBRT for primary lesion of RCC resulted in acceptable LPFS and toxicity. Because
of slow tumor response, we need long-term follow up to observe the effect of SBRT for RCC. Multicenter prospective study is
mandatory to evaluate true local effect and toxicity and to compare SBRT versus other local treatment modalities for RCC.
SSK08
Genitourinary (Functional Imaging of the Kidneys)
W ednesday, Dec. 2 10:30AM - 12:00PM Location: E450B
GU
MR
US
Participants
Harriet C. Thoeny, MD, Bern, Switzerland (Moderator) Nothing to Disclose
Sub-Events
SSK08-01
Assessing the Role of Quantification of Shear Wave Velocity and Tissue Elasticity in the Detection of
Interstitial Fibrosis within the Transplant Kidney
Participants
David Ferguson, MBBCh, Vancouver, BC (Presenter) Nothing to Disclose
Amdad M. Ahmed, MBChB, FRCR, Birmingham, United Kingdom (Abstract Co-Author) Nothing to Disclose
Mohammed F. Mohammed, MBBS, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Caitlin Schneider, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Christopher Nguan, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
Alison C. Harris, MBChB, Vancouver, BC (Abstract Co-Author) Nothing to Disclose
PURPOSE
Novel ultrasound techniques allow for the assessment of tissue fibrosis. One such technique ('Virtual Touch IQ') allows for both
qualitative and quantitative measurement of shear wave velocity to assess tissue strain and detect underlying fibrosis. Using this
technique, in the setting of renal allograft failure, we aim to compare the gold standard of renal biopsy and histological grade with
that of shear wave velocity measurement to evaluate for potential underlying interstitial fibrosis.
Patients undergoing renal biopsy for renal graft dysfunction within the ultrasound department were enrolled prospectively over an
eight-month period. In addition to routine routine renal ultrasound with Doppler imaging, shear wave velocity measurements using
'Virtual Touch IQ' were obtained from the target area for renal cortical biopsy. Sufficient magnitude of the shear wave was
confirmed on quality display. Biopsies were performed and reviewed by a nephropathologist, blinded to the imaging results, with
histological categorization according to the Banff classification.Shear wave velocities and histological grade were compared to
determine significance. Statistical analysis was performed using the Mann Whitney test and Spearman-correlation-coefficient (rho).
RESULTS
Fourteen patients were identified and subcategorized according to the Banff category with respect to interstitial fibrosis as normal
(n=4), grade 1(n=4), grade 2 (n=3) and grade 3(n=3). Median shear wave velocity was demonstrated to be significantly higher in
renal transplants with biopsy proven interstitial fibrosis (median=2.512m/s) than those without interstitial fibrosis
(median=1.925m/s) (Mann Whitney U=4, n1=4, n2=10, p<0.05). Positive correlation was also identified between the mean shear
wave velocity and Banff categories (rho= 0.731, p=0.003).
CONCLUSION
Preliminary data indicates that shear wave velocity within cortex of the transplant kidney correlates significantly with interstitial
fibrosis in the context of renal allograft failure.
Shear wave velocity analysis is a potentially valuable non-invasive tool to assess for renal allograft interstitial fibrosis.
SSK08-02
Improved Temporal Resolution and Image Contrast for Kidney DCE-MRI by 3D Spoiled Gradientrecalled Echo Sequence with Compressed Sensing
Participants
Kai Zhao, PhD, Beijing, China (Presenter) Nothing to Disclose
Bin Chen, Beijing, China (Abstract Co-Author) Nothing to Disclose
Jue Zhang, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To verify the feasibility of combine Compressed Sensing (CS) technique in dynamic contrast-enhanced magnetic resonance imaging
(DCE-MRI) of kidney
Nine healthy New Zealand rabbits underwent kidney DCE-MRI studies on a clinical 3.0T MR scanner. 3D spoiled gradient-recalled
echo sequence modified with CS scheme was scanned before and after the administration of 0.05 mmol/kg of Gd-DTPA with the
following parameters: TR = 3.3ms, TE = 1.3ms, FA = 15°, slice thickness = 3 mm, matrix =128×128, FOV = 180mm and 16 slices
were acquired. Four accelerations (2-x, 3-x, 4-x, 8-x) were scanned as well as the fully sampling every other day for each animal in
DCE MR imaging. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the reconstructed images of the kidney were
analyzed and compared to that of the fully sampled images separately.
RESULTS
The images with 2-X, 3-X, 4-X, 8-X CS acceleration and fully sampled results were shown from row 1 to row 5. The 8-X
accelerated images appeared blurring which may due to the loss of a mass of high frequency information (Figure 1).Signal intensity
curves of cortex and medulla were represented in Figure 2. The reconstructions of 8-X were also blurring.Superior CNR performance
between cortex and tissue CNR_ct, and medulla and tissue CNR_mt were found for all the time points after contrast administration.
CNR_ct of CS reconstructed images were significantly larger than that of the conventional fully sampled images at all accelerations
throughout the enhancement (p<.01 for 2-X; p<.001 for 3-X and 4-X). CNR_mt of CS reconstructed images were also significantly
larger than that of the fully sampled images (p<.01 for 2-X; p<.001 for 3-X and 4-X). CNR_cm measured from cortical and medullary
regions were larger in CS reconstructed images, especially at the initial time of enhancement: 44.00 10.0 for 2-X, 43.30 8.0 for 3-X
and 49.78 14.9 for 4-X vs. 15.28 6.7 for 1-X (p<.001 for all) (Table 1).In SNR analysis, SNR-cortex (SNR_c) and SNR-medulla
(SNR_m) of CS reconstructed images were all found statistically different from conventional fully sampled images (p<.001) (Table
2).
CONCLUSION
Compressed sensing is a feasible and promising acceleration method to improve temporal resolution and image contrast in renal
DCE-MRI.
CS is a promising imaging method with both improved temporal resolution and image contrast, which will be widely used in the
future.
SSK08-03
Noninvasive Evaluation of Stable Renal Allograft Function Using Shear-Wave Elastography
Participants
Beom Jun Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
Protocol renal allograft biopsies improve outcomes via early detection and treatment of subclinical rejection (SCR). Shear-wave
elastography (SWE) assesses quantitatively the tissue elasticity. The aim of our study was to investigate the feasibility of SWE in
evaluating patients with stable renal allograft function who underwent protocol biopsies.
95 patients (mean age, 48.3 years; range, 21-73 years) with stable renal allograft function who underwent ultrasound (US)-guided
protocol biopsies at 10 days or 1 year after transplantation were enrolled in this retrospective study. All US and elasticity
examinations of renal allograft were performed by a commercial scanner using a convex transducer (C5-1 ElastoPQ, Philips iU 22).
SWE was performed immediately before protocol biopsies. Tissue elasticity (kPa) in the cortex was measured for all renal allografts.
Clinical and US variables were compared between patients with SCR and without SCR using the Student t -test. The correlation
between estimated glomerular filtration rate (eGFR) and tissue elasticity was evaluated in all patients by Pearson correlation.
Diagnostic performance of tissue elasticity to distinguish between patients with SCR and without SCR was analyzed using a receiver
operating characteristics (ROC) curve analysis.
RESULTS
Acute rejection (AR) was pathologically confirmed in 34 patients. The mean tissue elasticity of ARs (31.0 ± 12.8 kPa) was
statistically greater than that no ARs (24.5 ± 12.2 kPa) ( P < 0.001), while the resistive index values did not show statistical
difference between ARs and no ARs ( P = 0.112). Clinical variables including age, kidney size, creatinine and eGFR revealed
statistical differences between ARs and no ARs ( P < 0.05). Tissue elasticity demonstrated a moderate negative correlation with
eGFR (correlation coefficient= -0.604, P < 0.001). At ROC curve analysis, the area under the curve (AUC) of tissue elasticity was
0.651 and followed eGFR (AUC= 0.728).
CONCLUSION
SWE, as a noninvasive tool, may be feasible in distinguishing between allograft with SCR and without SCR in patients with stable
renal function. Moreover, it may demonstrate functional state of renal allografts.
As a feasible technique, shear-wave elastography may help to noninvasively assess functional state of patients with stable renal
allograft function.
SSK08-04
Assessment of Renal Allograft Function Early after Transplantation Using Renal IVIM with Healthy as
Control
Participants
Lihua Chen, Tianjin, China (Presenter) Nothing to Disclose
Tao Ren, Tianjin, China (Abstract Co-Author) Nothing to Disclose
Wen Shen, Tianjin, China (Abstract Co-Author) Nothing to Disclose
Panli Zuo, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
Graft dysfunction is a common complication following transplantation,which is associated with allograft survial. Intravoxel incoherent
Graft dysfunction is a common complication following transplantation,which is associated with allograft survial. Intravoxel incoherent
motion (IVIM) has potential to assess renal function in patients with renal and allograft dysfunction. The purpose of the current
study in renal allografts early after transplantation was to investigate relationship between estimated glomerular filtration rate
(eGFR) and diffusion and perfusion parameters calculated using IVIM imaging, compared with healthy kidney, and to gain the
sensitive IVIM parameters for monitoring allograft function.
A total of 71 subjects were performed on a 3.0T MRI scanner (MAGNETOM Trio, a Tim system, Siemens AG, Erlangen, Germany)
using IVIM sequence with 11 b values( 0, 10, 20, 40, 60, 100, 150, 200, 300, 500, and 700 s/mm2 ). Subjects were divided into 3
groups: group 1, healthy volunteers (n=19); group 2, allografts with good allograft function(eGFR≥60mL/min/1.73m2, n=33); group
3, allografts with impaired allograft function(eGFR<60mL/min/1.73m2, n=19).To separate the perfusion and diffusion, a biexponential fit was used to calculate the diffusion coefficient of slow (ADCslow); the diffusion coefficient of fast (ADCfast) and
perfusion fraction (FP). Differences in IVIM parameters between the cortex and medulla in each group were compared using paired
samples t test. Differences of IVIM parameters between three groups were compared using LSD test.Relationships between eGFR
and IVIM parameters were assessed using spearman correlation coefficient.
RESULTS
The ADC, ADCslow, Fp values of renal cortex were significantly higher in group 1 and group 2 compared to group 3(all p<0.01). The
ADC, ADCslow values of renal medulla were significantly higher in group 1 and group 2 compared to group 3(all p<0.01). For
allografts, significant differences in ADC, ADCslow, FP values of renal cortex and ADC, ADCslow values of renal medulla were
observed between group 2 and group 3. In renal allografts, there was a significant positive correlation between eGFR and ADC,
ADCslow , Fp value of cortex, ADC, ADCslow value of medulla(all p<0.05).
CONCLUSION
The ADC, ADCslow, FP values of renal cortex and ADC, ADCslow values of renal medulla may be useful for detect renal allograft
dysfunction. IVIM technique is a reliable imaging for evaluating and monitoring allograft function.
IVIM technique can be used to evaluate and monitor allograft function
SSK08-05
Renal Hemodynamics and Oxygenation Evaluated by ASL, BOLD and Oxygen Extraction Fraction
(OEF) Imaging in Animal Model of Diabetic Nephropathy
Awards
Trainee Research Prize - Medical Student
Participants
Rui Wang, PhD, Beijing, China (Presenter) Nothing to Disclose
Kai Zhao, PhD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Xueqing Sui, Beijing, China (Abstract Co-Author) Nothing to Disclose
Zhiyong Lin, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the feasibility of evaluating renal hemodynamics and oxygenation changes by arterial spin labeling (ASL), blood
oxygen level dependent (BOLD) and oxygen extraction fraction (OEF) imaging in diabetic nephropathy (DN) rabbits.
Seventeen New Zealand rabbits were divided into 2 groups: DN group, 12 rabbits with intravenously injection of alloxan at 100
mg/kg; and control group, 5 rabbits with injection of same dosage of 0.9% saline. At 72hr after the injection, blood glucose level
was tested for all. Rabbits with blood glucose level higher than 16.0 mmol/L were considered as successfully established of diabetes
mellitus (DM) model. MR examination was performed at 3T MR scanner (GE) with an 8-channel knee coil. For each rabbit, 2 times of
MR exam were performed: baseline (before injection) and 72hr after model established successfully. ASL imaging was conducted
with the labeling strategy of flow-sensitive alternating inversion recovery (FAIR) and BOLD was conducted with multiple gradient
echo (mGRE) sequence. The measurement of renal OEF was derived from Yoblonsky's model with multi-echo gradient and spin echo
(MEGSE) sequence. Then the rabbits were sacrificed for pathological study of the kidney. Quantitative RBF, R2* and OEF values
were obtained within manually drawn ROIs, including cortex (CO) and outer medulla (OM). One-way ANOVA and paired-sample T
test was performed to test the differences of RBF, R2* and OEF for inter- and inner-group.
RESULTS
Ten of 12 rabbits in DN group were successfully established DM model and renal pathological damages can be observed in these
rabbits. There was no statistically significant difference of RBF, R2* or OEF between two groups at baseline (p>0.05). Compared
with baseline, R2* and OEF in OM at 72 hr was significantly increased in DN group (p=0.018 and 0.048, respectively), while the
control group was not (p>0.05). In CO, R2* also elevated significantly at 72 hr compared with baseline (p=0.04). For control group,
there was no significant difference in CO or OM between baseline and 72 hr (p>0.05).
CONCLUSION
The combination of ASL, BOLD and OEF MRI may enable a comprehensive assessment of the functional status of early DN
pathophysiological changes.
It would be valuable for clinicians to early detect renal pathophysiological changes for diabetes without symptoms.
SSK08-06
Diffusion Weighted Imaging and Diffusion Tensor Imaging for Detection of Acute Kidney Injury in
Patients Following Lung Transplantation
Participants
Susanne Tewes, MD, Hannover, Germany (Presenter) Nothing to Disclose
Gregor Warnecke, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Mi-Sun Jang, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Dagmar Hartung, MD, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Matti Peperhove, MD, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Marcel Gutberlet, Dipl Phys, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Christine Fegbeutel, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Bjoern Juettner, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Axel Haverich, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Frank K. Wacker, MD, Hannover, Germany (Abstract Co-Author) Research Grant, Siemens AG Research Grant, Pro Medicus Limited
Faikah Gueler, MD, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
Katja Hueper, Hannover, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Loss of renal function is a frequent complication after lung transplantation (lutx) and is associated with higher morbidity. Thus,
imaging biomarkers to noninvasively monitor renal damage and to guide treatment strategies to preserve renal function are of
clinical relevance. The purpose was to evaluate diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) for detection of
renal impairment in lutx-patients.
54 patients 14±2 days after lutx and 12 healthy volunteers underwent MRI on a 1.5T scanner. Respiratory-triggered DWI (10 bvalues, 0-1000 s/mm²) and DTI sequences (20 diffusion direction, b=0,600 s/mm²) were acquired. Maps of apparent diffusion
coefficient (ADC) and fractional anisotropy (FA) were calculated. Renal function was monitored daily and acute kidney injury (AKI)
was defined according to AKIN-criteria within 48h after surgery. Factors contributing to AKI such as duration of surgery,
immunosuppressive drugs and blood product infusion were documented. Statistical analysis comprised ANOVA and correlation
analysis. Values are given as mean±SEM.
RESULTS
59% (32/54) of lutx-patients developed AKI. ADC of renal medulla was significantly lower in patients with AKI compared to patients
without AKI (2.07±0.03 vs 2.17±0.04*10-³ mm²/s, p<0.05) and to healthy volunteers (2.07±0.03 vs 2.21±0.03*10-³ mm²/s,
p<0.01). FA-values of renal medulla were significantly reduced compared to healthy volunteers in both groups (AKI: 0.27±0.01, no
AKI: 0.28±0.01, healthy: 0.33±0.02, p<0.001), and did not differ between patients with and without AKI. ADC and FA negatively
correlated with the amount of blood product infusion (r=-0.41 and r=-0.42, p<0.01) and ADC was correlated with eGFR at the day
of MRI (r=-0.52, p<0.001). No correlations with duration of surgery and tacrolimus levels at the day of the MRI were observed.
CONCLUSION
Diffusion imaging showed significant renal changes in lutx-patients compared to healthy volunteers irrespective of whether AKI was
diagnosed according to standard criteria. ADC reduction was stronger in patients with AKI. Amount of blood product infusion
correlated with MRI parameters and may be a contributing factor to renal damage following major surgery.
Diffusion imaging detects renal damage following major surgery and may help to improve patient management to prevent further
renal damage.
SSK08-07
Evaluation of Ultra-fast, Single Breath-Hold Renal ASL Perfusion-Preliminary Results of Healthy
Volunteers
Participants
Melissa Ong, MD, Mannheim, Germany (Presenter) Nothing to Disclose
Thorsten Honroth, Bremen, Germany (Abstract Co-Author) Research funded, Siemens AG
Guenther Matthias, Bremen, Germany (Abstract Co-Author) Research funded, Siemens AG
Bernd Kuehn, PhD, Erlangen, Germany (Abstract Co-Author) Nothing to Disclose
Stefan O. Schoenberg, MD, PhD, Mannheim , Germany (Abstract Co-Author) Institutional research agreement, Siemens AG
Daniel Hausmann, MD, Mannheim, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
Evaluation of 3D ultra-fast, single breath-hold arterial spin labeling magnetic resonance imaging (ASL MRI) for the measurement of
renal perfusion.
We included 7 (5 male, mean age 29) healthy volunteers who did not suffer from any medical condition. A single-shot pulsed ASL
(PASL) prototype sequence with a 3D GRASE readout using background suppression was implemented on a 3.0 Tesla Magnetom
Skyra MRI scanner (Siemens Healthcare, Erlangen, Germany). 24 slices with a resolution of 4.7mm x 4.7mm x 4mm were acquired for
4 different inflow times (TI = 750ms, 1000ms, 1250ms, 1500ms) within a single breath-hold of 23s, including an integrated
calibration scan (M0). The prototype sequence allowed a multi-slice measurement of the whole kidney in one exam. The exam was
performed using a standard 18-channel body matrix coil. No contrast agent was applied. Subjective image quality was rated by two
radiologists according to a 5-point Likert-scale (5=excellent; 1=non-diagnostic). Mean renal cortical and medullary blood flow was
measured in the upper and lower pole of the kidney.
RESULTS
All images were rated as diagnostic. Overall image quality was rated as good (4; 25-75% quartile 3-4). Mean cortical perfusion
values were 224±28 mL/100mL/min for the upper and 224±37 mL/100mL/min for the lower pole, mean medullary perfusion value
ranged between 107±16 mL/100mL/min and 101±14 mL/100mL/min for the upper and lower pole, respectively.
CONCLUSION
Ultra-fast, single breath-hold renal ASL perfusion in healthy volunteers shows promising results regarding image quality and
feasibility.
Ultra-fast, single breath-hold ASL perfusion facilitates contrast-free creation of parametric perfusion maps, which can be repeated
arbitrarily and hence potentially serve to monitor therapy.
SSK08-08
Diffusion-weighted Magnetic Resonance Imaging of Kidneys in Patients with Chronic Kidney Disease
Participants
Katarzyna M. Sukowska, MD, Warsaw, Poland (Presenter) Nothing to Disclose
Piotr Palczewski, MD, Warsaw, Poland (Abstract Co-Author) Nothing to Disclose
Agnieszka Furmanczyk-Zawiska, Warsaw, Poland (Abstract Co-Author) Nothing to Disclose
Wojciech Szeszkowski, Warsaw, Poland (Abstract Co-Author) Nothing to Disclose
Dorota Piotrowska-Kownacka, Warsaw, Poland (Abstract Co-Author) Nothing to Disclose
Magdalena Durlik, Warsaw, Poland (Abstract Co-Author) Nothing to Disclose
Marek Golebiowski, Warsaw, Poland (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the apparent diffusion coefficient (ADC) values of renal parenchyma in patients in different stages of chronic kidney
disease (CKD). To correlate ADC measurements with creatinine blood level, estimated glomerular filtration rate (eGFR), and ADC
values obtained from healthy subjects.
20 healthy volunteers and 34 patients in different stages of CKD were examined on a 1.5 unit (Ingenia, Philips, The Netherlands).
The inclusion criteria for patients with CKD were: biopsy proven CKD and no hydronephrosis or renal artery stenosis. Blood samples
to assess the serum creatinine level were taken immediately before examination. The MR examination included two diffusion
weighted sequences: one with 16 b values uniformly distributed from 0 to 750; the other one with 10 b values including 6 low (0150) and 4 high (300-900) b values. ADC values were measured with whole-kidney manually placed region of interest. Statistical
analysis was performed using the Statistica software (version 10.0; Statsoft, Inc., US). Unpaired Student's t-test were used to
evaluate the differences in ADC. ROC curves were drawn to find out area under the curve for differentiation of CKD groups and cutoff ADC values were calculated so as to achieve the highest average sensitivity and specificity. To investigate the relationship
between ADC values and serum creatinine / eGFR, Pearson's correlation coefficient was calculated by bivariate correlation. All P
values <0.05 were taken as statistically significant.
RESULTS
A significant positive correlation between ADC and eGFR and a negative correlation between ADC and creatinine blood level was
observed. There were statistical differences between ADC values in healthy individuals and patients in moderate and severe stage
of CKD. Based on ADC measurements cut-off values were established allowing for identification of patients with eGFR higher than 60
ml/min/1.73m2 and lower then 30ml/min/1.73m2.
CONCLUSION
The DWI has a potential role in assessing renal function as ADC values correlate with eGFR and the level of renal damage in severe
stages of CKD.
The ability of DWI to noninvasively assess eGFR may provide an additional tool for monitoring the course of disease and for
stratifying the risk of contrast medium administration in patients with CKD.
SSK08-09
Intravoxel Incoherent Motion MRI for Differentiating Renal Hypoperfusion from Increased Cellularity
after Ischemia-Reperfusion
W ednesday, Dec. 2 11:50AM - 12:00PM Location: E450B
Participants
Mike Notohamiprodjo, Munich, Germany (Presenter) Nothing to Disclose
Katharina Stella Winter, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Michael Staehler, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Andreas D. Helck, MD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Olaf Dietrich, PhD, Munich, Germany (Abstract Co-Author) Nothing to Disclose
Moritz Schneider, Munich, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To differentiate hypoperfusion from inflammatory hypercellularity after renal ischemia-reperfusion due to partial nephrectomy using
Intravoxel Incoherent Motion MRI.
This IRB approved prospective study was performed according to the declaration Helsinki. 15 patients with renal tumors underwent
MR at 3T (Magnetom Verio, Siemens Healthcare) directly before and one week after partial nephrectomy. Diffusion weighted imaging
was acquired with an EPI-sequence (10 b-values 0-800 s/mm2, 3 averages, 6 directions). IVIM-analysis was performed with homebuilt software (PMI 0.4, IDL) by biexponential fitting of the tissue Dslow (mm2/s*10-3) and the pseudo-diffusion Dfast (mm2/s*103) as well as the perfusion component f (%). Apparent diffusion coefficient (ADC; mm2/s*10-3) was derived from monoexponential
analysis. To compare parameters between baseline and follow-up the paired Wilcoxon signed-rank test and to compare nonnephrectomized and partially nephrectomized kidneys the non-paired Mann-Whitney U test was used.
RESULTS
In the baseline examination prior to partial nephrectomy there were no significant differences between tumor bearing and
contralateral kidney, whereas the follow-up measurement showed significant differences for ADC (p<0.001), Dfast (p=0.02) and
most pronounced for f (p<0.001). Partially nephrectomized kidneys showed a significant decrease of ADC (2.5±0.3 vs. 2.3±0.2,
p<0.01), Dfast (8.6±1.8 vs. 7.3±1.7, p = 0.02) and again most pronounced for f (19.2±3.0 vs. 13.7±4.4 p < 0.01). There were no
significant differences for Dslow (operated kidney 2.0±0.2 vs. 2.0±0.2; contralateral kidney 2.1±0.2 vs. 2.0±0.1) Nonnephrectomized contralateral kidneys expressed a significant increase of ADC (2.5±0.2 vs. 2.7±0.3, p < 0.01), and f (19.3±2.6 vs.
21.5±4.0, p = 0.03). There was no significant correlation of the alteration of each parameter to clamping time.
CONCLUSION
IVIM detects significant changes, particularly of the perfusion fraction in the operated and contralateral kidney after partial
nephrectomy suggesting that ischemia-reperfusion associated diffusion restriction is correlated to hypoperfusion rather than
increasing inflammatory cellularity.
IVIM MRI suggest that renal ischemia-reperfusion associated diffusion restriction is correlated to hypoperfusion rather than
increasing inflammatory cellularity.
SSK09
Genitourinary (Prostate Imaging and Staging)
W ednesday, Dec. 2 10:30AM - 12:00PM Location: N228
GU
MR
OI
Participants
Andrew B. Rosenkrantz, MD, New York, NY (Moderator) Nothing to Disclose
Ronaldo H. Baroni, MD, Sao Paulo, Brazil (Moderator) Nothing to Disclose
Sub-Events
SSK09-01
Computed Very High B-Value Diffusion-Weighted Imaging of the Prostate: How High Should We Go?
Participants
Nainesh Parikh, MD, New York, NY (Presenter) Nothing to Disclose
Justin M. Ream, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Andrea S. Kierans, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Max X. Kong, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Samir S. Taneja, MD, New York, NY (Abstract Co-Author) Consultant, Eigen Consultant, GTx, Inc Consultant, Bayer AG Consultant,
Healthtronics, Inc Speaker, Johnson & Johnson Investigator, STEBA Biotech NV Royalties, Reed Elsevier
PURPOSE
To assess the impact of a broad range of computed b-values (1,500-5,000 s/mm2) on prostate cancer detection.
49 patients undergoing 3T prostate MRI before radical prostatectomy were included. Exams included DWI with a maximal acquired
b-value of 1,000 s/mm2, from which six computed DWI image sets (b-values ranging from 1,500-5,000 s/mm2) were generated.
Two radiologists [R1 (attending), R2 (fellow)] independently evaluated the ADC map as well as each DW image set, blinded to the
b-value, to assess dominant lesion location. Pathologic findings from radical prostatectomy served as the reference standard.
RESULTS
Sensitivity for tumor: R1-82% (ADC), 80% (b1000), 86% (b1500), 88% (b2000), 86% (b2500), 84% (b3000), 76% (b4000), 65%
(b5000); R2-71% (ADC), 63% (b1000), 76% (b1500), 71% (b2000), 70% (b2500), 65% (b3000), 57% (b4000), 37% (b5000).
Sensitivity for Gleason score≥7 tumor: R1-83% (ADC), 80% (b1000), 93% (b1500), 93% (b2000), 90% (b2500), 90% (b3000), 80%
(b4000), 65% (b5000); R2-75% (ADC), 68% (b1000), 80% (b1500), 78% (b2000), 78% (b2500), 70% (b3000), 60% (b4000), 38%
(b5000). PPV for tumor: R1-95% (ADC), 95% (b1000), 93% (b1500), 96% (b2000), 98% (b2500), 93% (b3000), 95% (b4000), 87%
(b5000); R2-85% (ADC), 82% (b1000), 93% (b1500), 88% (b2000), 92% (b2500), 94% (b3000), 93% (b4000), 75% (b5000).
Dominant lesion visual conspicuity (1-5 scale): R1-3.4±1.5 (ADC), 2.5±1.2 (b1000), 3.3±1.4 (b1500), 3.2±1.3 (b2000), 3.2±1.4
(b2500), 3.1±1.4 (b3000), 2.8±1.4 (b4000), 2.7±1.5 (b5000); R2-3.2±1.6 (ADC), 2.1±1.1 (b1000), 3.2±1.5 (b1500), 3.1±1.6
(b2000), 3.0±1.6 (b2500), 2.5± 1.5 (b3000), 1.8±1.0 (b4000), 1.3±0.6 (b5000). Reader confidence (1-5 scale): R1-3.2±1.5 (ADC),
2.6±1.3 (b1000), 3.1±1.4 (b1500), 3.1±1.4 (b2000), 3.1±1.5 (b2500), 3.1±1.5 (b3000), 3.0±1.6 (b4000), 2.8±1.7 (b5000); R23.3±1.7 (ADC), 2.2±1.2 (b1000), 3.2±1.6 (b1500), 3.4±1.7 (b2000), 3.4±1.8 (b2500), 3.1± 1.8 (b3000), 2.6±1.6 (b4000), 1.9±1.3
(b5000).
CONCLUSION
Computed b-values in the range of 1,500-2,500 s/mm2 were optimal for prostate cancer detection, comparing favorably with the
ADC map. b-values of 1,000 or 3,000-5,000 exhibited lower performance.
Computed b-values of 1,500-2,500 s/mm2 (but not higher) help optimize prostate DWI, thereby facilitating targeted prostate biopsy
and tailored treatments based on imaging guidance.
SSK09-02
Utility of Apparent Diffusion Coefficient (ADC) in Intermediate Grade (Gleason score 3+4=7) Prostate
Cancer Diagnosed at Non-targeted TRUS-guided Needle Biopsy
Participants
Radu Rozenberg, MD, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Nicola Schieda, MD, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Shaheed Hakim, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Trevor A. Flood, MD, FRCPC, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Rebecca Thornhill, PhD, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Christopher Lim, MD, Ottawa, ON (Presenter) Nothing to Disclose
PURPOSE
To determine the ability of ADC analysis to predict Gleason score (GS) upgrading of tumor and extra-prostatic extension (EPE) after
radical prostatectomy (RP) in 3+4=7 prostate cancer (PCa).
With REB approval, 54 men with GS 3+4=7 PCa at non-targeted TRUS-guided biopsy underwent 3-Tesla MRI and RP between 20122013. Outcomes at RP included: A) upgrading to GS 4+3=7 and B) organ confined disease (OCD). >0.5 mL tumors were contoured
by a blinded GU radiologist by correlating ADC to RP histopathology map. Mean ADC, ADC ratio (normalized to peripheral zone),
histogram analysis (10th, 25th and 50th centile ADC) and texture analysis features were compared between groups using multivariate analysis, regression modeling and ROC analysis.
RESULTS
25.9% (14/54) patients were upgraded to GS 4+3=7 and 51.9% (28/54) patients had EPE after RP. There was no difference in age
(p=0.38, 0.85), PSA (p=0.96, 0.95) or % of core biopsies with Gleason pattern 4 (p=0.56, 0.89) between groups. Mean ADC
(mm2/sec), ADC ratio, 10th, 25th and 50th centile ADC were similar between GS 3+4=7 (0.94 ± 0.24, 0.58 ± 0.15, 0.77 ± 0.31,
0.94 ± 0.28 and 1.15 ± 0.24) and GS 4+3=7 tumors (0.96 ± 0.20, 0.55 ± 0.11, 0.71 ± 0.26, 0.89 ± 0.19 and 1.11 ± 0.16), p>0.05.
10th centile ADC was lower in tumors with EPE (0.69 ± 0.31 versus 0.82 ± 0.28), p=0.02; with no difference comparing all other
conventional ADC parameters, p>0.05. Regression models combining texture features improved prediction of GS upgrade: A)
Kurtosis+Entropy+Skewness (AUC 0.76 [SE=0.07], p<0.001; sensitivity 71%, specificity 73%) and B)
Kurtosis+Heterogeneity+Entropy+Skewness (AUC 0.77 [SE=0.07], p<0.001); sensitivity 71%, specificity 78%).
CONCLUSION
Amongst Gleason score 3+4=7 prostate cancers diagnosed at TRUS-guided biopsy, mean ADC and ADC histogram analysis is not
predictive of upgrading after RP, while ADC texture-analysis improves accuracy. 10th centile ADC is predictive of EPE.
Conventional ADC analysis cannot predict upgrading of Gleason score 3+4=7 prostate cancer diagnosed at TRUS-guided biopsy;
however, ADC texture-analysis improves accuracy and 10th centile ADC can predict organ confined disease.
SSK09-03
High Resolution 3-Tesla Endorectal Prostate MR Imaging: A Multireader Study of Radiologist
Preference and Perceived Interpretive Quality of 2D and 3D T2-weighted FSE MR Images
Participants
Antonio C. Westphalen, MD, Mill Valley, CA (Presenter) Nothing to Disclose
Susan M. Noworolski, PhD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Saunak Sen, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Kartik S. Jhaveri, MD, Toronto, ON (Abstract Co-Author) Speaker, Bayer AG
Zhen J. Wang, MD, Hillsborough, CA (Abstract Co-Author) Nothing to Disclose
Ronald J. Zagoria, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
John Kurhanewicz, PhD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
The goal of this study was to compare the perceived quality of 3-Tesla axial T2-weighted high-resolution 2D and high-resolution 3D
FSE endorectal MR images of the prostate.
We studied 85 men (median age=65 years, 46 to 83) with proven or suspected prostate cancer who had endorectal MR imaging
with 2D and 3D T2-weighted FSE MR images. Six radiologists from various institutions independently reviewed axial T2 weighted MR
images shown individually and paired. Readers identified their preferred images and scored using a 5-point scale their confidence in
identifying tumor. They also scored the delineation of the zonal anatomy and capsule, tumor conspicuity, and image quality
(artifacts, distortion, and sharpness) using a 3-point scale. We used a meta-analysis routine to calculate pooled estimates based
on a random-effects model. A formal analysis of heterogeneity was also done. The presence of heterogeneity is consistent with
differences in the readers' scores. We used a mixed effect logistic regression, taking into account the clustering effect, to
determine if prior treatment and number of years of reader's experience were predictors of the option for 2D or 3D images.
RESULTS
Each reader had a strong preference for a given T2-weighted MR sequence, favoring one of the two techniques in at least
approximately 70% of cases; but the choices were evenly distributed between the two sequence options. The pooled estimate
shows that the 3D image is preferred in about 47% of the times (95% CI=20% to 74%). The choice for one or other techniques
was not associated with prior treatment or readers' years of experience. There was no significant difference in confidence in tumor
identification (p=0.16 to 1.00). There was no difference in delineation of the zonal anatomy (p=0.19), prostatic capsule (p=0.14),
and tumor conspicuity (p=0.89). Similarly, no difference was found when assessing motion artifact (p=0.48) and distortion
(p=0.41). 2D FSE images were significantly sharper than 3D FSE (p<0.001), but also more likely to exhibit artifacts not related to
motion (p=0.002).
CONCLUSION
There are strong individual preferences for the 2D or 3D FSE MR images, but a wide variability among radiologists. There were
differences in image quality, but not in the sequences' ability to delineate the glandular anatomy and depict cancer.
2D and 3D FSE techniques appear to be equally adequate fro clinical use.
SSK09-04
Multi-Parametric MRI Performance in Prostate Cancer Detection: Stratified by Gleason Scores and
Tumor Size on Whole Mount Histopathology
Participants
Pooria Khoshnoodi, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Hector E. Alcala, MPH, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Nelly Tan, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Wei-Chan Lin, MD, Taipei, Taiwan (Abstract Co-Author) Nothing to Disclose
David Y. Lu, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Jiaoti Huang, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Robert E. Reiter, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
David S. Lu, MD, Los Angeles, CA (Abstract Co-Author) Consultant, Medtronic, Inc Speaker, Medtronic, Inc Consultant, Johnson &
Johnson Research Grant, Johnson & Johnson Consultant, Bayer AG Research Grant, Bayer AG Speaker, Bayer AG
PURPOSE
To evaluate the prostate cancer (CaP) detection rate by multi-parametric MR imaging (MP-MRI) confirmed by whole mount
histopathology (WMHP) stratified by Gleason Scores (GS) and tumor size.
A HIPPA-compliant, IRB-approved study of 290 consecutive men who underwent prostate MP-MRI before radical prostatectomy
(RP) from October 2010 to January 2015 was performed. Clinical, MP-MRI (T2W, DWI and DCE) and pathologic features (WMHP
slides, GS, maximal diameter) were obtained. The index tumor was defined as the pathological lesion with the highest GS or largest
tumor when multiple foci had identical GS. A genitourinary (GU) radiologist and a GU pathologist reviewed each case. Each tumor
focus on WMHP which matched with concordant target on MP-MRI was considered detected tumor. Chi-squared tests were used to
test difference in MRI tumor detection rates by tumor grade (GS=3+3 defined as low grade vs. GS>6 as high grade) and tumor size
(<1 cm defined as small vs. ≥ 1cm as large tumor). Logistic regression was used to test a tumor grade by tumor size in MRI
detection. Statistical analyses were conducted using Stata 12.1. P-values below .05 were considered significant.
RESULTS
290 patients had 639 unique CaP foci on WMHP. Of 639 total tumors foci on pathology, 310 (48.5%) and of 290 total index lesions,
224 (77.2%) were detected on MP-MRI. MRI detected 86/326 (26.4%) of low grade tumors vs. 223/313 (71.2%) of high grade
tumors, and 56/257 (21.8%) of small vs. 253/382 (66.2%) large tumors. MRI detected 44/212 (20.8%) of low grade small tumors
vs. 12/45 (26.7%) of high grade small tumors, and 42/114 (36.8%) low grade large tumors vs. 211/268 (78.7%) of high grade large
tumors. (p<.05)
CONCLUSION
We found that MP-MRI missed 51.6% of all CaP. However, when CaP stratified by size and GS, larger tumors were associated with
increased detection rate for both high and low grade tumors. There was also a significant size by grade interaction, such that the
difference in detection rates by grade was much larger among tumors 1cm or larger. These findings suggest that the MP-MRI tends
to detect larger with higher grade CaP lesions. In our study, MP-MRI detected 78.7% of all high grade large CaP foci.
MP-MRI which combines anatomic with functional and physiologic assessment of prostate cancer has substantially improved
diagnostic capabilities of detecting clinically significant prostate tumors.
SSK09-05
Distortion in Diffusion-Weighted Prostate MRI: Readout-Segmented EPI DWI vs. Single-Shot EPI
DWI
Participants
Ivan Platzek, MD, Dresden, Germany (Presenter) Nothing to Disclose
Angelika Borkowetz, MD, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Marieta Toma, MD, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Thomas Brauer, MD, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Hagen H. Kitzler, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Verena Plodeck, MD, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Manfred Wirth, Dresden, Germany (Abstract Co-Author) Nothing to Disclose
Michael Laniado, MD, Dresden, Germany (Abstract Co-Author) Reviewer, Johnson & Johnson
PURPOSE
The aim of this study was to evaluate the utility of segmented-readout echo planar diffusion-weighted imaging (SR EPI DWI) for
prostate imaging in comparison to conventional single shot EPI DWI (SS EPI DWI), with an emphasis on distortion artifacts.
Sixty-eight patients with suspected prostate cancer were included in this prospective study. Patient age varied between 46 and 77
y (65 y on average). All patients underwent multiparametric prostate MRI (mpMRI) at 3T, which included T2-weighted images,
dynamic contrast-enhanced (DCE) images, and both SR EPI DWI and SS EPI DWI. Apparent diffusion coefficient maps (ADC) maps
were generated for both SR EPI DWI and SS EPI DWI. Overall lesion classification was based on the PI-RADS scoring system
proposed by the European society of Urogenital Radiology (ESUR). Distortion on ADC maps was classified on a five point scale.
Furthermore, the maximum distortion in the anteroposterior direction was measured in each patient for both SR EPI DWI and SS EPI
DWI.
RESULTS
ADC maps based on SR EPI DWI showed no evidence of distortion in 58/68 patients (85%), while ADC maps based on SS EPI DWI
showed no distortion in 42/68 patients (61.7%). Distortion scores were higher (indicating stronger distortion) for SS EPI DWI as
compared to SR EPI DWI in 19/68 patients (27.9%) and lower in only one patient (1.5%). Visual evaluation showed significantly less
distortion for SR EPI DWI in comparison to EPI DWI (p = 0.0001). Average maximum distortion (1.5 ± 2.6 mm) was significantly lower
in SR EPI DWI in comparison to SS EPI DWI (4.9 ± 9.7 mm) (p < 0.0001). Ninety-six prostate lesions were detected with mpMRI in
total. PI-RADS scores did not differ significantly between mpMRI including SR EPI DWI and mpMRI including SS EPI DWI (p = 0.464).
Mean ADC values based on SS EPI DWI (0.93 ± 0.21) were slightly lower than those based on SR EPI DWI (0.96 ± 0.22)(p = 0.047).
CONCLUSION
SR EPI DWI of the prostate has significantly less pronounced distortion artifacts compared to SS EPI DWI. As prostate lesion
detection and lesion classification based on PI-RADS scores do not change significantly when SR EPI DWI is used instead of SS EPI
DWI, SR EPI DWI is a promising alternative to conventional diffusion-weighted sequences.
The use of SR EPI DWI instead of conventional SS EPI DWI in prostate MRI reduces distortion and can help improve correlation
between DWI and T2-weighted images.
SSK09-06
Accuracy and Inter-Observer Variability of Prostate Imaging-Report and Data System (PI-RADS)
Version 2.0 for Characterization of Lesions Identified on Multiparametric Magnetic Resonance
Imaging of the Prostate
Participants
Andrei S. Purysko, MD, Cleveland, OH (Presenter) Nothing to Disclose
Brian R. Herts, MD, Cleveland, OH (Abstract Co-Author) Research Grant, Siemens AG
Erick M. Remer, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Andrew J. Stephenson, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Jennifer Bullen, MSc, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Cristina Magi-Galluzzi, MD, PhD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Eric Klein, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
PURPOSE
To measure the accuracy and inter-observe variability of PI-RADS version 2.0 for the characterization of prostate lesions identified
on mpMRI.
IRB-approved, HIPAA compliant retrospective study including 171 men (mean age: 61.5 yrs.) either being investigated for prostate
cancer (n = 128) or enrolled in active surveillance (n =43), who were examined on a 3.0 T magnet without endorectal coil, and
were found to have potential targets for biopsy. Two readers with 8 yrs. of experience in abdominal imaging independently reviewed
and assigned a PI-RADS V.2 assessment category to the dominant MRI targets. The reference standard was the combined results
from the MR/US fusion biopsy and transrectal ultrasound guided 12-core systematic biopsy (SB) performed in all the patients and in
the same procedure. Clinically significant (CS) PCa was defined as tumors with Gleason score >= 3 + 4. Receiver operating
characteristic (ROC) analysis was performed.
RESULTS
PCa was detected in 49.1% (84/171) and CS PCa was detected in 32.3% (55/171) of the men. Using PI-RADS category > 3 to
discriminate any PCa from non-cancerous lesions, the sensitivity (Sen), specificity (Sp) and area under the ROC curve (AUC) were
77.4%, 84.9% and 85.7% for reader 1 and 69.1%, 87.2%, and 77.9% for reader 2. Using PI-RADS category > 3 to discriminate only
clinically significant PCa from clinically insignificant prostate cancer and benign lesions, the Sen, Sp, and AUC were 98.2%, 79.1%,
and 91.1% for reader 1 and 92.7%, 84.4%, and 90.4% for reader 2. The inter-observer agreement coefficient was 0.68 (95% CI:
0.61- 0.75).
CONCLUSION
PI-RADS V.2 had high sensitivity, specificity and accuracy for the discrimination of clinically significant PCa from other pathology,
with good inter-observer agreement.
Lesions with a PI-RADS V.2 assessment category > 3 should be considered for targeted biopsy, while avoiding the biopsy of lesions
with a category < 3 reduces the number of negative biopsies and/or detection of clinically insignificant lesions.
SSK09-07
Predicting Organ-confined Prostate Cancer in the Era of Multiparametric MRI: Comparing the
Accuracy of the Partin Tables and mpMRI
Participants
Alison F. Brown, BA, Durham, NC (Presenter) Nothing to Disclose
Rachel K. Silverman, MS, Chapel Hill, NC (Abstract Co-Author) Nothing to Disclose
Kae Jack Tay, MBBS,MMed, Durham, NC (Abstract Co-Author) Nothing to Disclose
Rajan T. Gupta, MD, Durham, NC (Abstract Co-Author) Consultant, Bayer AG; Speakers Bureau, Bayer AG; Consultant, Invivo
Corporation
PURPOSE
To investigate the accuracy of the Partin tables and multiparametric magnetic resonance imaging (mpMRI) in predicting organconfined (OC) prostate cancer (PCa) after radical prostatectomy (RP), and to determine if radiologic staging information from
mpMRI versus digital rectal exam (DRE) to augment the Partin tables increases the predictive accuracy of this widely used
nomogram.
In this retrospective, HIPAA-compliant, IRB-approved study, 157 patients underwent 3T mpMRI with endorectal coil before RP.
MpMRI was used to assess clinical stage and an updated version of the Partin tables was used to calculate the probability of each
patient to harbor OC disease. Logistic regression models predicting OC disease were created using mpMRI staging alone and with
PSA as a covariate. Two sets of probabilities were obtained from the Partin tables, using clinical staging from either DRE or mpMRI.
The area under curve (AUC) was used to calculate the predictive accuracy of each of these four predictive methods.
RESULTS
The predictive accuracy of mpMRI alone in predicting OC disease on pathological analysis is greater (AUC=0.86) than the Partin
tables (AUC=0.70), and is further improved when combined with PSA values (AUC=0.88). The accuracy of the Partin nomogram in
predicting OC disease decreases (AUC=0.59) when clinical stage is based on mpMRI versus DRE.
CONCLUSION
The superior predictive accuracy of mpMRI compared to Partin tables in predicting OC disease on pathological analysis validates
results of smaller previously published studies, including one from our group. Partin table probabilities are calculated using clinical
stage based on DRE result, a less sensitive test than mpMRI; therefore, this frequently leads to disease understaging.
Consequently, although mpMRI has been shown to more accurately predict clinical stage than DRE, using mpMRI stage in the Partin
nomogram does not improve its accuracy. In conclusion, mpMRI staging information is valuable as a stand-alone test when available
based on its AUC value, but should not be applied to the Partin nomogram in its existing form.
As more accurate clinical staging information is becoming available due to mpMRI, nomograms that incorporate mpMRI stage are
needed to better predict OC PCa and assist in surgical planning prior to RP.
SSK09-08
Diagnostic Differentiation of Prostate Cancer from Prostatic Hyperplasia: What Diffusion Kurtosis
Imaging Can Help Us?
Participants
Chen Lihua, Dalian, China (Presenter) Nothing to Disclose
Ailian Liu, MD, Dalian, China (Abstract Co-Author) Nothing to Disclose
Qingwei Song, MD, Dalian, China (Abstract Co-Author) Nothing to Disclose
Ma Chunmei, MD, Dalian, China (Abstract Co-Author) Nothing to Disclose
Meiyu Sun, Dalian, China (Abstract Co-Author) Nothing to Disclose
Zibin Tong, Dalian, China (Abstract Co-Author) Nothing to Disclose
Ye Li, Dalian, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the feasibility of the typical parameters of DKI in diagnositic differentiation of prostate carcinoma from prostatic
hyperplasia.
One hundred and thirteen patients with the suspicion of prostate disease were recruited in the study. All the patients, with written
informed consent obtained, were performed MRI exams on a 3.0T scanner in a protocol containing the routine T1WI, T2WI,
contrast-enhanced MRI, DWI and DKI. From the following histopathological examination, it was confirmed that prostate carcinoma
was in 30 and prostatic hyperplasia in 29. MR images were reviewed and analyzed by author and one experienced radiologist who
has five years experience in prostate diagnosis, using a dedicated software in Functool on GE ADW4.4 workstation. For each focus,
the mean value of the parameters of DKI (MK, Ka, Kr, FA, MD, Da, Dr) and DWI(ADC) was measured: in PCa group, the area where
shows low signal on T2WI image, high signal on MK image and histopathological positive was the focus, regions of interest (ROIs)
drew three times in the tumor, the size of the ROI was chosen to cover the 2/3 of the tumor(fig 1) , then the average value was
used in statistics. In BPH group, three identical ROIs (70mm2)were drew in the central zone, the average value was used in
statistics. The type of time-signal intensity curve(TIC) was observed by two observers collectively. ICC test was used to examine
the consistency of the measurements, Pearson test was used to examine the relevance between MD and ADC value,and student's
t-test was executed to compare the obtained parametric values with p> 0.05 concerned statistical significant. The ROC curve of all
the parameters were drew and analyzed.
RESULTS
The ICC value of the DKI parameters and DWI parameter in the PCa group and BPH group were respectively,
0.963,0.935,0.959,0.905,0.970,0.909,0.967,0.977and 0.804,0.899,0.913,0.901,0.923,0.902,0.911,0.931, exhibiting an amenable
consistency. The mean MK, Ka, Kr of PCa were significantly higher (p < 0.01) than the BPH, while the mean MD, Da, Dr of
cancerous tissue was found to be significantly lower (p < 0.01) than the hyperplasia tissue. No statistically significant difference
was observed between FA values of two groups (p >0.05). The area under the ROC curve of all parameters were higher than 0.9.
CONCLUSION
DKI demonstrated can supply many meritorious parameters, with most useful in diagnostic differentiation of prostate cancer from
prostatic hyperplasia. Combining with the routine prostate MRI, DKI may help in increasing the sensitivity and specificity of cancer
detection.
Combining with the routine prostate MRI, DKI may help in increasing the sensitivity and specificity of cancer detection.
SSK09-09
Incidental Bone Lesions on Staging MRI for Prostate Cancer: Prevalence and Clinical Importance
W ednesday, Dec. 2 11:50AM - 12:00PM Location: N228
Participants
Rachel Schor-Bardach, MD, New York, NY (Presenter) Nothing to Disclose
Niamh M. Long, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
Jane D. Cunningham, FFRRCSI, New York, NY (Abstract Co-Author) Nothing to Disclose
Anna Kirzner, MD, Brooklyn, NY (Abstract Co-Author) Nothing to Disclose
Debra A. Goldman, MS, New York, NY (Abstract Co-Author) Nothing to Disclose
Chaya Moskowitz, New York, NY (Abstract Co-Author) Nothing to Disclose
David M. Panicek, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the prevalence of bone lesions identified on prostate MRI and determine the associations between their imaging
features, clinical/pathologic characteristics and the presence of prostate cancer (PCa) bone metastases.
In this IRB approved, retrospective study, the medical records of 3765 patients undergoing staging prostate MRI for newlydiagnosed (PCa) between 2000-2014 were reviewed. Amongst these, the MRI exams of all patients with bone metastases and a
random selection of patients without bone metastases (matched with a 3:1 ratio to patients with bone metastases) were reviewed
by 2 independent readers (R1 and R2) for presence, size and signal characteristics of bone lesions on T1-weighted sequences along
with their subjective level of suspicion (1-5 Likert scale) for the likelihood of bone metastases on MRI. Prostate-specific antigen
levels, biopsy Gleason Score, clinical stage and National Comprehensive Cancer Network (NCCN) risk categories were recorded. The
reference standard was bone biopsy and/or at least 1-year follow-up after MRI. Associations between MRI and clinical/pathologic
findings were tested using Fisher's exact and Wilcoxon Rank Sum tests. Inter-reader agreement and diagnostic accuracy for bone
metastases detection were assessed using Cohen's simple Kappa statistic and areas under the receiving operating characteristics
curve (AUC).
RESULTS
57 out of 3765 patients (1.5%) had bone metastases. None of the patients with low-risk PCa according to the NCCN criteria had
bone metastases. Inter-reader agreement on MRI was fair to substantial (k=0.26-0.70). There was at least 1 bone lesion present
on MRI in 72% (95% CI: 0.66-0.78) and 70% (95% CI: 0.64-0.76) of patients according to R1 and R2. The AUC for detecting bone
metastases on MRI was 0.97 (95% CI: 0.94-1.00) and 0.90 (95% CI: 0.84-0.95) for R1 and R2. Larger lesion diameter (p<0.0001
for both) and absence of intratumoral fat (p=0.0013-0.0020) were significantly associated with bone metastases for both readers.
CONCLUSION
Bone lesions in prostate MRI are present in the majority of patients undergoing initial staging for PCa, and infrequently represent
metastatic disease.
MRI findings should be interpreted in the context of clinical features which increase the likelihood of metastatic disease.
GUS-W EA
Genitourinary Wednesday Poster Discussions
W ednesday, Dec. 2 12:15PM - 12:45PM Location: GU/UR Community, Learning Center
GU
Participants
Sub-Events
GU234-SDWEA1
Dose 70 kV CT Imaging with 3rd Generation Dual-source CT Simply Increase Pseudo-enhancement of
Renal cyst? Importance of Considering Reduced Requirement of Contrast Dosage: A Phantom Study
Station #1
Participants
Erina Suehiro, RT, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Wakiko Tani, RT, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Toshinori Sekitani, MS, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
Hideaki Kawamitsu, MD, Kobe, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Thanks to improved iodine absorption of lower kV, attenuation of iodine contrast medium (CM) at 70 kV is 2.0-time greater than
those at 120 kV with 3rd generation dual-source CT scanner. Although identical HU values could be theoretically achieved with half
dose of CM at 70 kV comparing to 120 kV, diagnostic ability would be impaired with increased beam hardening effect at lower kV
imaging. The purpose of this phantom study is to compare the degree of pseudo-enhancement under identical surrounding
attenuation at different energy CT scan, assuming contrast enhanced CT protocols of 70 kV CT with half dose CM and 120 kV CT
with full dose.
Circular phantom (26 cm in diameter) filled with different concentration of diluted CM (240 HU or 116 HU at 120 kV) and equipped
with 7 cylindrical inserts of water and various concentration of CM (0.4, 4.5, 10.7, 24.8, 63.6, 127.6 HU at 120 kV, respectively)
was scanned at 70 kV or 120 kV with identical radiation dose (CTDIvol of 7.6 mGy) using 3rd generation dual-source CT scanner.
HU values of inserted water, representing pseudo-enhancement due to beam-hardening artifacts, as well as those of diluted CM in
cylindrical inserts, indicating slightly enhancing lesions, were measured. Pseudo-enhancement and contrast to noise ratio (CNR) of
the phantoms with surrounding 116 HU CM scanned at 70 kV were compared to those of 240 HU at 120 kV to simulate contrast
enhanced CT protocols of 70 kV with half dose CM and 120 kV with full dose CM.
RESULTS
Diluted CM of 116 HU at 120 kV demonstrated HU value of 234±18 at 70 kV, while 240 HU CM showed 501±29 HU at 70 kV. Pseudoenhancement of water insert with 240 HU phantom at 120 kV scan (23.9±0.3 HU) were significantly greater than those with 116 HU
at 70 kV scan (12.4±0.7 HU, p<.0001). At 120 kV scan with surrounding 240 HU diluted CM, CNR of 24.8 HU or greater phantom
showed significant difference from water, while 4.5 HU or greater phantom showed significantly different CNR from water at 70 kV
scan with 116 HU diluted CM.
CONCLUSION
To consider double HU values of iodine CM at 70 kV compared to 120 kV scans, a half contrast dose CT at 70 kV causes less
pseudo-enhancement and better CNR for subtle enhancement.
Considering pseudo-enhancement of renal cyst, contrast enhanced CT protocol of 70 kV with half dose CM would be more desirable
than 120 kV with full dose CM.
GU251-SDWEA2
Multiphasic MDCT Imaging Features Can Help Discriminate Sarcomatoid RCC and Collecting Duct
Carcinoma from Clear Cell RCC
Station #2
Participants
Jonathan R. Young, MD, Los Angeles, CA (Presenter) Nothing to Disclose
Jocelyn A. Young, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Steven Sauk, MD, Saint Louis, MO (Abstract Co-Author) Nothing to Disclose
Margaret Hsu, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate whether imaging features on multiphasic MDCT can discriminate sarcomatoid RCC (sRCC) and collecting duct
carcinoma (CDC) from clear cell RCC (ccRCC). sRCC and CDC are rare, aggressive variants of RCC. In the setting of metastasis,
upfront cytoreductive nephrectomy has survival benefit in ccRCC. However, for sRCC and CDC, upfront cytoreductive nephrectomy
has little or no survival benefit, as it delays the administration of systemic therapy.
With IRB approval for this HIPAA-compliant retrospective study, we derived a cohort of 166 ccRCCs, 7 sRCCs, and 4 CDCs with
preoperative multiphasic MDCT with up to four phases (unenhanced, corticomedullary, nephrographic, and excretory). Each lesion
was reviewed by two fellowship-trained GU radiologists with 7 and 12 years experience for contour, spread pattern, pattern of
enhancement, neovascularity, and calcification until a consensus was reached.
RESULTS
sRCCs were more likely than ccRCCs to have an irregular contour (57% v 2%, p<0.001) and an infiltrative spread pattern, defined
as infiltration into adjacent renal parenchyma, collecting system, or neighboring structures, (71% v 10%, p<0.001). CDCs were also
more likely than ccRCCs to have an irregular contour (75% v 2%, p<0.001) and an infiltrative spread pattern (100% v 10%,
p<0.001). An infiltrative spread pattern has a specificity of 90% and sensitivity of 71% in discriminating sRCC from ccRCC and a
specificity of 90% and sensitivity of 100% in discriminating CDC from ccRCC. An irregular contour has a specificity of 98% and
sensitivity of 57% in discriminating sRCC from ccRCC and a specificity of 98% and sensitivity of 75% in discriminating CDC from
ccRCC.
CONCLUSION
Solid renal lesions with an irregular contour or an infiltrative spread pattern are suspicious for sRCC or CDC. Lesions with these
imaging features should be biopsied first rather than taken directly to nephrectomy, as upfront cytoreductive nephrectomy has little
or no survival benefit and delays the administration of systemic therapy.
An infiltrative spread pattern and irregular contour have a relatively high specificity and sensitivity in discriminating sRCC and CDC
from ccRCC. Lesions with these imaging features should be biopsied first rather than taken directly to nephrectomy, as upfront
cytoreductive nephrectomy has little or no survival benefit and delays the administration of systemic therapy.
GU236-SDWEA3
CT Findings of Advanced Papillary Renal Cell Carcinoma Type-2: Comparison with Advanced Clear
Cell Renal Cell Carcinoma
Station #3
Participants
Nagaaki Marugami, Kashihara, Japan (Presenter) Nothing to Disclose
Toshiko Hirai, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
Junko Takahama, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
Aki Takahashi, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
Kimihiko Kichikawa, MD, Kashihara, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Papillary renal cell carcinoma (papRCC) type-2 is categorized as a subtype with worse prognosis. Advanced papRCC type-2 is likely
to show heterogeneous and ill marginated mass mimicking advanced clear cell renal cell carcinoma (ccRCC). The purpose of this
study is to clarify the features of the CT findings of papRCC type-2 and to compare between advanced papRCC type-2 (over T3a)
and advanced ccRCC.
The materials ware 19 papRCC and 44 ccRCC (over T3a) histologically proven in 256 consecutive patients with RCC undergoing
preoperative CT and nephrectomy. Before and after injection of contrast media, CT images were obtained at plain,
corticomedullary, and nephrogenic phases. For visual assessment, the tumor size, heterogeneity, tumor margin, calcification, renal
vein invasion, lymph node/ distant metastasis and degrees of enhancement at corticomedullary phase (type A: same or less than
renal medulla enhancement, type B: less than renal cortex enhancement, type C: same as renal cortex enhancement). For
quantitative assessment, CT values at each phase were measured. We compared between papRCC and ccRCC for these factors.
RESULTS
Among all papRCC, 11 advanced papRCC (T3a over) were evaluated: the mean tumor size (7.3cm), heterogeneity (8/11), ill margin
(8/11), calcification (2/11), renal vein invasion (7/11), metastases (3/11), enhancement type (type A; 4, type B; 5, type C; 2).
The mean CT values were 34.0, 64.7 and 60.2 HU at plain, corticomedullary, and nephrogenic phases, respectively. Compared with
advanced ccRCC, there were significant difference only in CT values at corticomedullary phase (papRCC vs.cc RCC:64.7 vs. 104.7
HU) and degrees of enhancement (type A; 4, B; 5, C; 2 vs. type A; 0 ,B; 8,C; 36).
CONCLUSION
Although advanced papRCC type-2was morphologically similar to advanced ccRCC, the degree of enhancement of papRCC type-2 at
corticomedullary phase was significantly less than that of advanced ccRCC.
For the patient with unresectable advanced RCC, contrast-enhanced CT findings may help us to determine whether it is
conventional ccRCC or papRCC type-2 and to select the appropriate drug for molecular targeting therapy as part of a personalized
treatment plan.
GU237-SDWEA4
Is it Possible to Indicated Renal Function by Virtue of Iodine Concentration Derived from DECT Renal
Imaging?
Station #4
Participants
Min Li, Shenyang, China (Abstract Co-Author) Nothing to Disclose
Ke Ren, MD, ShenYang, China (Abstract Co-Author) Nothing to Disclose
Yangyang Kan, Shenyang, China (Abstract Co-Author) Nothing to Disclose
Yu Zhao, Shenyang, China (Abstract Co-Author) Nothing to Disclose
Ke Xu, MD, Shenyang, China (Abstract Co-Author) Nothing to Disclose
Long Cui, MD, PhD, Shenyang, China (Presenter) Nothing to Disclose
PURPOSE
This study aims at assess the feasibility of using quantified iodine concentration derived from DECT renal imaging to reflect renal
function.
78 patients who underwent enhanced DECT abdominal scanning in our hospital were enrolled in this study. According to the renal
function results, they were divided into healthy group and abnormal group given serum creatinine, blood urea and cysteine-c level
separately. Enhanced renal images were derived at arterial phase, nephrographic phase and late phase respectively, and the Iodine
concentration was determined by virtue of the dual energy material decomposition algorithm. However, to avoid the across
differences, the iodine enhancement level were normalized by divide the iodine concentration in renal cortex with the iodine
concentration in the aorta at arterial phase. The normalized iodine concentration (NIC) level between normal and abnormal renal
function group were compared to analysis the difference.
RESULTS
Out of the 78 patients (Age: 59.6±10.4, Male: 53), there were 3, 15 and 42 patients whose blood urea, cys-c and serum creatinine
level were out of the healthy range. NIC difference analysis based on serum creatinine was neglect due to limited abnormality
cases. NIC in the abnormal blood urea group were 0.59±0.12, 1.22±0.23 and 1.17±0.16 for arterial, nephrographic and late phase
respectively; while in the normal blood urea group were 0.60±0.21, 1.40±0.34 and 1.30±0.25. The difference between these two
groups was significant at late phase (t=-1.992, P=0.05). NIC in the normal cys-c group were 0.56±0.12, 0.66±0.15, 0.61±0.08
respectively, while in the abnormal cys-c group they were 0.64±0.26, 0.71±0.18, 0.68±0.14. The difference between two groups is
also significant at late phase (t=-2.688, P<0.01).
CONCLUSION
It is feasible to indicate serum creatinine abnormality and cys-c abnormality given the late phase NIC derived from dual energy.
Dual energy scanning is able to not only provide the anatomical details but also reflect the functionality of the kidney.
GU239-SDWEA6
Single-phase Split-bolus Dual-energy CT Urography after Furosemide Intravenous Injection for
Evaluating Urinary Stones and Bladder Tumors
Station #6
Participants
Sohee Song, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the feasibility of single-phase split-bolus dual-energy CT (DECT) after furosemide intravenous injection for evaluating
urinary stones and bladder tumors, and to measure the potential radiation dose reduction.
A total of 218 consecutive patients (mean age, 53 years; range, 28-77 years) who underwent split-bolus DECT urography after
furosemide intravenous injection were enrolled in this retrospective study. The protocol included true noncontrast (TNC) and singlephase (combined nephrographic-excretory) postcontrast DECT scans. Virtual noncontrast (VNC), linearly blended and iodine overlay
(IO) images were reconstructed from postcontrast DECT scans. The number and size of urinary stones were assessed on TNC and
VNC images. Image quality of VNC and TNC was qualitatively evaluated using a 5-point scale. The CT numbers of bladder tumors
were also analyzed on TNC and reconstructed image. The potential dose reduction of a single-phase from dual-phase protocol was
measured.
RESULTS
169 urinary stones (mean size, 7.58 mm; range, 2-32.2 mm) in 56 patients and 19 bladder tumors (mean size, 12.7 mm; range, 4-56
mm) in 10 patients were analyzed. On VNC images, 98.2% (149/169) stones were detected and the remaining 11.8% (20/169)
stones were missed. The mean size of the missed stones on VNC image was 2.33 mm (range, 1.6-3.4 mm), but all stones ≥ 3.5 mm
were detected. For bladder tumors, the CT numbers on TNC and VNC images were 34.0 HU and 32.9 HU, respectively ( P = 0.754);
the enhancement values of linearly blended and IO images were 68.2 HU and 78.2 HU, respectively ( P = 0.023); and accordingly,
all tumors were characterized on IO images. The overall imaging quality of the VNC was significantly inferior to the TNC images (P=
0.012), but the quality scales of the VNC were fair or more. The mean dose of single-phase DECT acquisition was 4.23 mSv
comparing with 7.08 mSv of the dual-phase study, resulting in about 40% reduction of radiation exposure by omitting TNC.
CONCLUSION
Single-phase split-bolus DECT urography using furosemide intravenous injection appears to be feasible for evaluating clinically
significant stones and bladder tumors, with potentially reduced radiation exposure.
Single-phase split-bolus DECT urography after furosemide intravenous injection can be used to evaluate clinically significant stones
and bladder tumors.
UR131-EDWEA7
Optimizing Renal Transplant Ultrasound Parameters
Station #7
Participants
Rajiv Rao, MD, Sacramento, CA (Presenter) Nothing to Disclose
Ghaneh Fananapazir, MD, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Teaching Points for this Exhibit:1. Optimization: To discuss the technical principles that contribute to optimal ultrasound imaging of
renal transplants.2. Artifacts: To review the major imaging artifacts that the radiologist commonly encounters when interpreting a
post-operative renal transplant ultrasound.
1. Probe selection: use of high frequency probes2. Pressure artifact and its effect on resistive indices3. Gain settings on grayscale,
color and spectral Doppler images4. Wall filter settings: masking true arcuate artery resistive indices5. Velocity scale settings: color
and spectral Doppler6. Angle of Insonation Optimization to eliminate false spectral broadening Optimization to eliminate directional
ambiguity Optimization to obtain accurate velocity measurements 7- Aliasing Physical principles behind the phenomenon Artifacts
created on color and spectral Doppler settings Clinical use of the artifact to demonstrate stenosis Fixing aliasing artifact8- Spectral
broadening9- Color Doppler findings in nonvascular structures
GUS-W EB
Genitourinary Wednesday Poster Discussions
W ednesday, Dec. 2 12:45PM - 1:15PM Location: GU/UR Community, Learning Center
GU
Participants
Sub-Events
GU240-SDWEB1
Diffusion Kurtosis Imaging of Uterine Endometrial Cancer: Preliminary Study
Station #1
Participants
Shigeaki Umeoka, MD, Osaka City, Japan (Presenter) Nothing to Disclose
Akira Yamamoto, MD, PhD, Kyoto, Japan (Abstract Co-Author) Nothing to Disclose
Koji Sakai, Kyoto, Japan (Abstract Co-Author) Nothing to Disclose
Aki Kido, MD, Kyoto, Japan (Abstract Co-Author) Nothing to Disclose
Thorsten Feiweier, DIPLPHYS, PhD, Erlangen, Germany (Abstract Co-Author) Employee, Siemens AG Stockholder, Siemens AG Patent
holder, Siemens AG
Kaori Togashi, MD, PhD, Kyoto, Japan (Abstract Co-Author) Research Grant, Bayer AG Research Grant, DAIICHI SANKYO Group
Research Grant, Eisai Co, Ltd Research Grant, FUJIFILM Holdings Corporation Research Grant, Nihon Medi-Physics Co, Ltd Research
Grant, Shimadzu Corporation Research Grant, Toshiba Corporation Research Grant, Covidien AG
PURPOSE
1.To investigate the feasibility and utility of DKI for the assessment of uterine endometrial cancer2.To correlate ADC, D and K
values with histologic subtypes of endometrial lesion
A total of twenty-nine patients (age 28-86) with clinically suspected endometrial lesions prospectively underwent MR imaging at
3T, including DKI ( b-factors 0, 100, 500, 1000, 1500, 2000, 2500s/mm², Three orthogonal MPG directions with monopolar scheme
(prototype sequence)). D (diffusion coefficient) and K (Kurtosis; the deviation of tissue diffusion from a Gaussian pattern) map
images were generated on a voxel-by-voxel basis with in-house software. ADC map images were also calculated based on diffusionweighted images with b-factors of 0, 500 and 1000 s/mm². Obtained ADC, D, and K values of the endometrial lesions were
correlated with histological findings, subdivided into three categories (1. No malignant endometrial lesion, 2. Low-grade (grade 1)
endometrial cancer, 3. High-grade (grade 2 or 3) endometrial cancer) using student t-test.
RESULTS
Histologically, 17 patients had endometrial carcinoma (11 low grade, 6 high grade) and 12 patients had benign conditions. 26 of 29
endometrial lesions (89.7%) could be successfully visualized as lower signal intensity areas compared to the myometrium on ADC, D,
and K map images. Of these 26 cases, the D, ADC (10-3mm2/s) and K values were 1.65±0.72, 1.52±0.50 and 0.64±0.11 for nonmalignant endometrial lesion, 0.79±0.13, 0.67±0.11 and 0.87±0.08 for low-grade endometrial cancer, 0.81±0.16, 0.73±0.11 and
1.10±0.08 for high-grade endometrial cancer, respectively. All K-, D- and ADC-values of the tumor show significant differences
between non-malignant and malignant lesion. Although no significant differences of D- and ADC-values between low- and highgrade cancer are observed, the K-value tends to be significantly higher in high-grade cancer than in low-grade cancer..
CONCLUSION
DKI seems an effective, non-invasive method for the assessment of endometrial lesions. ALL D-, K-, and ADC-values are helpful for
the differentiation between benign and malignant endometrial lesion. Only the K-value shows an excellent correlation with
histological subtypes of uterine endometrial cancer, and may serve as a new, useful prognostic biomarker.
Diffusion kurtosis imaging is well related to histological characteristics, including tumor cellularity and architectural distortion.
GU241-SDWEB2
Prediction of Disease Progression after Concurrent Chemoradiotherapy in Uterine Cervical Cancer:
Value of Diffusion-weighted Imaging
Station #2
Participants
PURPOSE
To investigate the value of diffusion-weighted imaging (DWI) as a predictor of disease progression after concurrent
chemoradiotherapy (CCRT) in uterine cervical cancer.
Our retrospective study included 100 consecutive patients (median age, 55 years) who received CCRT for locally advanced cervical
cancer. All enrolled patients underwent 3T-MRI including T2-weighted imaging (T2WI) and DWI at 1 month after completion of
CCRT. The presence or absence of residual tumor on T2WI and DWI was determined using a 5-point probability scale. For predicting
disease progression after completion of CCRT, the diagnostic performance of the presence of residual tumor on T2WI and DWI was
evaluated using the time-dependent receiver operating characteristics (ROC) curve analysis. The relationship between MR
(presence of residual tumor on T2WI and DWI, and tumor size) and clinical variables (age, FIGO stage and histologic type) and
disease progression was investigated using the Cox regression analysis.
RESULTS
After a mean follow-up of 2.6 years, disease progression developed in 24 patients (24.0%): local recurrence (n= 10), distant
metastasis (n= 11) and both local recurrence and distance metastasis (n= 3). At ROC curve analysis, the integrated area under the
curve was significantly greater on DWI (0.751) than on T2WI (0.659) for predicting disease progression ( P = 0.009). For predicting
disease progression, the positive predictive values of DWI versus T2WI were 54.4% versus 32.7% at the first, 73.0% versus 37.2%
at the second, and 72.7% versus 39.3% at the third year after CCRT, respectively, which were statistically different (all P -values<
0.03). On univariate analysis, the presence of residual tumor on T2WI or DWI, and non-squamous cell carcinoma were significantly
associated with disease progression ( P < 0.01). However, the presence of residual tumor on DWI was the only independent
predictor of disease progression (hazard ratio, 6.34; P < 0.0001) on multivariate analysis.
CONCLUSION
The presence of residual tumor on DWI at 1 month after completion of CCRT appears to be the only independent predictor for
disease progression in patients with locally advanced cervical cancer.
As an imaging marker, the presence of residual cervical cancer on DWI at 1 month after completion of CCRT may help to predict
therapeutic outcomes, which may play a crucial role in developing a personalized treatment.
GU242-SDWEB3
Percutaneous and Laparoscopic Cryoablation (CA) of Renal Carcinomas: Mid-term CT and MR
Imaging Follow-up
Station #3
Participants
Gianpiero Cardone, MD, Milano, Italy (Presenter) Nothing to Disclose
Maurizio Papa, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Andrea Losa, MD, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Tommaso Maga, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Paola Mangili, PhD, Milano, Italy (Abstract Co-Author) Nothing to Disclose
Giuseppe Balconi, Ornago, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study aims to determine the safety and efficacy of CA in the management of small renal carcinomas and to assess its medium
term outcome.
We report the mid-term CT/MR imaging follow-up in 115 pts who gained at least 5 years follow-up after CA of 96 renal carcinomas.
Treatment was administered under laparoscopic US guidance in 101 pts and using percutaneous CT guidance in 14 pts. Pts were
followed up clinically, biochemically and by imaging 24 hours after surgery, and subsequently every 6 months. Imaging follow-up
was obtained using a 1,5T MR system in 104 cases and using CT in 11 pts with contraindications to MR.
RESULTS
24 hours after treatment all cryolesions were more than 1 cm larger than the original masses; cryolesions decreased in size by an
average of 38% at 1 month, 64% at 6 months, 80% at 12 months and 93% at 84 months following LC. Early postprocedural MR and
CT ce- images showed complete ischemia of cryolesions. Follow-up revealed no evidence of local recurrence in 111/115 pts (96%).
4 pts showed local recurrence at 12, 24 and 96 months. 12/115 pts (9%) demonstrated metachronous nodules in the same or in
the contralateral kidney at 12, 24 and 48 months. 2 pts showed a pancreatic metastatic nodule at 12 and 24 months. 11/115 pts
died for metastasis of a previous malignancy. 1 pt showed ureteral fistula and 1 pt showed proximal ureteral stenosis. No significant
rise in creatinine level was noted postprocedurally. After surgery 11% of the cases showed small perilesional haematomas.
CONCLUSION
Our experience suggests that CA is a safe, well tolerated and minimally invasive therapy for small renal carcinomas. MR is an
effective tool in the imaging follow-up of renal lesions treated with CA, and the high contrast resolution of MR allows a better
evaluation of vascularization of treated areas on subtracted ce images compared to CT. CT can be used as an alternative choice to
MR, but lower contrast resolution of CT to MR makes it difficult to differentiate the cryolesion from the surrounding perilesional
collections.
CA is a safe, well tolerated and minimally invasive therapy for small renal carcinomas. MR and CT are effective imaging techniques in
the follow-up of renal lesions treated with CA.
GU243-SDWEB4
Correlation of Renal IVIM Diffusion Parameters to DCE-MRI Perfusion Parameters from a ThreeCompartment Model
Station #4
Participants
Octavia Bane, PhD, New York, NY (Presenter) Nothing to Disclose
Mathilde Wagner, MD,PhD, Paris, France (Abstract Co-Author) Nothing to Disclose
Hadrien Dyvorne, PhD, New York, NY (Abstract Co-Author) Nothing to Disclose
Henry Rusinek, PhD, New York, NY (Abstract Co-Author) Nothing to Disclose
Jeff L. Zhang, PhD, Salt Lake Cty, UT (Abstract Co-Author) Consultant, Bristol-Myers Squibb Company
Bachir Taouli, MD, New York, NY (Abstract Co-Author) Consultant, Guerbet SA
PURPOSE
To correlate cortical and medullary intravoxel-incoherent motion diffusion-weighted imaging (IVIM-DWI) parameters to DCE-MRI
parameters using a validated three-compartment model.
IVIM-DWI and DCE-MRI data were analyzed in 20 patients (M/F 14/6, age 58±7 y; serum eGFR=85± 26 ml/min) with liver disease
who underwent abdominal MRI at 1.5T. A bipolar diffusion sequence with single-shot EPI readout and spectral fat saturation was
acquired in 17 interleaved slices in the coronal plane with respiratory triggering and 16 b-values. 64 coronal 3D FLASH DCE-MRI
volumes were acquired over repeat breath-holds with a mean temporal resolution of 2.7 sec, during injection of 0.05 mmol/kg of GdBOPTA at 3 ml/sec.ROIs were placed on the motion-corrected IVIM images (FireVoxel) in the renal cortex and medulla, avoiding
major vessels, lesions and fat. Mean ROI signal was fitted to the IVIM model.The cortex and medulla in each kidney, as well as the
aorta at the level of the renal arteries, were semi-automatically segmented from the DCE-MRI volumes using validated software
(Perf4DSegm).GFR, whole kidney, cortical and medullary renal plasma flow (RPF), as well as mean transit times (MTT) for the
compartments and the whole kidney, were calculated.
RESULTS
Renal IVIM parameters obtained were in accordance with previous studies; cortical ADC and perfusion fraction (PF) were
significantly higher compared to medulla (p=0.0005 and p=0.0007, respectively). DCE-MRI parameters obtained in 18/20 patients
(due to truncated arterial input function in 2 patients) were in agreement with previous studies using the three-compartment
model. DCE-MRI eGFR was significantly correlated with serum eGFR (Spearman r=0.595, p=0.011), but under-estimated serum eGFR
(slope = 0.47, p = 0.005; intercept = 14.12, p = 0.279). RPF values were significantly higher in the cortex than in the medulla
(p<10^-6). Significant correlation was observed for pooled cortical and medullary PF and ADC with RPF (Fig.1; PF r=0.327,
p=0.005, ADC r=0.387, p=0.001). Cortical RPF correlated with ADC (r=0.49, p=0.003), but not with PF. No other DCE-MRI and IVIM
parameters were correlated.
CONCLUSION
Cortical and medullary ADC and PF were moderately correlated with RPF in this initial ongoing study.
IVIM diffusion cannot be substituted for DCE-MRI in the evaluation of renal plasma and tubular flow. The techniques provide
complementary information on renal function.
GU244-SDWEB5
Texture Analysis on T2-weighted MRI to Evaluate for Biochemical Recurrence in Prostate Cancer
Patients
Station #5
Participants
Anna M. Brown, BEng, Bethesda, MD (Presenter) Nothing to Disclose
Sandeep Sankineni, MD, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Joanna Shih, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Richard Ho, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Maria Merino, MD, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Peter Pinto, Bethesda, MD (Abstract Co-Author) Nothing to Disclose
Peter L. Choyke, MD, Rockville, MD (Abstract Co-Author) Researcher, Koninklijke Philips NV Researcher, General Electric Company
Researcher, Siemens AG Researcher, iCAD, Inc Researcher, Aspyrian Therapeutics, Inc Researcher, ImaginAb, Inc Researcher, Aura
Biosciences, Inc
Baris Turkbey, MD, Ankara, Turkey (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess whether texture analysis can evaluate whole-prostate T2-weighted MRI scans for biochemical recurrence (BCR) in postprostatectomy patients.
Initially 337 patients who underwent prostate multi-parametric MRI (mpMRI) followed by radical prostatectomy between 5/2007 3/2014 were included in this study, all with ≥1 year follow-up. In this cohort, 21 patients were determined to have BCR based on
the American Urologic Association definition. One patient was excluded for having brachytherapy seeds present on his baseline
mpMRI. A matched cohort analysis was performed on the basis of age, pre-treatment prostate specific antigen (PSA), and race,
and 18/20 patients were able to be matched with controls (recurrence-free prostate cancer patients). Ultimately, 36 patients were
included in the study (n=18 BCR, n=18 matched controls).Pre-treatment T2-weighted turbo-spin echo MRI scans were acquired at
3T using an endorectal coil and a 16-channel surface/cardiac coil. Whole-prostate contour voxels of interest (VOIs) were assessed
using the texture analysis program MaZda (Technical University of Lodz, Poland). Feature reduction was performed using the Mutual
Information method in MaZda, resulting in seven texture features that were incorporated into a linear discriminant analysis (LDA)
model. Receiver-operator characteristic (ROC) curve analysis was then used to evaluate the LDA model.
RESULTS
For the BCR patients, mean age and PSA were 59 yrs (range 41-73) and 19.2 ng/mL (range 4.5-51.1), respectively. The mean age
and PSA for the matched control patients were 60 yrs (range 51-76) and 19.1 ng/mL (range 2.62-55.7), respectively. ROC analysis
of the LDA model of the seven texture features resulted in an area under the curve (AUC) of 0.87 and p=0.00017 in distinguishing
BCR from matched control whole-prostate VOIs. Using a cutoff MDF1 of 3.01, the sensitivity was 89% and specificity was 78%, and
30/36 (83%) patients were classified correctly.
CONCLUSION
The LDA model separates BCR from matched control patients with reasonably high accuracy. Our approach can potentially be used
to predict BCR candidates at the pre-treatment phase. Further work is now needed to prospectively test this model.
Texture analysis shows potential to distinguish prostate cancer patients with biochemical recurrence from a matched cohort of
recurrence-free patients based on baseline T2-weighted MRI features.
GU245-SDWEB6
Single Phase Enhanced CT for the Detection of Urolithiasis: Can It be an Alternative to Nonenhanced
CT or Muliphase Protocols?
Station #6
Participants
Christelle Chedrawy, MD, Chicago, IL (Presenter) Nothing to Disclose
Girish Kumar, MD, Stickney, IL (Abstract Co-Author) Nothing to Disclose
Nancy Wilkins, Glenview, IL (Abstract Co-Author) Nothing to Disclose
Anita H. Kelekar, MD, Palatine, IL (Abstract Co-Author) Nothing to Disclose
Dheeraj Reddy Gopireddy, MD, MPH, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Rita Agarwala, MD, Oak Brook, IL (Abstract Co-Author) Nothing to Disclose
PURPOSE
To determine the usefulness of enhanced CT for detection of renal and ureteral calculi. To determine the usefulness of enhanced
CT in identifying alternate diagnosis if not suspected.
Between January 2014 and December 2014, 70 CT scans performed in the outpatient center for renal stone detection, hematuria or
flank pain were randomly reviewed. 69 were performed with at least 2 phases, including a noncontrast examination. One study was
performed with contrast only. 27 studies positive for renal calculi were reviewed independently by two radiology residents. The
number of stones seen on enhanced examinations was then compared to the number detected on the nonenhaned studies.
RESULTS
Stones were not seen in 7 studies (26 %) and 9 (33%) studies by observer 1 and 2 respectively. At least 66 % of the missed
stones were less than 3 mm in size. Nearly all of the stones were calyceal. None of the stones that were not detected on the
enhanced study were associated with hydronephrosis, hydroureter, perinephric stranding or other secondary signs. The studies
negative for urolithiasis demonstrated on the enhanced examination significant pathology such as prostatomegaly and bladder
cancer, accounting for patient's presenting symptoms.
CONCLUSION
Enhanced CT can be used in the detection of urolithiasis. Missed stones on enhanced CT were not associated with significant
obstructive changes and may be questionably clinically significant.
Although nonenhanced CT has been proven to be the most accurate diagnostic study with a high sensitivity (95-96%) and
specificity (98%) , enhanced CT performed in the nephrographic phase may present an alternative to detection of urolithiasis.
Additionally, it increases a physician diagnostic certianty by identifying alternate significant pathology not initially suspected.
UR132-EDWEB7
PI-RADS v2.0 - An Atlas and Illustrated Manual
Station #7
Participants
Erick S. Hollanda, Rio de Janeiro, Brazil (Presenter) Nothing to Disclose
Dafne D. Melquiades, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Fernanda Miraldi, MD, Rio de Janeiro/Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Andrei S. Purysko, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The joint initiative for standardization of the interpretation and communication of multiparametric prostate MR findings has
culminated on the development of the second version of PI-RADS. In this presentation, we demonstrate the typical imaging findings
in each assessment category, underscoring the main changes over the previous PI-RADS version. Of note, we highlight the
adoption of a 'dominant' parameter for each zonal compartment of the prostate, corresponding to DWI for the peripheral zone and
T2WI for the transition zone. DCE is now only applied to differentiate between scores 3 and 4 in the peripheral zone. The notion of
lesion size was now incorporated to DWI and T2WI criteria, using a threshold of 1.5 cm to differentiate between scores 4 and 5 for
highly-suspicious lesions.
Why and when to use Multiparametric prostate magnetic ressonace imaging (mpMRI).PI-RADS v2 vs. PIRADS v1. Brief history and
evolution. Rationale for the imaging criteria.mpMRI protocols and functinal sequences.The 'dominant' sequence based on zonal
anatomy, a recent implementation from PI-RADS v2.Sample cases, with assessment categories and troubleshooting.How to use
mpMRI with PI-RADS in routine clinical practice. Decision making and risk stratification.Besides detection, is PI-RADS any good for
tumor staging?
MSSR43
RSNA/ESR Emergency Symposium: Abdominal Emergencies (An Interactive Session)
W ednesday, Dec. 2 1:30PM - 3:00PM Location: S402AB
GI
CT
ER
Participants
Ronald J. Zagoria, MD, San Francisco, CA, (ron.zagoria@ucsf.edu) (Moderator) Nothing to Disclose
Andras Palko, MD, PhD, Szeged, Hungary (Moderator) Medical Advisory Board, Affidea Group;
Sub-Events
MSSR43A
Abdominal Injuries
Participants
Andras Palko, MD, PhD, Szeged, Hungary, (palko.andras@med.u-szeged.hu) (Presenter) Medical Advisory Board, Affidea Group;
LEARNING OBJECTIVES
1) To explain the significance of injury mechanism and its role in the formation of consequent abdominal lesions and their
complications. 2) To outline the role of proper imaging technique and diagnostic algorithm in the sufficiently fast diagnosis of
abdominal injuries. 3) To learn more about the typical and unusual findings of various abdominal traumatic conditions.
ABSTRACT
Abdominal injuries require a timely and reliable diagnosis in order to prevent the potentially lethal outcome. The armory of clinical
tools (physical examination, lab tests) does not fulfill these criteria, since they are either not fast, or not reliable. Imaging
diagnostic modalities help the clinician to acquire the necessary amount of information to initiate focused and effective treatment.
However, the selection of the appropriate imaging algorithm, modality and technique, as well as the precise detection and
interpretation of essential imaging findings are frequently challenging, especially because the circumstances, under which these
examinations are performed (open wounds, bandages, non-removable life-supporting equipment, lack of patient cooperation, etc.),
are frequently less than optimal. Knowledge of critical imaging signs, symptoms and the role they play in the evaluation of the
patient's condition, but also fast decision-making and ability to closely cooperate with the clinicians are skills of key importance for
radiologist members of the trauma team.
MSSR43B
The Enemy Within, Non-Traumatic Abdominal Emergencies
Participants
LEARNING OBJECTIVES
1) Attendees will be able to better analyze CT scans for non-traumatic causes of abdominal pain. 2) Attendees will learn the CT
signs and causes of bowel ischemia. 3) Attendees will learn the CT findings of common causes of an "acute" abdomen. 4) Attendees
will learn the imaging findings of acute, nontraumatic urinary tract and GI tract emergencies.
ABSTRACT
This segment of the course will go over the optimal imaging approach for patients presenting with acute abdominal pain. CT findings
will be emphasized. Key imaging findings of nontraumatic causes of acute abdominal pain including gastrointestinal tract and urinary
tract pathology will be explained. A systematic approach for the imaging evaluation of patients wih abdominal emergencies will be
illustrated and explained including proper scan protocols and analysis of imaging findings. Imaging diagnosis of urinary tract
obstruction, infection, bowel obstruction, and ischemia will be emphasized.
MSSR43C
Interactive Case Discussion
Participants
Andras Palko, MD, PhD, Szeged, Hungary (Presenter) Medical Advisory Board, Affidea Group;
LEARNING OBJECTIVES
1) Attendees will be able to better analyze CT scans for traumatic and non-traumatic causes of abdominal pain. 2) Attendees will
learn the CT signs and causes of bowel ischemia and injuries. 3) Attendees will learn the CT findings of common causes of a
traumatic and non-traumatic 'acute' abdomen. 4) Attendees will learn the imaging findings of acute, traumatic and nontraumatic
urinary tract and GI tract emergencies.
ABSTRACT
Using cases and an audience response system, this segment of the course will go over the optimal imaging approach for patients
presenting with acute abdominal pain and abdominalk injuries. CT findings will be emphasized. Key imaging findings of traumatic and
nontraumatic causes of acute abdominal pain including gastrointestinal tract and urinary tract pathology will be explained. A
systematic approach for the imaging evaluation of patients wih abdominal emergencies will be illustrated and explained including
proper scan protocols and analysis of imaging findings. Imaging diagnosis of blunt an penetrating abdominal injuries, urinary tract
obstruction, infection, bowel obstruction, and ischemia will be emphasized.
MSRO43
BOOST: Genitourinary-Case-based Review (An Interactive Session)
W ednesday, Dec. 2 3:00PM - 4:15PM Location: S103CD
GU
RO
Participants
Spencer C. Behr, MD, Burlingame, CA (Moderator) Research Grant, General Electric Company; Consultant, General Electric Company
Paul Nguyen, Boston, MA (Moderator) Consultant, Medivation, Inc; Consultant, GenomeDx Biosciences Inc
Daniel J. Margolis, MD, Los Angeles, CA, (daniel.margolis@ucla.edu) (Presenter) Research Grant, Siemens AG
George B. Rodrigues, MD, London, ON (Presenter) Nothing to Disclose
Todd Morgan, MD, Ann Arbor, MI (Presenter) Research funded, Myriad Genetics, Inc; Research funded, MDxHealth SA
Russell Szmulewitz, MD, Chicago, IL (Presenter) Advisory Board, Pfizer Inc; Advisory Board, Bayer AG
LEARNING OBJECTIVES
1) To apply oncologic decision making in prostate cancer. 2) To recognize critical clinical manifestations of prostate cancer. 3) To
discern clinically significant from insignificant signs and findings in prostate cancer.
SSM11
ISP: Genitourinary (Intravenous Contrast Issues and CT Dose Reduction)
W ednesday, Dec. 2 3:00PM - 4:00PM Location: E352
CT
GU
SQ
Participants
Matthew S. Davenport, MD, Cincinnati, OH (Moderator) Book contract, Wolters Kluwer nv; Book contract, Reed Elsevier;
Dean A. Nakamoto, MD, Beachwood, OH (Moderator) Research Grant, Galil Medical Ltd; Research agreement, Toshiba Corporation
Sub-Events
SSM11-01
Genitourinary Keynote Speaker: Safety and Efficacy of Corticosteroid Prophylaxis
Participants
Matthew S. Davenport, MD, Cincinnati, OH (Presenter) Book contract, Wolters Kluwer nv; Book contract, Reed Elsevier;
SSM11-02
The Effect of IV Contrast on Renal Function in Patients on Metformin
Participants
Cody W. McHargue, BA, San Francisco, CA (Presenter) Nothing to Disclose
Arti D. Shah, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Judy Yee, MD, Clayton, CA (Abstract Co-Author) Research Grant, EchoPixel, Inc
Priyanka Jha, MBBS, Sacramento, CA (Abstract Co-Author) Nothing to Disclose
Isabel Allen, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Donald Chau, BA, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
Robert Rushakoff, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Due to concerns of acute kidney injury and the theoretical risk of lactic acidosis with metformin, the Food and Drug Administration
mandates that metformin be held for two days after intravenous (IV) contrast until renal function is checked and in an acceptable
range. However, there is minimal evidence to support this practice. Further investigation is warranted.
We conducted a retrospective cohort study of 130 adult outpatients at the San Francisco Veterans Affairs Medical Center to
determine if there was a change in renal function in diabetic patients on metformin who underwent computed tomography (CT)
scans with IV contrast between 2007-2014. Patients were excluded if immediately hospitalized after the CT scan. The generalized
estimating equations method was used to determine whether IV contrast and pre-contrast creatinine (Cr; or pre-contrast
estimated glomerular filtration rate [eGFR]) were associated with a change in Cr (or eGFR). Covariates included: age, gender, BMI,
diabetes (DM) duration and HbA1c.
RESULTS
In our cohort, mean age was 67±10 years, 119 (91%) were male, 71 (55%) were Caucasian, and 63 (49%) were higher risk (precontrast eGFR <60 ml/min/1.73m2). Mean DM duration was 6.5±6.0 years and mean HbA1c was 7.1±1.3%. Mean pre- and postcontrast Cr were 1.13±0.25 mg/dL and 1.09±0.26 mg/dL; p=0.02 (overall t-test). Mean pre- and post-contrast eGFR were 72±24
ml/min/1.73m2 and 75±26 ml/min/1.73m2; p=0.006 (overall t-test). In fully-adjusted models, there was a significant decrease in Cr
post-contrast: β-coefficient -0.24 (95% confidence interval [CI] -0.35 to -0.12), p<0.001. There was no significant change in
eGFR post-contrast: β-coefficient -0.06 (95% CI -0.16 to 0.03), p=0.19. A subgroup analysis of patients with pre-contrast eGFR <
60 ml/min/1.73m2 showed similar results.
CONCLUSION
There is no evidence of deterioration in renal function in outpatients on metformin who receive IV contrast, even in a cohort with a
large proportion of higher risk patients. Therefore, our results suggest that the current practice of holding metformin after IV
contrast should be re-evaluated.
The practice of holding metformin and checking Cr two days after IV contrast should be re-evaluated as there was no evidence to
suggest a decline in renal function in a cohort with high risk patients.
SSM11-03
The Presence of a Solitary Kidney is not an Independent Risk Factor for Acute Kidney Injury
Following Contrast-enhanced CT
Participants
Jennifer S. McDonald, PhD, Rochester, MN (Abstract Co-Author) Research Grant, General Electric Company
Richard W. Katzberg, MD, Sacramento, CA (Abstract Co-Author) Research Grant, Siemens AG Research Grant, Bayer AG
Investigator, Siemens AG Investigator, Bayer AG
Robert J. McDonald, MD, PhD, Rochester, MN (Presenter) Nothing to Disclose
Eric E. Williamson, MD, Rochester, MN (Abstract Co-Author) Research Grant, General Electric Company
David F. Kallmes, MD, Rochester, MN (Abstract Co-Author) Research support, Terumo Corporation Research support, Medtronic, Inc
Research support, Sequent Medical, Inc Research support, Benvenue Medical, Inc Consultant, General Electric Company Consultant,
Medtronic, Inc Consultant, Johnson & Johnson
PURPOSE
To determine whether patients with a solitary kidney are at higher risk for contrast-induced acute kidney injury (AKI) than matched
control bilateral kidney patients.
This retrospective study was HIPAA compliant and approved by our Institutional Review Board. Adult patients with bilateral kidneys
or a solitary kidney from unilateral nephrectomy who received a contrast-enhanced computerized tomography (CT) scan at our
institution from January 2004 to August 2013 were identified. The effects of contrast exposure on the rate of AKI (defined as a rise
in maximal observed serum creatinine (SCr) of either 1) > 0.5 mg/dL or 2) > 0.3 mg/dL or 50% over baseline within 24-72 hours of
exposure), and 30-day post-scan emergent dialysis and death were determined following propensity score-based 1:3 matching of
solitary and control bilateral kidney patients.
RESULTS
Propensity score matching yielded a cohort of 247 solitary kidney patients and 691 bilateral kidney patients. The rate of AKI was
similar between the solitary and bilateral kidney groups [SCr > 0.5 mg/dL AKI definition odds ratio (OR) = 1.11 (95% confidence
interval (CI) 0.65 - 1.86); p = 0.70; SCr > 0.3 mg/dL or 50% AKI definition OR = 0.96 (95% CI 0.41 - 2.07). p = 0.99]. The rate of
emergent dialysis was rare and also similar between cohorts (OR = 1.87 (0.16-16.4), p=.61). Though the rate of mortality was
higher in the solitary kidney group (OR = 1.70 (1.06-2.71), p=.0202), chart review found that no death was attributable to AKI.
CONCLUSION
This study did not detect any significant differences in the rate of AKI, dialysis, or death attributable to contrast-enhanced CT in
patients with solitary versus bilateral kidneys.
Contrast-enhanced CT protocols can be guided by image optimization, rather than contrast-induced nephropathy risk in solitary
kidney patients.
SSM11-04
New Insights in the MRI Excretory Phase: The Use of Gd-EOB-DTPA for the Evaluation of the
Excretory System
Participants
Caterina Colantoni, MD, Milan, Italy (Presenter) Nothing to Disclose
Antonio Esposito, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Anna Palmisano, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Francesco A. De Cobelli, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
Alessandro Del Maschio, MD, Milan, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
Excretory MR urography is a useful complementary technique in many MR imaging studies of the abdomen to assess kidney
excretion and the urinary collecting system. However, after the injection of a standard dose gadolinium-based contrast media,
frequently, the collecting system is unassessable for T2* effect due to very high concentration of Gd in the urine. Aim of the
present study was to compare the enhancement of the urinary collecting system after the injection of a single standard dose of
Gd-based contrast media known for different renal excretion rates: Gadobutrol, Gadobenate dimeglumine, and Gd-EOB-DTPA.
In 60 patients (pts) with normal creatinine clearance and without urinary tract dilatation, mean signal intensities (pixel values) of
the renal pelvis and of the paravertebral muscles for the calculation of renal pelvis/skeletal muscle ratio, were evaluated on 3D fast
T1-weighted gradient-echo sequences with fat suppression obtained during excretory phase after intravenous injection of 0.1
mmol/kg contrast media: 20pts were studied with Gadobutrol, 20pts with Gadobenate dimeglumine, and 20pts with Gd-EOB-DTPA,
respectively. Urinary collecting system was considered assessable/not-assessable according to the presence of T2* effect.
RESULTS
The mean signal intensities of renal pelvis were 1954±1368.5 (pixel values) for Gadobutrol, 2488±843.8 for Gadobenate dimeglumine,
and 3605±1025.3 for Gd-EOB-DTPA, respectively. The mean signal intensity ratio was 2.2±1.59 for Gadobutrol, 2.7±0.88 for
Gadobenate dimeglumine, and 3.8±1.46 for Gd-EOB-DTPA. No significant differences were found between the mean signal intensity
ratio of Gadobutrol and that of Gadobenate dimeglumine (p>0.05); significant differences were found between the mean signal
intensity ratio of Gadobutrol and of Gd-EOB-DTPA (p<0.005), and that of Gadobenate dimeglumine and of Gd-EOB-DTPA (p<0.001).
Urinary collecting system was considered not-assessable in 8/20pts for Gadobutrol, in 1/20pt for Gadobenate dimeglumine, and in
0/20pts for Gd-EOB-DTPA.
CONCLUSION
The urinary collecting system was considered assessable in all pts studied after injection of a standard dose of Gd-EOB-DTPA, and
this could be due to the low urine excretion rate.
The use of Gd-EOB-DTPA in the excretory MR urography can improve the assessability of the excretory system, with no evidence of
T2* shortening effects.
SSM11-05
Feasibility and Image Quality of Reduced Dose CT Intravenous Pyelogram Using Model-Based
Iterative Reconstruction in Patients with Hematuria
Participants
Isabelle Boulay-Coletta, MD, Paris, France (Abstract Co-Author) Nothing to Disclose
Linda N. Morimoto, MD, Stanford, CA (Presenter) Nothing to Disclose
Dominik Fleischmann, MD, Palo Alto, CA (Abstract Co-Author) Research support, Siemens AG;
Lior Molvin, Stanford, CA (Abstract Co-Author) Speakers Bureau, General Electric Company
Lu Tian, Stanford, CA (Abstract Co-Author) Nothing to Disclose
Juergen K. Willmann, MD, Stanford, CA (Abstract Co-Author) Research Consultant, Bracco Group; Research Consultant, Triple Ring
Technologies, Inc; Research Grant, Siemens AG; Research Grant, Bracco Group; Research Grant, Koninklijke Philips NV; Research
Grant, General Electric Company
PURPOSE
To evaluate the feasibility and image quality of Reduced Dose (RD) CT Intravenous Pyelogram (IVP) using Model-Based Iterative
Reconstruction (MBIR) compared to Standard Dose (SD) CT IVP using Adaptive Statistical Iterative Reconstruction (ASIR) in
patients referred for work-up of hematuria.
In this IRB approved and HIPAA compliant study, 66 consecutive patients (44 males and 22 women; mean age, 62 years; mean BMI,
27 kg/m²) referred for a dual phase CT IVP (non-contrast and combined split-bolus nephrographic-excretory phase) were
prospectively included and either imaged with SD CT IVP with 40% ASIR technique (n=34) or RD CT IVP with MBIR technique (n=32)
on a 64-slice CT scanner (GE Discovery 750 HD). Quantitative measurements of image noise on both non-contrast and postcontrast imaging in addition to radiation dose and patients' BMI were recorded by one reader. Two independent, blinded readers
assessed subjective image quality, including image noise, sharpness of the renal cortex and collecting system (calyces, renal pelvis,
ureters, and bladder), presence of artifacts, and overall image quality impression on non-contrast and post-contrast images utilizing
4 or 5-point grading scales.
RESULTS
Both patient groups were not significantly different (26.8 +/- 7.8 kg/m² versus 27.5 +/- 4.8 kg/m²) in regards to BMI. Radiation
dose was reduced by an average of 49% (p<0.01) on RD CT IVP (CTDI vol = 7.7 +/- 2.8 mGy) compared to SD CT IVP (CTDI vol
=15.1 +/- 4.8 mGy) on post-contrast imaging. Overall dose reduction averaged 36% with non-contrast and contrast-enhanced
imaging (RD CT IVP CTDIvol =15.31 +/- 2.8 mGy versus SD CT IVP CTDI vol = 23.91 +/- 5.3 mGy). Overall image quality impression
of the collecting system, artifacts, and image sharpness were not significantly different (p>0.05) between RD CT IVP and SD CT
IVP. Subjective image noise was significantly lower (p<0.01) in RD CT IVP, which was also reflected by a quantitative reduction of
image noise by an average of 44% (p<0.01) on non-contrast imaging and 37% (p<0.01) on post-contrast imaging.
CONCLUSION
RD CT IVP is feasible and allows for a substantial dose reduction compared to SD CT IVP protocol without compromising image
quality.
Introduction of iterative reconstruction algorithms which can be implemented with routine clinical CT IVP protocols to reduce
radiation exposure while yielding diagnostic quality images.
SSM11-06
Reduced Radiation Dose with Iterative Reconstruction in 100 kVp CT Urography: With different
Iodine Dosage
Participants
Huihui Wang, MD, Beijing, China (Presenter) Nothing to Disclose
Juan Hu, Kunming, China (Abstract Co-Author) Nothing to Disclose
He Wang, MD, Beijing, China (Abstract Co-Author) Research Grant, General Electric Company
Jian Jiang, MD, Beijing, China (Abstract Co-Author) Research Grant, General Electric Company
PURPOSE
To evaluate the image quality and radiation dose in CT urography at 100kVp with iterative reconstruction, combining a different
iodine dosage.
This study was approved by the institutional review board. From March to June 2012, 45 consecutive patients who underwent CTU
for hematuria were divided into 3 groups: group A, 100kVp and 0.9mL/kg contrast material (CM) (9 men, 6 female; mean age 49.4
years; mean BMI 22.6kg/m2); group B, 100kVp and 1.1mL/kg CM (8 men,7 female; mean age 50.1years; mean BMI 22.6kg/m2);
group C, 120kVp and 1.1mL/kg CM (13men, 2 female; mean age 58.5 years, mean BMI 23.5kg/m2). Automatic tube current was
used in all groups. The 100kVp images (group A and B) were reconstructed with 80% adaptive statistical iterative reconstruction
(ASiR), while filter back projection (FBP) for 120kVp images (group C). Urinary tract was divided into 11 segments, and mean CT
values and contrast-to-noise ratio (CNR) of each segment in the excretory phase were measured respectively in 3 groups. The
radiation dose in excretory phase was compared (volume computed tomography dose index, CTDIvol; size-specific dose estimate,
SSDE and estimated effective dose, ED).
RESULTS
There were no significant differences among group A, B and C for age, BMI and transverse circumstance (all P>0.05). All
examinations were considered to be of acceptable image quality and inter-observer agreement was good (K=0.717, P<0.001). There
were no significant differences in mean attenuations of all urinary segments among 3 groups (P>0.05). Image noise was much less
in group A and B (both P<0.001) than that of group C, but there was no significant difference between group A and B (P=0.934).
CNRs in most segments were higher in group B than group C(P=0.001~0.062) and similar between group A and C(P=0.024~0.896),
but there were no notable differences in CNRs between group A and B (P>0.05). Mean CTDIvol, SSDE and ED in excretory phase in
group A and B were significantly lower than those of group C(P<0.05). Iodine dosage was reduced by 18.2% in group A than group
B and C.
CONCLUSION
Given subjective and objective image quality, CTU at 100 kVp with 80% ASiR resulted in reduction of radiation dose, and 0.9mL/kg
CM (320mgI/ml) iodine dosage was workable.
High radiation exposure and Contrast-Induced Nephropathy for CTU have drawn much attention and anxiety, 100kVp with 80% ASiR
and 0.9mL/kg CM may offer a means of resolution.
SSM24
ISP: Vascular/Interventional (Gentiourinary Interventions-Treating Conditions of the Prostate and Uterus)
W ednesday, Dec. 2 3:00PM - 4:00PM Location: E450B
GU
IR
FDA
Participants
Sandeep Bagla, MD, Woodbridge, VA (Moderator) Consultant, Hansen Medical Inc; Consultant, NeuWave Medical, Inc; Consultant,
CeloNova BioSciences, Inc; Consultant, Medtronic, Inc; Consultant, DFINE, Inc'; Consultant, Boston Scientific
Charles T. Burke, MD, Chapel Hill, NC (Moderator) Nothing to Disclose
Sub-Events
SSM24-01
Evaluation of Changes in Quality of Life Related to Uterine Fibroid Embolization (UFE): Preliminary
Results of the French SFICV EFUZEN Study
Participants
Helene Kovacsik, MD, PhD, Montpellier, France (Abstract Co-Author) Nothing to Disclose
Sebastien Bommart, MD, Montpellier, France (Abstract Co-Author) Nothing to Disclose
Marc R. Sapoval, MD, PhD, Paris CEDEX 15, France (Abstract Co-Author) Nothing to Disclose
Denis Herbreteau, MD, Tours, France (Presenter) Nothing to Disclose
Jean-Paul Beregi, MD, Nimes, France (Abstract Co-Author) Nothing to Disclose
Jean-Michel Bartoli, MD, Marseille, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
Main goal:- To evaluate quality of life before and one year after UFESecondary goals:- To determine impact of imaging findings
(MRI data) before and 3-6months after UFE on changes in quality of life
Study design: prospective, multicenter (25 centers) French observational studyPatients: 264 consecutive symptomatic women
referred in the center for UFE using EmbozeneÒ (Celonova) particles. Methods:Clinical data: the quality of life score was calculated
using the previously validated UFS-QOL by Spies, before and one year after UFE.Imaging data: MRI were performed before and 3-6
months after UFE. Data recorded were uterine and main fibroid volume, percentage of fibroid enhancement after injection of
gadolinium. Impact of imaging data before and after UFE on QOL scores was searched.
RESULTS
189 patients (85.9%) showed monorrhagia at baseline. This was reduced to 39 patients (18%) at 1 year of follow up. 171 patients
(78.1%) had pelvic pressure symptoms at baseline. This was reduced to 42 patients (19.4%) after 1 year of follow up.Complete
QOL study was obtained in 192 women. Improvement of QOL score at one year after UFE a was found 183/203 (90.2%) for HRQL,
163/192 (84.9%) for Symptoms Severity. The probability of presenting a profuse bleeding was significantly reduced (by 62%)
among patients with high reduction of fibroid volume (>=30%), as compared to patients with low fibroid volume reduction (<30%)
(OR=0.38; 95%CI: [0.18;0.80]) (p = 0.011) The Impact of percentage of uterine volume or main fibroid reduction and decrease of
fibroid enhancement on change in post embolization global UFS-QOL score was not established.
CONCLUSION
At one year post embolization, UFE improves significantly quality of life
UFE is not only an effective technique but is also considered highly satisfactory by women
SSM24-02
Vascular/Interventional Keynote Speaker: Current Status of Prostate Artery Embolization as a
Treatment for BPH
Participants
Sandeep Bagla, MD, Woodbridge, VA (Presenter) Consultant, Hansen Medical Inc; Consultant, NeuWave Medical, Inc; Consultant,
CeloNova BioSciences, Inc; Consultant, Medtronic, Inc; Consultant, DFINE, Inc'; Consultant, Boston Scientific
SSM24-03
Percutaneous Ablation of Oligometastatic Prostate Cancer: Oncologic Outcomes and Safety
Participants
Andrew Erie, MD, Rochester, MN (Presenter) Nothing to Disclose
Jonathan M. Morris, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Brian T. Welch, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Anil N. Kurup, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Adam J. Weisbrod, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Thomas D. Atwell, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Grant D. Schmit, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Eugene D. Kwon, MD, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Matthew R. Callstrom, MD, PhD, Rochester, MN (Abstract Co-Author) Research Grant, Thermedical, Inc Research Grant, General
Electric Company Research Grant, Siemens AG Research Grant, Galil Medical Ltd
PURPOSE
To determine the oncologic outcomes and safety of percutaneous ablation in the treatment of oligometastatic prostate cancer.
This is a retrospective, single-institution review of 31 patients with oligometastatic prostate cancer who underwent 43
percutaneous ablations of their limited (≤5) metastatic sites. Eight patients (26%) were antigen deprivation therapy-naïve (ADTnaïve) and received ablation with the purpose of delaying ADT. Twenty-three patients (74%) underwent ablation either because of
resistance to systemic therapies or a more aggressive multimodal treatment approach was preferred. Study endpoints included
procedural complications, local control, progression free survival (PFS), and androgen deprivation therapy-free survival (ADT-FS).
ADT-FS was defined as the time between percutaneous ablation and the initiation of ADT.
RESULTS
Local control was achieved in 35 (81.4%) of 43 tumors with a median follow-up of 8 months (range, 3-60 mo) after ablation. Tumor
recurrence was found in 8 (18.6%) of 43 tumors at a median follow-up of 6 months (range, 2-38 mo). Median prostate-specific
antigen (PSA) measurements were significantly lower approximately 2 months after ablation compared to before ablation (0.27 ng/dl
[range <0.01 to 7.7] and 1.5 ng/dl [range <0.01 to 72.0], respectively (p=0.02)). Estimated PFS rates for all patients at 6 and 12
months after ablation were 65% (95% CI, 44-80) and 45% (95% CI, 24-64), respectively. Of the 8 ADT-naïve patients who
underwent ablation with purpose to delay ADT, all (100%) achieved local control and the ADT-FS at 12 months was approximately
70%. None of the ablations were associated with major complications.
CONCLUSION
Percutaneous ablation of oligometastatic prostate cancer appears safe, achieves acceptable local control rates, and can delay
disease progression when used in combination with other therapies. Percutaneous ablation may be particularly valuable in ADTnaïve patients who do not tolerate or prefer to delay ADT.
Percutaneous ablation can be used as part of a multimodal treatment approach for oligometastatic prostate cancer and can delay
hormone therapy in ADT-naïve patients.
SSM24-04
Frequency of Penile and Rectal Collateral Flow from Prostatic Arteries during Prostatic Artery
Embolization
Participants
Ari J. Isaacson, MD, Chapel Hill, NC (Abstract Co-Author) Advisory Board, BTG International Ltd
Charles T. Burke, MD, Chapel Hill, NC (Presenter) Nothing to Disclose
PURPOSE
The most common mechanism of complication during prostatic artery embolization (PAE) is non-target embolization. Avoidance of
branches supplying the bladder is commonly described. Less commonly discussed are intra-prostatic collaterals supplying the penis
and rectum, although they are frequently seen during PAE. Because of the risks associated with non-target embolization as a result
of these shunts, it would be beneficial to have an understanding of their incidence, as well as from what prostatic artery branches
they arise. The purpose of this study was to retrospectively determine the frequency of rectal and penile collateral flow from each
prostatic artery branch as seen during PAE.
DSA images from PAEs performed between April 2013 and March 2015 were evaluated by two interventional radiologists experienced
in performing PAE. A consensus determination was made about which arteries were catheterized (the anterolateral prostatic artery
(ALPA), the posterolateral prostatic artery (PLPA) or a common trunk (CT) of the two) and about the presence of collateral flow to
the arteries supplying the penis and/or the rectum from each catheterized artery. The overall incidence of such collaterals was
calculated as well as the frequency in which they arose from each prostatic artery branch.
RESULTS
During 26 PAEs, 58 prostatic arteries were catheterized (36 ALPAs, 10 PLPAs and 12 CTs). Collateral flow to arteries supplying the
penis or rectum was identified in 18/26 PAEs (69%). Flow to the penile arteries was seen in 13/36 (36%) ALPA catheterizations and
in 5/12 (42%) CT catheterizations. Flow to rectal branches was seen in 8/10 (80%) PLPA catheterizations and in 4/12 (33%) CT
catheterizations. No flow to penile branches was observed from a PLPA, nor was there flow to a rectal branch seen from an ALPA.
CONCLUSION
Shunting to the penis and/or rectum was present during the majority of PAEs. Collateral flow to the rectum from the PLPA or from a
CT was seen quite frequently and collateral flow to the penis from an ALPA or CT was seen with moderate frequency during
prostatic artery catheterization.
Understanding the incidence of rectal and penile collateral pathways from the specific branches of the prostatic arteries will allow
for greater detection of these findings during PAE in order to avoid complications.
SSM24-05
Prostate Cancer Treatment with Irreversible Electroporation (IRE): Experience, Safety and Efficacy
after 4.5 Years in 222 Patients
Participants
Michael K. Stehling, MD, PhD, Offenbach, Germany (Presenter) Nothing to Disclose
Enric Guenther, Dipl Phys, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Nina Klein, MSc, Offenbach am Main, Germany (Abstract Co-Author) Nothing to Disclose
Stephan Zapf, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
Ducksoo Kim, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Boris Rubinsky, PhD, Berkeley, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Irreversible Electroporation (IRE) is a novel tissue ablation method. It selectively destroys cells whilst preserving tissue
infrastructure and is hence an ideal method for focal prostate cancer (PCa) therapy. It preserves (or allows regeneration of) vital
surrounding structures such as neurovascular bundle, inferior sphincter and rectum, thus minimizing the side-effects of PCa
therapy, mainly being impotence and incontinence.
We have employed IRE for the treatment of 222 patients with primary (stages T1-T4) and recurrent PCa after surgery (18/222),
radiation therapy (4/222) and HIFU (3/222). All patients underwent mp-MRI prior to and after IRE (T2, diffusion, perfusion, in
selected cases 1H spectroscopy). 44% of patients underwent additional 3D-transperineal biopsy before IRE. Treatment was carried
out by rectal US-guided transperineal IRE-electrode insertion under general anesthesia and deep muscle relaxation. 161 patients
had focal and 61 whole gland ablations. All patients had follow-ups with PSA and mp-MRI for documentation of local tumor control.
RESULTS
Initial tumor control was achieved in all patients. Within the follow-up period of up to 4y, the recurrence rates were 0/45 (Gleason
<7), 4/103 (Gleason 7) and 5/54 (Gleason >7). There were no IRE-related complications and toxicity was extremely low: 16
patients reported a transient reduction of erectile function (EF) (recurred after 6-8m), 5 a permanent reduction and 2 a permanent
loss of EF. There were no cases of IRE-related incontinence, even when the lower urinary sphincter was included in the treatment
field; a partially included rectum also remained intact. Treatment was completed within 24h in all patients with a single overnight
stay in the clinic. Patients had no wound pain.
CONCLUSION
IRE treatment of PCa is safe. In the short-term follow-up with MRI and PSA (maximum 4.5y) it is effective. Toxicity is significantly
lower compared to other PCa treatments. Based on our data incontinence can be avoided altogether. MRI and 3D-biopsy are
suitable for pre-treatment work-up and MRI for post-treatment follow-up. IRE has the potential to become an important tool for
PCa therapy.
IRE treatment is an alternative to the current treatment options for PCa, with much lower invasiveness and toxicity. It is effective
in all stages of PCa and offers treatment options in advanced and recurrent PCa not amenable to other therapies.
SSM24-06
Phase II Clinical Trial for Evaluation of MRI-guided Laser Induced Interstitial Thermal Therapy
(LITT) for Low-to-intermediate Risk Prostate Cancer
Participants
Aytekin Oto, MD, Chicago, IL (Presenter) Research Grant, Koninklijke Philips NV; ; ;
Shiyang Wang, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Ambereen Yousuf, MBBS, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Sydeaka Watson, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Tatjana Antic, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Scott Eggener, Chicago, IL (Abstract Co-Author) Research Grant, Visualase, Inc Speakers Bureau, Johnson & Johnson
PURPOSE
To assess the oncologic efficacy and safety of MRI-guided laser-induced interstitial thermal therapy of biopsy confirmed and MRvisible prostate cancer.
27 patients with biopsy proven low-to-intermediate risk prostate cancer underwent MRI-guided laser ablation of the cancer using
Visualase laser ablation device. All patients had a pre-procedure endorectal MRI which showed suspicious foci concomitant with the
positive sextant on TRUS-guided biopsy. The area of interest was targeted transperineally using 1.5 T Philips MRI scanner and
Visualase ablation device. Ablation was monitored by real time MR thermometry using Visualase MRI thermometry software.
Perioperative, early and late complications and adverse events were recorded. Follow-up was performed with 3-month MRI and MRguided biopsy, 12-month MRI and TRUS guided biopsy and validated quality of life questionnaires to assess urinary and sexual
function.
RESULTS
MRI-guided laser ablation of prostate cancer was successfully performed in all 27 patients without significant peri-procedural
complications. All patients were discharged home the same day. Average duration of the procedure was 3 hours 17 minutes and
average duration of a single laser ablation was 1 minute 22 seconds. Total number of ablations per patient ranged from 2-8, with a
median of 4. The treatment created an identifiable hypovascular defect in all cases. Post procedure complications were minor and
included urinary symptoms, perineal bruising and erectile dysfunction, all of which self- resolved. Validated quality of life urinary and
sexual questionnaires obtained before and 12 months after the procedure did not reveal any significant differences (p≥0.05). 1/27
and 3/17 patients had residual cancer in the ablation zone at 3 months and 12 months respectively.
CONCLUSION
Short-term follow-up results of MRI-guided focal laser ablation for treatment of clinically localized, low-to-intermediate risk prostate
cancer appear promising. It may offer a minimally invasive procedure for select patients that does not appreciably alter sexual or
urinary function.
Short-term results of our phase II trial show that MRI-guided focal laser ablation can be a safe and feasible option for treatment of
low-to-intermediate risk prostate cancer.
Honored Educators
MSCU42
Case-based Review of US (An Interactive Session)
W ednesday, Dec. 2 3:30PM - 5:00PM Location: S406A
GI
GU
US
Participants
Deborah J. Rubens, MD, Rochester, NY (Moderator) Nothing to Disclose
LEARNING OBJECTIVES
1) Recognize the diverse applications of ultrasound throughout the body and when it provides the optimal diagnostic imaging
choice. 2) Understand the fundamental interpretive parameters of ultrasound contrast enhancement and its applications in the
abdomen. 3) Know the important factors to consider when choosing ultrasound vs CT for image guided procedures and how to
optimize ultrasound for technical success.
ABSTRACT
Ultrasound is a rapidly evolving imaging modality which has achieved widespread application throughout the body. In this course we
will address the major anatomic areas of ultrasound use, including the abdominal and pelvic organs, superficial structures and the
vascular system. Challenging imaging and clinical scenarios will be emphasized to include the participant in the decision-making
process. Advanced cases and evolving technology will be highlighted, including the use of ultrasound contrast media as a problem
solving tool, and the appropriate selection of procedures for US-guided intervention.
Active Handout:Deborah J. Rubens
http://abstract.rsna.org/uploads/2015/15002752/Active MSCU42.pdf
Sub-Events
MSCU42A
Challenging Abdominal Cases
Participants
Oksana H. Baltarowich, MD, Philadelphia, PA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
ABSTRACT
View abstract under main course title.
MSCU42B
Acute Pelvic Pain
Participants
Leslie M. Scoutt, MD, New Haven, CT, (leslie.scoutt@yale.edu) (Presenter) Consultant, Koninklijke Philips NV
LEARNING OBJECTIVES
Honored Educators
MSCU42C
Superficial Ultrasound Imaging: Head to Toe
Participants
Deborah J. Rubens, MD, Rochester, NY (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
MSRT46
ASRT@RSNA 2015: Prostate Cancer and MR Imaging: What Do We Want to See and How to Get It
W ednesday, Dec. 2 3:40PM - 4:40PM Location: N230
GU
MR
OI
Participants
James Stirling, DCR, DMS, Middlesex, United Kingdom, (james.stirling@kcl.ac.uk ) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To learn the anatomy and comon pathology of the prostate gland. 2) To learn the factors and how to optimise prostate
sequences eg. T1, T2 and STIR whole pelvis sequences, small field of view T2 axial, sagital and coronal sequences, diffusion
weighted imaging, contrast enhanced T1 and T2* dynamic sequences. 3) To learn how different sequences are used with primary,
secondary and metastatic prostate cancer. 4) To give a taste of hybid PET/MR 18F Choline imaging.
ABSTRACT
Over the last couple of years MRI of prostate cancer has moved from just T1 and T2 imaging to multi-parametric, multi-modality
imaging. To produce high quality imaging, sequence parameter factors have to be optimized, balancing clinical requirements with
patient comfort, total on-table time, scanner capabilities and limitations. The lecture will include prostatic anatomy and how
different sequences can characterize benign and malignant disease. The talk will show the sequences that are needed and how to
optimize them. This will include T2 small field of views, diffusion weighted imaging, T1 and T2* dynamic contrast enhanced
sequences and intrinsic susceptibility weighted imaging. As prostate cancer develops and is treated the imaging protocols change.
The protocols include surveillance and staging and then progress to recurrence and metastatic whole body imaging. MRI is now
being complemented with PET in hybrid machines combining the strengths of both modalities. This lecture will show how MR imaging
of malignant prostate disease changes as the disease progresses.
SPSC44
Controversy Session: Prostate Imaging: Just What MR Technique is Best?
W ednesday, Dec. 2 4:30PM - 6:00PM Location: E450A
GU
MR
Participants
Rajan T. Gupta, MD, Durham, NC (Moderator) Consultant, Bayer AG; Speakers Bureau, Bayer AG; Consultant, Invivo Corporation
LEARNING OBJECTIVES
1) The goal of this session is to explore the different techniques that comprise high quality multiparametric MRI of the prostate.
More specifically, we will deal with some of the key protocol questions that one must tackle in order to set up mpMRI in their own
practice. Examples of the topics to be discussed include 1.5T vs. 3T imaging; endorectal coil vs. phased array body coil use; the
optimal diffusion weighted metrics to be used to assess lesion aggressiveness, etc.; the changing role of dynamic contrast
enhanced MRI in prostate imaging, especially in light of the recent release of PI-RADS version 2; and finally, the optimal techniques
to evaluate for disease recurrence after therapy. The format of the session will be both didactic and interactive with audience
participation.
Sub-Events
SPSC44A
Introduction to Session and Overview of Multiparametric Prostate MRI
Participants
LEARNING OBJECTIVES
SPSC44B
1.5T vs 3T Imaging: Pros and Cons
Participants
Francois Cornud, MD, Paris, France (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
SPSC44C
Diffusion Weighted Imaging
Participants
Andrew B. Rosenkrantz, MD, New York, NY (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
SPSC44D
Dynamic Contrast Enhanced Imaging
Participants
LEARNING OBJECTIVES
Honored Educators
SPSC44E
Imaging of Recurrence in Prostate Cancer
Participants
Adam Froemming, MD, Rochester, MN (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
SPSC46
Controversy Session: Ultrasound versus CT for Suspected Renal Colic: Which Modality Rocks in the ER?
W ednesday, Dec. 2 4:30PM - 6:00PM Location: S404CD
GU
CT
US
ER
Participants
Judy Yee, MD, San Francisco, CA (Moderator) Research Grant, EchoPixel, Inc
Mitchell E. Tublin, MD, Pittsburgh, PA (Presenter) Nothing to Disclose
Aaron D. Sodickson, MD, PhD, Wayland, MA, (asodickson@bwh.harvard.edu) (Presenter) Research Grant, Siemens AG; Consultant,
Bracco Group
D. Mark Courtney, MD, MSc, Chicago, IL (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe the advantages of ultrasound and present a cost effective, rational algorithm for its use in the evaluation of ER
patients with potential renal colic. 2) Understand the benefits of CT over ultrasound in ER imaging of suspected renal colic. 3)
Understand the perspective and preferences of the ER physician for the workup of renal colic and the effect on clinical workflow.
Honored Educators
Aaron D. Sodickson, MD, PhD - 2014 Honored Educator
ED006-TH
Genitourinary Thursday Case of the Day
Thursday, Dec. 3 7:00AM - 11:59PM Location: Case of Day, Learning Center
GU
Participants
TEACHING POINTS
Honored Educators
SPSH50
Hot Topic Session: Dual-energy CT for GU Imaging
Thursday, Dec. 3 7:15AM - 8:15AM Location: E350
GU
CT
Participants
Hersh Chandarana, MD, New York, NY (Moderator) Equipment support, Siemens AG; Software support, Siemens AG; Consultant,
Bayer, AG;
LEARNING OBJECTIVES
1) This course will cover the basics and application of Dual Energy CT in GU Radiology.
ABSTRACT
Sub-Events
SPSH50A
Principles of DECT
Participants
Daniel T. Boll, MD, Durham, NC (Presenter) Research Grant, Siemens AG; Research Grant, Koninklijke Philips NV; Research Grant,
Bracco Group
SPSH50B
DECT of GU Masses-2015 Update
Participants
Terri J. Vrtiska, MD, Rochester, MN (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Discuss DECT advantages for renal mass evaluation. 2) Describe useful DECT applications for renal mass characterization. 3)
Summarize recent literature and future opportunities of DECT of renal masses.
ABSTRACT
Application of DECT to renal mass evaluation and improved characterization.
URL
SPSH50C
Establishing DECT in Your Practice: Nuts and Bolts
Participants
Avinash R. Kambadakone, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe the basic principles, technique and clinical applications of DECT. 2) Identify and appraise the different technologies,
workflow implications and challenges of DECT in day-to-day practice. 3) Apply and incorporate the most appropriate DECT protocols
into routine practice.
ABSTRACT
URL
RC607
A Case-based Audience Participation Session (Genitourinary) (An Interactive Session)
Thursday, Dec. 3 8:30AM - 10:00AM Location: E352
GU
Participants
Paul J. Chang, MD, Chicago, IL, (pchang@radiology.bsd.uchicago.edu) (Coordinator) Co-founder, Stentor/Koninklijke Philips NV;
Researcher, Koninklijke Philips NV; Medical Advisory Board, lifeIMAGE Inc; Medical Advisory Board, Merge Healthcare Incorporated
William W. Mayo-Smith, MD, Boston, MA (Presenter) Author with royalties, Reed Elsevier; Author with royalties, Cambridge
University Press
Andrea G. Rockall, MRCP, FRCR, London, United Kingdom (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) The participant will be introduced to a series of Genitourinary case studies via an interactive team game approach designed to
encourage "active" consumption of educational content. 2) The participant will be able to use their mobile wireless device (tablet,
phone, laptop) to electronically respond to various Genitourinary case challenges; participants will be able to monitor their individual
and team performance in real time. 3) The attendee will receive a personalized self-assessment report via email that will review the
case material presented during the session, along with individual and team performance. Please bring your charged mobile wireless
device (phone, tablet or laptop) to participate.
ABSTRACT
The extremely popular audience participation educational experience is back! :GU Diagnosis Live is an expert-moderated session
featuring a series of interactive Genitourinary case studies that will challenge radiologists' diagnostic skills and knowledge. Building
on last year's successful Diagnosis Live premiere, GU Diagnosis Live is a lively, fast-paced game format: participants will be
automatically assigned to teams who will then use their personal mobile devices to test their knowledge of GU radiology in a fastpaced session that will be both educational and entertaining. After the session, attendees will receive a personalized selfassessment report via email that will revview the case material presented durinig the session, along with individual and team
performance. :
RC610
Ultrasound Contrast (An Interactive Session)
Thursday, Dec. 3 8:30AM - 10:00AM Location: S402AB
GI
GU
US
FDA
Participants
Sub-Events
RC610A
Renal Masses
Participants
Edward G. Grant, MD, Los Angeles, CA (Presenter) Research Grant, General Electric Company ; Medical Advisory Board, Nuance
Communications, Inc
LEARNING OBJECTIVES
1) Understand the indications for the use of contrast enhanced ultrasound in renal masses. 2) Be familiar with the advantages and
disadvantages of contrast enhanced ultrasound in comparison to other forms of cross sectional imaging with regard to its
application to renal masses. 3) Be able to analyze contrast enhanced ultrasound images of the kidney. 4) Understand the basics of
quantitative contrast imaging of renal masses.
ABSTRACT
Contrast enhanced ultrasound (CEUS) has numerous applications in the imaging of renal masses. It has the particular advantage in
this population of being able to be used in patients with renal failure which is not the case with either CT or MRI. Obviously CEUS
does not use ionizing radiation and is less expensive than other techniques. A further advantage is the fact that ultrasound is a real
time technique and vascular characteristics of lesions can be evaluated throughout the examination. Applications of CEUS in the
kidney include imaging of complex cysts (flow in wall, septae etc.) and evaluation of pseudolesions (column of Bertin, infarct,
scars). It can also be used to further characterize indeterminate masses on CT/MR and may be able to classify some lesions as
benign versus malignant, or suggest their actual histology. The diagnostic capability of CEUS is facilitated by its ability to provide
quantitative information. Given the lack of ionizing radiation and absence of nephrotoxicity CEUS is ideal for patients undergoing
active surveillance of a renal mass or post resection/RFA.The evaluation of complex renal cysts is one of the most common
indications for CEUS. Observed features at CEUS are typically similar to those of the Bosniak classification and this has now been
adapted for use with ultrasound contrast. In solid renal masses CEUS may provide information that can help determine the nature of
the mass and its anatomy as well as the number of individual lesions. This is particularly valuable in patients in whom other contrast
agents are contraindicated. One notable example is the characteristic enhancement pattern of papillary versus clear cell renal cell
carcinoma. The former typically enhances less than the surrounding parenchyma throughout the examination while the latter
dramatically hyperenhances in the arterial phase. Again, quantitative imaging can further add to the confidence of the diagnosis in
such cases.
RC610B
Contrast Ultrasound of the Liver and Gallbladder
Participants
Hans-Peter Weskott, MD, Hannover, Germany, (weskotthp@t-online.de) (Presenter) Luminary, General Electric Company; Speaker,
Bracco Group
LEARNING OBJECTIVES
1) Understanding the indications of contrast enhanced ultrasound (CEUS) in focal liver and gallbladder diseases. 2) Learning about
the importance of the three contrast phases and how CEUS performes in detecting and characterizing focal liver lesions and to
characterize inflammatory and tumorous changes of the gallbladder wall. 3) Learning about the potential value as well as the
limitations of CEUS in liver an gallbladder diseases. 4) Learning how CEUS performs when compared to B-mode and Color Doppler
ultrasound, CT and MRI imaging.
ABSTRACT
Liver: In patients with favorable scanning conditions CEUS is at least as sensitive as contrast enhanced CT (CECT) in detecting
malignant liver lesions. Due to its high temporal resolution, even a hyper-enhancement of a few seconds can reliably be detected,
thus improving the characterization of focal liver lesions. A majority of malignant lesions can therefore be characterized as hypo-,
iso- or hyper-enhancing. During the arterial phase the tumor`s vessel architecture and direction of contrast filling is important for
characterizing a lesions character. Due to a high spatial resolution, novel contrast imaging techniques allow detection of washed
out lesions down to 3mm in size. CEUS characterizes focal liver lesions with a much higher diagnostic confidence than conventional
US and is comparable to CT and MRI. CEUS also improves intraoperative tumor detection and characterization. Using time intensity
analysis a change in contrast enhancement and kinetics helps in estimating tumor response to chemotherapy. CEUS is also used to
monitor local ablation therapy and is a useful imaging tool to detect early tumor recurrence. Gallbladder: CEUS can be used to
better visualize ulceration, perforation, and tumors of its wall. It thus helps in optimizing clinical management, including timing for
surgery. CEUS does not affect renal or thyroid function and is therefore helpful in older patients and the preferred imaging
technique in young patients and those with impaired renal function.
RC610C
Participants
Contrast Ultrasound of Bowel
Stephanie R. Wilson, MD, Calgary, AB (Presenter) Research Grant, Lantheus Medical Imaging, Inc; Equipment support, Siemens AG;
Equipment support, Koninklijke Philips NV
LEARNING OBJECTIVES
1) Attendees will recognize the association of hypervascularity with inflammatory processes in the bowel on the basis of
neoangiogenesis. 2) They will appreciate the value of CEUS of the bowel, with provision of both subjective and objective blood flow
determinations, useful in determining disease activity and in assessing response to therapy. . 3) They will apply the common
interpretations of time itensity curves to obtain peak enhancement and area under the curve information, recognizing their direct
relationship to inflammatory disease with increasing parameters.
ABSTRACT
RC629
Prostate MRI Using PI-RADS (Prostate Imaging Reporting and Data System) (An Interactive Session)
Thursday, Dec. 3 8:30AM - 10:00AM Location: E450B
GU
MR
Participants
LEARNING OBJECTIVES
1) Describe the clinical indications for prostate MRI and MRI-targeted interventions. 2) Assess technical considerations for
performance of multi-parametric prostate MRI, including pulse sequences, coils, contrast administration, magnetic field strength. 3)
Integrate information from T2, DCE, and DWI to analyze and report prostate MRI exams using new ACR-PIRADS methodology. Please
bring your charged mobile wireless device (phone, tablet or laptop) to participate.
Sub-Events
RC629A
Introduction to PI-RADS
Participants
Jeffrey C. Weinreb, MD, New Haven, CT (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
RC629B
Technical Considerations
Participants
Clare M. Tempany-Afdhal, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
RC629C
How to Use PI-RADS
Participants
Jelle O. Barentsz, MD, PhD, Nijmegen, Netherlands (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
Active Handout:Jelle O. Barentsz
RC629D
Interactive Clinical Case Review
Participants
LEARNING OBJECTIVES
SSQ09
ISP: Genitourinary (Renal Mass Evaluation)
Thursday, Dec. 3 10:30AM - 12:00PM Location: E353B
GU
CT
MR
Participants
Raghunandan Vikram, MBBS, FRCR, Houston, TX (Moderator) Nothing to Disclose
Daniele Marin, MD, Cary, NC (Moderator) Nothing to Disclose
Sub-Events
SSQ09-01
Genitourinary Keynote Speaker: Contemporary Challenges of Imaging Renal Masses
Participants
John R. Leyendecker, MD, Dallas, TX (Presenter) Nothing to Disclose
SSQ09-02
Do Incidental Hyperechoic Renal Lesions Measuring ≤ 1cm Warrant Further Imaging? Outcomes of
161 Lesions
Participants
Abimbola Ayoola, MD, New York, NY (Presenter) Nothing to Disclose
Ankur Doshi, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
Although follow-up CT or MRI has been advised for further evaluation of incidental hyperechoic renal lesions on ultrasound (US),
this approach is variably followed in clinical practice given the lack of robust data to guide optimal follow-up recommendations.
Thus, the purpose of our study was to determine the outcomes of incidental hyperechoic renal lesions measuring ≤ 1cm based on a
large single-center cohort in order to better inform management strategies for such lesions.
We retrospectively identified 161 hyperechoic renal lesions on US measuring ≤ 1cm (mean size 0.7 ± 0.2 cm) that had either (a) a
follow-up CT or MRI or (b) at least 2 year follow-up by US. Mean patient age was 63 ±13 years (range 30-88 years). The initial US
and follow-up imaging were reviewed to assess for a change in size or definitive lesion characterization.
RESULTS
Follow-up imaging consisted of US in 23.0% (37/161), CT in 45.3% (73/161) and MRI in 31.7% (51/161). 57.1% (92/161) of lesions
were confirmed as angiomyolipomas on CT or MRI. 19.9% (32/161) showed less than 4mm growth on long-term US follow-up (mean
62±26 months, range 24-110 months). 11.8% (19/161) had no correlate on CT or MRI. 6.2% (10/161) were too small to definitively
characterize on CT. 3.1% (5/161) were not visualized on follow-up US. CT characterized one lesion (0.6%) as a stone and one
lesion (0.6%) as a hyperdense cyst. One lesion (0.6%) on CT was an enhancing solid mass without macroscopic fat, presumed to
represent an RCC, although was lost to follow-up. This lesion was not as hyperechoic as the renal sinus fat on the initial US.
CONCLUSION
The overwhelming majority of hyperechoic renal lesions ≤ 1cm with the classic US appearance of an angiomyolipoma were benign or
stable on follow-up imaging. Thus, these lesions may not warrant any further imaging evaluation.
To our knowledge, we have provided the largest study to date to assess outcomes of small hyperechoic renal lesions on follow-up
imaging that support the benignity of this US finding.
SSQ09-03
Post-operative Outcomes of Cystic Renal Cell Carcinomas Defined on Pre-operative Computed
Tomography: A Retrospective Study in 1315 Patients
Participants
Byong Chang Jeong, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Seong Il Seo, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
PURPOSE
Post-operative outcomes of cystic renal cell carcinomas (RCCs) defined on preoperative imaging were not widely investigated and
the cut-off of cystic proportion is arbitrary. We aimed to evaluate the post-operative outcomes of cystic RCCs defined on preoperative computed tomography (CT) and to identify the optimal cut-off of cystic proportion in association with patients' prognosis.
Our retrospective study included 1315 consecutive patients who received surgery for single sporadic RCC and had adequate preoperative CT for analysis. The cystic proportion of RCC was calculated on pre-operative CT by a radiologist. The optimal cut-off of
cystic proportion in RCC was explored by locating the minimum P value on log rank test regarding cancer-specific survival. The RCCs
were categorized as cystic and non-cystic groups according to (1) conventional cut-off (i.e. proportion of cystic component≥
75%) and (2) the optimal cut-off, and then cancer-specific and recurrence-free survival rates were compared between the two
groups. The clinical, pathologic, and imaging variables were analyzed using the Cox regression analysis to determine the
independent predictor of cancer-specific survival.
RESULTS
Of the 1315 RCCs, 107 (8.1%) were identified as cystic RCCs using the conventional cut-off. During a median follow-up of 4.9
years, patients with cystic RCC revealed neither metastasis nor recurrence after surgery. The cancer-specific and recurrence-free
survival rates of cystic RCCs were significantly better than those of non-cystic RCCs (both P < 0·001). In association with cancerspecific survival rate, the optimal cut-off of cystic proportion in RCC was 45%, and 197 (15.0%) patients were defined as cystic
RCCs accordingly. On multivariate Cox regression analysis, cystic RCC defined by the optimal cut-off (45%) was one of the
independent predictors of cancer-specific survival (hazard ratio, 0.34; P = 0.03).
CONCLUSION
Cystic RCCs defined on pre-operative CT are associated with low metastatic potential and favorable outcomes after surgery.
Furthermore, the optimal cut-off of cystic proportion in association with cancer-specific survival is 45%.
Cystic renal cell carcinomas (RCCs) defined by preoperative CT may be managed differently from non-cystic RCCs for selecting
optimal treatment methods.
SSQ09-04
The Radiogenomic Risk Score: Construction of a Prognostic Quantitative, Noninvasive Image-based
Molecular Assay for Renal Cell Carcinoma
Participants
Neema Jamshidi, MD, PhD, Los Angeles, CA (Presenter) Nothing to Disclose
Eric Jonasch, MD, Houston, TX (Abstract Co-Author) Consultant, Pfizer Inc Consultant, Novartis AG Consultant, GlaxoSmithKline plc
Consultant, AstraZeneca PLC Research funded, Pfizer Inc Research funded, GlaxoSmithKline plc Research funded, Bristol-Myers
Squibb Company Research funded, Novartis AG Research funded, Exelixis, Inc Research funded, Onyx Pharmaceuticals, Inc
Matthew A. Zapala, MD,PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Ronald L. Korn, MD, PhD, Scottsdale, AZ (Abstract Co-Author) Chief Medical Officer, Imaging Endpoints; Founder, Imaging
Endpoints; Shareholder, Imaging Endpoints
Lejla Aganovic, MD, La Jolla, CA (Abstract Co-Author) Nothing to Disclose
Hongjuan Zhao, Stanford, CA (Abstract Co-Author) Nothing to Disclose
T S. Raviprakash, Umea, Sweden (Abstract Co-Author) Nothing to Disclose
Robert Tibshirani, Stanford, CA (Abstract Co-Author) Nothing to Disclose
Sudeep Banerjee, BA, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
James Brooks, Stanford, CA (Abstract Co-Author) Nothing to Disclose
Borje Ljungberg, MD, San Diego, CA (Abstract Co-Author) Nothing to Disclose
Michael D. Kuo, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Quantitative multi-gene assays are effective clinical decision making tools in oncology, however cost, risks associated with tissue
procurement, and difficulty in framing subcellular information within a larger physiological context limits their overall utility. We
evaluated the feasibility of reconstructing quantitative non-invasive molecular assays (NIMA) in clear cell renal cell cancer (ccRCC)
using data extracted from a single computed tomography (CT) scan.
In this IRB approved study, gene expression profile data and contrast enhanced CT scans from 70 ccRCC patients in a training set
were initially analyzed. A NIMA for a previously validated ccRCC-specific SPC prognostic gene signature was constructed termed
the Radiogenomic Risk Score (RRS), using the microarray data and a 28 trait image array to evaluate each CT scan using multiple
regression of gene expression analysis. The predictive power of the RRS NIMA was then prospectively validated in an independent
dataset (n=77) to confirm its relationship to the SPC gene signature and to quantify individual risk.
RESULTS
Our quantitative NIMA faithfully represents the tissue-based molecular assay it models. The RRS scaled with the SPC gene
signature (R=0.57, p=6.2e-4, classification accuracy 70.1%, p<0.001) and predicted disease-specific survival (log rank p<0.001).
Independent validation confirmed the relationship between the RRS and the SPC gene signature (R=0.45, p=1.3e-4, classification
accuracy 68.6%, p<0.001) and disease-specific survival (log-rank p<0.001) and that it was independent of stage, grade and
performance status (multivariate Cox model p<0.05, log-rank p<0.001).
CONCLUSION
A NIMA for the ccRCC-specific SPC prognostic gene signature that is predictive of disease-specific survival and independent of
stage was constructed and validated confirming that quantitative NIMA construction is feasible.
Non-invasive molecular assays can be constructed that efficiently capture both pre-specified quantitative molecular phenotypes as
well as systems-level phenotypes not accessible by genomic-based tests alone, with a range of potential clinical applications
including prognostication and patient stratification in human clinical trials.
SSQ09-05
CAD Derived Absolute Attenuation Discriminates Clear Cell Renal Cell Carcinoma from Benign Mimics
and RCC Subtypes at Four-Phase MDCT
Participants
Heidi Coy, Los Angeles, CA (Presenter) Nothing to Disclose
Jonathan R. Young, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Moe Moe Ko, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
War War Ko, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Pechin Lo, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Matthew S. Brown, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
James Sayre, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Currently, all solid enhancing non-fatty renal neoplasms are presumed to be malignant. Up to 30% of these lesions are benign, most
commonly oncocytoma. Renal Cell Carcinoma (RCC) subtypes are a heterogeneous group treated by surgery, ablation or active
surveillance with a prognosis based on histology. The purpose of our study is to determine if peak enhancement derived from
volumetric 3D lesion contour and a Computer Aided Diagnostic (CAD) algorithm can discriminate clear cell RCC (ccRCC) from benign
RCC mimics and RCC subtypes.
With IRB approval for this HIPAA-compliant retrospective study, our pathology and imaging databases were queried to obtain a
cohort of RCC, oncocytoma, and lipid-poor angiomyolipoma (AML) with preoperative multiphasic multidetector CT imaged with a
four-phase renal mass protocol (unenhanced, corticomedullary (C), nephrographic (N), and excretory (E)). A whole lesion 3D
contour was obtained in all phases with proprietary software. The CAD algorithm determined a 0.5cm diameter region of peak
enhancement ≤300HU within the 3D lesion contour. All contours were confirmed by a radiologist. T-tests were used to compare
peak multiphasic enhancement. P values <0.05 were considered significant.
RESULTS
206 patients (65% men, 35% women) with 223 unique renal masses (105 (47%) ccRCC, 41(18%) oncocytoma (O), 18 (8%)
chromophobe RCC (chRCC), 45 (20%) papillary RCC (pRCC), 14 (6%) lipid-poor AML) were analyzed. In the C phase, CAD absolute
peak attenuation of the ccRCC (174 HU) was greater than that of O (167 HU, p=0.333), chRCC (136 HU, p=0.007), pRCC (85 HU,
p<0.0001), and lipid-poor AML (144 HU, p=0.004). In the N phase, CAD absolute peak attenuation of the ccRCC (144 HU) was
greater than that of O (132 HU, p=0.015), chRCC (106 HU, p<0.0001), pRCC (103 HU, p<0.0001), and lipid-poor AML (115 HU,
p<0.0001). In the E phase, CAD absolute peak attenuation of the ccRCC (118 HU) was greater than that of O (104 HU, p=0.001),
chRCC (86 HU, p<0.0001), pRCC (86 HU, p<0.0001), and lipid-poor AML (98 HU, p=0.001).
CONCLUSION
CAD derived absolute attenuation discriminates ccRCC from indolent RCC subtypes and benign RCC mimics at four-phase MDCT
CAD enhancement is a robust method to discriminate clear cell RCC from RCC subtypes and benign mimics, enabling clinicians to
stratify patients to active surveillance, preoperative biopsy or surgical therapy.
SSQ09-06
Prognostic Value of Newly Proposed Response Criteria in Assessing Tumor Response in Advanced
Renal Cell Carcinoma
Participants
Hyunseon C. Kang, MD, PhD, Houston, TX (Presenter) Nothing to Disclose
Shiva Gupta, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
Wei Wei, Houston, TX (Abstract Co-Author) Nothing to Disclose
Lina Lu, MS, Houston, TX (Abstract Co-Author) Nothing to Disclose
Marc Matrana, MD, New Orleans, LA (Abstract Co-Author) Nothing to Disclose
Nizar M. Tannir, MD, Houston, TX (Abstract Co-Author) Consultant, Onyx Pharmaceuticals, Inc; Consultant, Bayer AG; Consultant,
Pfizer Inc; Speakers Bureau, Bayer AG; Speakers Bureau, Onyx Pharmaceuticals, Inc; Speakers Bureau, Pfizer Inc; Research funded,
Pfizer Inc; Research funded, Eli Lilly and Company; Research funded, F. Hoffmann-La Roche Ltd; Spouse, Stockholder, Merck & Co,
Inc
Haesun Choi, MD, Houston, TX (Abstract Co-Author) Nothing to Disclose
PURPOSE
Several new solid tumor response criteria have been proposed to overcome the limitations of traditional size based criteria. This
study examines the prognostic value of these criteria, and the additive value of clinical risk factors, in patients with advanced renal
cell carcinoma (RCC) treated with pazopanib.
Fifty-seven patients with metastatic RCC, who were treated with pazopanib after progression with other targeted therapies, were
studied retrospectively. Two sets of CTs (pre- and 1-3.5 months post-treatment) were reviewed by 2 abdominal radiologists.
Tumor response on the post-therapy scan was evaluated with RECIST, Choi, modified Choi, MASS, the 10% threshold criteria, as
well as a consensus subjective reader assessment, simulating radiologists' clinical interpretation. In addition to these criteria,
combined criteria incorporating MSKCC risk factors + imaging criteria were used to define response groups. Response evaluations
were correlated with overall survival (OS) and progression-free survival (PFS) using the log-rank test. Only patients with partial
response (PR) or stable disease (SD) were included in the analysis of PFS.
RESULTS
The 6 patients with progressive disease (PD) by RECIST, and the 22 patients with PD by the subjective reader assessment, had
significantly worse OS compared to patients with SD or PR. There was no significant difference in OS between responders and
nonresponders by Choi, modified Choi, or MASS criteria. When MSKCC risk factors were combined with imaging criteria, the
combined criteria defined groups of patients with significantly worse OS. Patients with PR by modified Choi criteria showed
significantly longer PFS compared to those with SD (p=0.033). PR and SD groups defined by other criteria did not show a significant
difference in PFS. The MSKCC risk factors did not improve the prognostic ability of imaging-based criteria to predict patients with
longer PFS.
CONCLUSION
Patients with PD by either RECIST or the subjective reader assessment had significantly worse survival compared to SD or PR
groups. The addition of MSKCC risk factors significantly increased the predictive value of all criteria for OS. This effect was
dominated by the MSKCC criteria, which were strongly correlated with survival.
In the salvage therapy setting, the addition of clinical risk factors improves the predictive value of imaging-based tumor response
criteria.
SSQ09-07
Diagnostic Accuracy of Unenhanced MRI for Suspicious Malignant Renal Lesions Inend Stage Renal
Failure Patients with Acquired Cystic Disease
Participants
Rafel Tappouni, MBBCh, FRCPC, Winston-Salem, NC (Presenter) Nothing to Disclose
David D. Childs, MD, Clemmons, NC (Abstract Co-Author) Research Grant, Endocare, Inc
Shadi Qasem, Winston-Salem, NC (Abstract Co-Author) Nothing to Disclose
Keyanoosh Hosseinzadeh, MD, Winston-Salem, NC (Abstract Co-Author) Consultant, Bayer AG
PURPOSE
To determine sensitivity, specificity and accuracy of unenhanced MRI in detecting malignant lesions in end stage renal failure
patients with acquired renal cystic disease (ARCD). To assess added value of diffusion weighted imaging (DWI) in characterizing
lesions. To identify MRI features associated with malignant lesions.
Unenhanced renal MRIs of 55 patients with ARCD were retrospectively reviewed in consensus by two blinded radiologists. Lesions
less than 1 cm were excluded. Lesions were scored based on size, T1 and T2 signal, homogeneity, hemosiderin, and DWI on a 5
point scale: 1 as definitely benign, 2 as probably benign, 3 as indeterminate, 4 as probably malignant and 5 as definitely malignant.
Preliminary scoring was performed without DWI and repeated with DWI. Scores 1-2 were grouped as benign and 3-5 as
malignant.Sensitivity, specificity and accuracy of diagnosis was calculated by comparing to nephrectomy samples performed within
6 months of the MRI in 40 patients and five year imaging and clinical follow up in 15 patients. Stability over a 5 year period was
deemed benign. Chi square test assessed the imaging features. Scores were renumbered to a 3-level confidence score: 0,
indeterminate; 1, probably benign and malignant; 2, definitely benign and malignant, and a paired t-test was performed to compare
confidense levels.
RESULTS
There were 26 cysts (8 nephrectomy, 18 imaging follow up) and 34 solid lesions including 1 urothelial carcinoma, 2 oncocytomas
and 31 renal cell carcinomas. Lesion size ranged from 1-17cm.MRI features suggestive of malignancy included T1 iso or
hyperintensity (p=0.0003), T1 heterogeneity (p=0.0037), T2 heterogeneity (p=0.0092), and presence of hemosiderin (p=0.0034).
The sensitively, specificity and accuracy for preliminary diagnosis versus final diagnosis using DWI were 82, 69, 77 and 82, 73, 78
respectively. The area under the receiver operator curve for the diagnosis with DWI was 0.8512. The addition of DWI resulted in an
increase of the confidence score (p=0.001).
CONCLUSION
Unenhanced renal MRI is an accurate modality in characterizing lesions in ARCD. DWI can increase the confidence for the diagnosis
of malignant renal lesions. T1 iso and hyperintensity, T1 and T2 signal heterogeneity and the presence of hemosiderin are
associated with malignant lesions.
Unenhanced renal MRI is accurate in the detection of malignant lesions in ARCD.
SSQ09-08
Impact of Imaging and Histological Findings on the Prognosis of xp-11 Translocation Renal Cell
Cancer
Participants
Pauley T. Gasparis, MD, Indianapolis, IN (Presenter) Nothing to Disclose
Kevin A. Parikh, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
Kunal B. Gala, MBBS, MD, Mumbai, India (Abstract Co-Author) Nothing to Disclose
Clinton D. Bahler, MD, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
Chandru P. Sundaram, Indianapolis, IN (Abstract Co-Author) Nothing to Disclose
PURPOSE
Xp11 translocation renal cell cancer (Xp11RCC) is an uncommon RCC (<1%) in the general population but accounts for 30% of RCC
presenting under the age of 18 years. We wanted to identify imaging features at presentation and histological findings of the
resected tumor that predicted overall survival (OS), progression-free survival (PFS), and the occurrence of local and distant
metastases.
Retrospective review of pathology database from Jan 2001 to Mar 2015 revealed 22 cases with Xp11RCC. Imaging findings at
presentation were available in 18 of these cases. Detailed analysis of imaging findings for tumor size, calyceal invasion, necrosis,
hemorrhage, exophytic growth, presence of local or distant metastases at presentation were recorded. Pathological findings
including T-staging, margin positivity, Fuhrman grade and immunostain positivity were recorded. Clinical and imaging databases were
used to determine OS, and PFS. Multivariate regression analysis and Kaplan-Meier survival statistics were performed.
RESULTS
Mean age at surgery was 40.2 (range 10-83) years. 15 of 22 patients were over 18 years. 1-, 2- and 3-year survivals were 88%,
79%, and 73% respectively. On CT / MRI, the majority of tumors enhanced to a lesser degree than adjacent cortex (13/18), were
heterogeneous (11/18) and exophytic (14/18). Necrosis was seen in 5 tumors and correlated with larger tumor size (p<0.01), while
calyceal invasion (seen in 6 tumors) did not (p=0.07). On multivariate logistic regression analysis, PFS correlated only with Fuhrman
grade (p=0.04) and calyceal invasion (p=0.05) and recurrence of metastatic disease correlated only with initial tumor size (p=0.05).
Age and gender at presentation, tumor heterogeneity, and necrosis did not correlate with prognosis. On analysis of overall survival,
tumors > 5 cm had a substantially worse outcome than those < 5 cm (log rank test, Chi Square 6.73, p<0.01).
CONCLUSION
For staging scans of Xp11RCC, radiologists should assess tumor size and calyceal invasion as these have the most impact on
survival. Unlike previous studies, we did not find younger patients to have better clinical outcomes.
Calyceal invasion by tumor and tumor size > 5cm predict adverse outcome in Xp11 RCC.
Honored Educators
SSQ09-09
How Does the Surrounding Background Fat Affect Enhancement of Exophytic Renal Lesions? A
Phantom Study
Participants
Adeel R. Seyal, MD, Chicago, IL (Presenter) Grant, Siemens AG
Atilla Arslanoglu, MD, Chicago, IL (Abstract Co-Author) Grant, Siemens AG
Faezeh Sodagari, MD, Chicago, IL (Abstract Co-Author) Grant, Siemens AG
Yuri Velichko, PhD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Paul Nikolaidis, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
Vahid Yaghmai, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the effect of surrounding tissue composition on renal lesion enhancement at multidetector computed tomography.
Two phantoms (A and B) simulating renal lesions were constructed with 15 test tubes (1.5 cm in diameter) each. For phantom A,
the tubes were embedded in fat (-90 HU); and for phantom B, the tubes were embedded in agar gel (neutral medium; 7.3HU). The
tubes were filled with a serial dilution of iodinated contrast [iohexol (300mg/mL)]. Both phantoms were scanned twice using a 64slice scanner at 120kVp and constant 150mAs. Attenuation was calculated by a centrally placed region-of-interest within each test
tube and the surrounding medium and averaged over five slices for each acquisition. Mean of measurements from both acquisitions
were used for analysis. The amount of contrast needed to attain an enhancement of 10HU and 20HU were determined. Regression,
paired t and Wilcoxon signed rank tests were used for analysis.
RESULTS
Iodine concentration of 0.285 and 0.675 mg/mL resulted in enhancement of 10 HU and 20 HU, respectively, for a lesion surrounded
by fat and 7.3 HU and 16.62 HU when lesion surrounded by neutral medium. At any given iodine concentration, the contrast
enhancement was significantly greater for a lesion surrounded by fat when compared with the lesion surrounded by neurtal medium
(P<0.0001).
CONCLUSION
A renal mass surrounded by fat tends to show greater enhancement compared with one surrounded by a neutral medium.
Thresholds for enhancement may be different for renal lesions surrounded by fat when compared to intraparenchymal or partially
exophytic lesions.
Honored Educators
SSQ10
Genitourinary (Benign and Malignant Gynecological Diseases)
GU
MR
Participants
Harris L. Cohen, MD, Memphis, TN (Moderator) Nothing to Disclose
Mindy M. Horrow, MD, Philadelphia, PA (Moderator) Spouse, Director, Merck & Co, Inc
Sub-Events
SSQ10-01
Fractal Analysis of the Leiomyoma before Uterine Artery Embolization Using Contrast-Enhanced MRI
and Its Effect on the Outcome
Participants
Nagy N. Naguib, MD, MSc, Frankfurt Am Main, Germany (Presenter) Nothing to Disclose
Nour-Eldin A. Nour-Eldin, MD,PhD, Frankfurt Am Main, Germany (Abstract Co-Author) Nothing to Disclose
Tatjana Gruber-Rouh, Frankfurt Am Main, Germany (Abstract Co-Author) Nothing to Disclose
Thomas Lehnert, MD, Frankfurt Am Main, Germany (Abstract Co-Author) Nothing to Disclose
Renate M. Hammerstingl, MD, Frankfurt Am Main, Germany (Abstract Co-Author) Nothing to Disclose
Stefan Zangos, MD, Frankfurt Am Main, Germany (Abstract Co-Author) Nothing to Disclose
Thomas J. Vogl, MD, PhD, Frankfurt, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
To test whether fractal analysis of the leiomyoma using contrast-enhanced MRI correlates with the leiomyoma volume before and
after uterine artery embolization (UAE) and with the percentage change at 3 month follow-up enabling its usage as a prognostic
factor for treatment success.
The study was retrospectively performed on 33 females (Mean Age: 44.85 +/- 3.95) with 64 leiomyomas. For fractal analysis; MRI
images were exported and converted into 8-Bit greyscale images. The greyscale images were then loaded into the computer
program ImageJ and analysis was performed using the FracLac plugin. The analysis was performed using the differential-boxcounting method at 12 different grid positions. The Mean Fractal dimension for each leiomyoma was calculated by drawing a ROI
around each leiomyoma. On the other hand the volume of each leiomyoma was calculated before and 3 months after UAE using
contrast-enhanced MRI. The correlation between the mean Fractal dimension of each leiomyoma and its volume before and after
UAE as well as the percentage change in leiomyoma volume was tested for statistical significance using Spearman-Rank Correlation
test.
RESULTS
The mean Fractal Dimension of all leiomyomas was 1.0622 +/- 0.1472 (Range: 0.74 - 1.31). The mean leiomyoma volume before
UAE was 97.38 ml +/- 160.86 (Range: 1.65 - 987.34). At follow-up the mean leiomyoma volume was 68.08 ml +/- 138.3 (Range:
0.15 - 875.05). The mean percentage volume change at follow-up was 52.54% [reduction] +/- 26.99 (Range: 40.05%[increase] 96.57%[reduction]). A statistically significant strong positive correlation between the mean fractal dimension of each leiomyoma
and its volume before and after UAE was observed (rho = 0.77, p<0.0001 and rho = 0.78, p<0.0001 respectively). A statistically
significant strong negative correlation between the mean fractal dimension of each leiomyoma and its percentage volume change at
3 month follow-up was noted (rho = -0.68, p<0.0001).
CONCLUSION
The smaller the mean fractal dimension of a leiomyoma before UAE the higher will be the percentage volume reduction at 3 month
follow-up after UAE.
Leiomyomas with low mean fractal dimension tend to have a significantly better response at 3 month follow-up following UAE.
Hence fractal dimension can be used as a prognostic factor for patient selection.
SSQ10-02
Color Doppler Evaluation Of Utero-Ovarian Circulation In Polycystic Ovarian Syndrome and Its
Correlation With Hormonal and Biochemical Parameters
Participants
Shivi Jain, MD, Varanasi, India (Presenter) Nothing to Disclose
Akanksha Singh, MD, Varanasi, India (Abstract Co-Author) Nothing to Disclose
Madhu Jain, MD, Varanasi, India (Abstract Co-Author) Nothing to Disclose
Ram C. Shukla, MD, MBBS, Varansi, India (Abstract Co-Author) Nothing to Disclose
Ashish Verma, MBBS,MD, Varanasi, India (Abstract Co-Author) Nothing to Disclose
Arvind Srivastava, Varanasi, India (Abstract Co-Author) Nothing to Disclose
PURPOSE
To find out the variations in utero-ovarian circulation and their association with various endocrinal and biochemical parameters in
women with Polycystic Ovarian Syndrome (PCOS).
65 patients of reproductive age group who had clinical and biochemical findings suggestive of PCOS by Rotterdam criteria (2003)
were selected for TVS with Color Doppler study in early follicular phase (3rd-5th day of menstrual cycle). 58 age-matched women
with normal clinical and biochemical parameters were taken as controls. The RI (Resistance Index), PI (Pulsatility Index) and PSV
(Peak Systolic Velocity) of ovarian stromal and uterine arteries were assessed after the estimation of LH, LH: FSH ratio, free
testosterone level, fasting Insulin level and fasting glucose:insulin ratio.
RESULTS
The mean value of LH, LH: FSH, free testosterone and fasting glucose:insulin ratio was significantly higher (p<0.001) in PCOS
patients in comparison to control (LH 7.95 ± 1.34 vs 5.60 ± 0.51; LH: FSH=1.93 ± 0.17 vs 1.16 ± 0.22; free testosterone 3.63 ±
0.40 vs 1.71 ± 0.31; fasting glucose:insulin ratio 4.0 ± 0.60 vs 7.51 ± 0.49). The mean ovarian stromal RI, PI and PSV in PCOS was
significantly lower (p<0.001) as compared to control (0.43 ± 0.08, 0.58 ± 0.10, 11.41 ± 2.53 vs 0.79 ± 0.21, 0.86 ± 0.03, 9.40 ±
0.73 respectively). Similarly, uterine artery PI was significantly higher (p<0.001) in PCOS when compared to control (3.05 ± 0.45 vs
2.43 ± 0.31). There was significantly negative correlation of ovarian stromal RI with serum LH: FSH ratio(r=0.617.p< 0.01). The
Uterine artery PI positively correlated with LH: FSH ratio(r=0.548, p<0.01), free testosterone (r=0.532, p< 0.01), fasting
Insulin(r=0.414, p< 0.01), fasting glucose:insulin ratio (r=0.484, p<0.01) and inversely with ovarian stromal RI (r=0.410, p<0.01).
CONCLUSION
Hormonal dysfunction is responsible for hemodynamic changes in utero-ovarian circulation in patients with PCOS. Ultrasonography
along with color Doppler plays a significant role in the diagnosis and monitoring of Polycystic Ovarian Syndrome.
The decreased PSV and increased PI and RI of uterine artery may explain recurrent early abortions in PCOS. Significant negative
correlation between ovarian stromal RI and LH: FSH ratio confirms hormonal dysfunction.
SSQ10-03
Contrast Enhanced 3D STIR T2-Weighted SPACE in Evaluating Sacral Nerve Plexus in Pelvic
Endometriosis: Compared with Conventional 2D Sequence
Participants
Xiaoling Zhang, Guangzhou, China (Presenter) Nothing to Disclose
Meizhi Li, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Jian Guan, MD, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Mingjuan Liu, MMEd, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Shurong Li, GuangZhou, China (Abstract Co-Author) Nothing to Disclose
Yan Guo, MD, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Huanjun Wang, MD, GuangZhou, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To prospectively evaluate microstructural abnormalities in sacral nerve plexus in women with pelvic endometriosis at 3.0T MRI.
Twenty women with clinically diagnosed pelvic endometriosis and 20 age-matched healthy women were enrolled in this study. In
addition to conventional coronal 2D T2WI TSE imaging, contrast enhanced coronal 3D STIR T2-weighted SPACE was obtained to
produce multiplanar (MPR) images. All examinations were assessed independently by two radiologists for the infiltration of the sacral
plexus by endometriotic lesions and the abnormal anatomical features of the sacral plexus. Agreement between 2D- and 3Dsequences and inter-observer-agreement was evaluated using kappa-statistics.
RESULTS
The sacral nerve roots in healthy subjects and patients were clearly visualized on both sequences. The diameter of the sacral
nerve roots in patients was larger than in the control group. Most of the patients with endometriosis displayed local thickening or
indistinction in the fibers of sacral plexus. There were no significant difference between the results of the 2 radiologists (F=2.563,
P=0.086). Contrast enhanced 3D STIR T2-weighted SPACE was preferable in evaluating sacral nerve plexus in pelvic endometriosis
than regular 2D sequences.
CONCLUSION
Changes of the microarchitecture of the sacral nerve plexus were revealled in the patients with pelvic endometriosis on MRI.
Contrast enhanced 3D STIR T2-weighted SPACE can display the infiltration of scaral nerve fibers by endometriotic lesions and the
abnormal anatomical features of scaral nerve plexus.
Contrast enhanced 3D STIR T2-weighted SPACE was applied as a method of magnetic resonance neurography to reveal the
correlation between the changes of scracal plexus and chronic pelvic pain in patients with pelvic endometriosis .
SSQ10-04
MRI-US Fusion Imaging in Real-Time Virtual Sonography for the Evaluation of Pelvic Endometriosis:
Preliminary Study
Participants
Maria Eleonora Sergi, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Federica Capozza, Rome, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
Real-time virtual sonography (RVS) is a new technique that uses magnetic navigation and computer software for the synchronized
display of real-time US and multiplanar reconstruction MRI images. The purpose of this study was to evaluate the feasibility and
ability of RVS to detect pelvic endometriosis.
This study was conducted over a two-month period in march-april 2015 on 25 patients referred for a Clinical and US suspect of
endometriosis. Patients underwent pelvic MRI at 3 T and fusion imaging was offered (Hitachi HI Vision Ascendus) . The MRI image
dataset acquired at the time of the examination was loaded into the fusion system and displayed together with the US image on
the same monitor. Both sets of images were then manually synchronized and image were registered using multiple planes MR
imaging.
RESULTS
2patients had endometriosis of the vescico-uterine pouch, with urinary symptoms associated.7patients had endometriosis of the
middle compartment mainly shown as ovarian endometriomas in 6 cases and adenomyosis in 3 cases.19had signs of endometriotic
implants in the posterior compartment shown as fibrotic plaque over the serosal surface of the uterus and rectum in 12 cases. In 1
case there was a deep infiltrating intestinal endometriosis over the rectum. A retroflexed uterus was associated in 6 cases. 6 cases
showed fibrotic strands between the uterus and the rectum with thickening of the uterosacral ligaments.Regarding endometriosis of
the medial compartment, there was an overlap of data of 100% between MRI and RVS, both appearing superior to a standard US
evaluation.Endometriosis of the vescico-uterine pouch was better visualized in MRI.Fibrotic strand were displayed in both methods
with an overlap of 100%; on the contrary, relying on RVS it was more difficult to differentiate between active plaque and
predominantly fibrotic plaque because of the difficulty in visualizing the hemorrhagic foci. However the infiltration of the bowel wall
was better undressed in RVS.
CONCLUSION
Thanks to information from both US and MRI, fusion imaging allows better identification of the pelvic implants, superior to the
standard US evaluation.
Thanks to information from both US and MRI, fusion imaging allows better identification of the pelvic implants, superior to the
standard US evaluation.
SSQ10-05
Diagnostic Value of MR Imaging to Diagnose Adnexal Torsion
Participants
Sophie Beranger-Gibert, Paris, France (Abstract Co-Author) Nothing to Disclose
Hajer Sakly, Paris, France (Abstract Co-Author) Nothing to Disclose
Marcos Ballester, MD, Paris, France (Abstract Co-Author) Nothing to Disclose
Marie Bornes, Paris, France (Abstract Co-Author) Nothing to Disclose
Marc J. Bazot, MD, Paris, France (Abstract Co-Author) Nothing to Disclose
Emile Darai, Paris, France (Abstract Co-Author) Nothing to Disclose
Medical
PURPOSE
To retrospectively evaluate the diagnostic performance of MR imaging for the diagnosis of adnexal torsion (AT) in a series of
patients with an equivocal adnexal mass at ultrasonography in a context of acute or sub acute pelvic pain.
Our institutional ethics committee approved the study and granted a waiver of informed consent. All patients with acute or subacute pelvic pain undergoing MR exam for the exploration of an equivocal adnexal mass (January 2007 to December 2012) with
surgical exploration or clinical and radiological follow up at least of 3 months were retrospectively included (n=58). Three
radiologists blinded to the clinical, ultrasonographic and surgical data retrospectively and independently reviewed MR images.
Features associated with AT were identified using univariate and recursive partitioning multivariate analysis.
RESULTS
Twenty-two patients (38%) had a diagnosis of AT. The accuracy of MR image interpretation by each reader was 83.8% (26/31),
90.3% (28/31), 83.8% (26/31) in a context of acute pelvic pain and 92.5% (25/27), 88,8% (24/27), 81.5% (22/27) in a context of
sub acute pelvic pain for reader 1, 2 and 3 respectively. On multivariate analysis, whirlpool sign (OR=6.5 [1.36-31], p=0.01) and a
thickened tube (OR=8.2 [1.2-56.8], p=0.03) were associated with adnexal torsion, with substantial inter-reader agreement (kappa
0.71-0.84, and 0.82-0.86, respectively). The presence of adnexal hemorrhagic content helps to predict ovarian viability (p=0.009)
CONCLUSION
MR imaging is an accurate technique for the diagnosis of adnexal torsion in the setting of patients with adnexal mass having acute
or sub acute pelvic pain.
MR imaging is an accurate second line technique to diagnose adnexal torsion without any pelvic irradiation with the ability to predict
ovarian viability without any gadolinium injection.
SSQ10-06
Can Diffusion-weighted MR Imaging Differentiate Uterine Sarcomas from Leiomyomas?
Participants
PURPOSE
Differentiation uterine sarcoma from leiomyoma is a major challenge. The aim of this study was to investigate the utility of diffusionweighted imaging (DWI) in differentiating uterine sarcomas from leiomyomas.
Between January 2010 and August 2014, 188 patients with surgically confirmed 38 uterine sarcomas (16 leiomyosarcomas, 12
malignant mixed Mullerian tumors, 9 endometrial stromal sarcomas, and 1 undifferentiated pleomorphic sarcoma) and 150 leiomyomas
were enrolled in this retrospective study. All patients underwent preoperative routine pelvic MR imaging at 3T, including DWI. DWI
was obtained using a STIR single-shot echo-planar imaging technique with background suppression (b= 0 and 1000 s/mm2). The
apparent diffusion coefficient (ADC) and signal intensity on T2-weighted imaging (T2SI) were calculated in the tumors, normal
myometrium and gluteus muscle. In the differentiation of sarcomas from leiomyomas, various parameters (ADC, diffusion restriction,
tumor-myometrium or gluteus muscle contrast ratio [TCRm or TCRg] on T2-weighted imaging, necrosis, hemorrhage, and size) were
evaluated.
RESULTS
The mean ADC values of sarcomas (0.939 ± 0.253) were statistically lower than those of leiomyomas (1.347 ± 0.327 × 10-3mm2) (
p < 0.001). For differentiating sarcomas from leiomyomas, the parameters including diffusion restriction, T2SI, TCRm, TCRg, necrosis
and hemorrhage were statistically significant (all p -values < 0.001). At receiver operating characteristics curve analysis, the area
under the curves of diffusion restriction and ADC in differentiating sarcomas from leiomyomas were 0.902 and 0.860, respectively
and were statistically greater than other parameters (TCRm, TCRg, necrosis, hemorrhage and size) ( p < 0.05): with a cutoff ADC
value of 1.111 × 10-3mm2, the sensitivity and specificity were 79% and 80%, respectively. For the degree of diffusion restriction,
sarcomas showed moderate or strong in 97% (37/38), while leiomyomas revealed absent or mild in 69% (104/150).
CONCLUSION
DWI at 3T may be a useful technique for the differentiation of uterine sarcomas from leiomyomas.
As a noninvasive technique, preoperative DWI at 3T can be used to predict sarcomas in patients with uterine myometrial masses,
which may give potential for planning treatment strategies.
SSQ10-07
Variations in Reporting Recommendations for Son Graphically Evaluated Endometrial Stripe in Post
Menopausal Bleeding in a Subspeciality Practice
Participants
Aoife Kilcoyne, MBBCh, Boston, MA (Presenter) Nothing to Disclose
Avinash R. Kambadakone, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Colin J. McCarthy, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Giles W. Boland, MD, Boston, MA (Abstract Co-Author) Principal, Radiology Consulting Group; Royalties, Reed Elsevier
Susanna I. Lee, MD, PhD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Debra A. Gervais, MD, Chestnut Hill, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
Endometrial cancer is the most common gynecologic cancer in the United States. Early diagnosis and intervention is imperative to
improve prognosis and survival. In the setting of postmenopausal vaginal bleeding (PMB), sonographically determined endometrial
stripe thickness is an established criteria for predicting risk of cancer and thereby serving as a guide to trigger endometrial
sampling. Current guidelines recommend tissue sampling for endometrial stripe measuring >5mm, however, there is limited data on
adherence to these guidelines. The purpose of this study was to evaluate the variability in reporting recommendations for
sonographically determined endometrial stripe thickness measuring 5mm in patients with PMB at a subspecialty practice in an
academic teaching institution.
In this ongoing study, we performed a review of the 'RENDER' radiology database to identify pelvic ultrasound exams performed on
women aged 18-80years between January 1st 2009 and December 31st 2014 for evaluation of PMB. Using natural language
processing, the radiology reports of these exams were then analysed for endometrial stripe thickness, reporting patterns in the
body, impression of radiology report and the recommendations, if any. The search terms used for the focused search included
'endometrial stripe', '5mm', 'postmenopausal'. The variations in the reporting recommendations based on the endometrial stripe
thickness were then evaluated.
RESULTS
Of the 253 reports reviewed, 58 (24.6%) were not relevant - the search identified patients with an endometrial stripe of greater or
less than 5mm. In 74 reports (29.2%), no recommendation was made. In 73 reports (28.8%), endometrial biopsy was recommended.
Other recommendations included: biopsy or imaging 14 (6%), no intervention 11 (4%), further imaging 8 (3%), gynaecology review
4 (2%), gynaecology review and biopsy 4 (2%), follow-up imaging 2 (1%).
CONCLUSION
In a subspecialty abdominal imaging practice at an academic institution, considerable variation exists on the reporting
recommendation for evaluation of PMB with endometrial stripe thickness measuring 5mm with only 30% of reports adhering to
established guidelines.
The findings of this study highlight the need for development of standardised approaches/tools to bring about clarity in terms of
management options/further investigation of abnormal endometrial thickening in the setting of postmenopausal bleeding.
Honored Educators
Debra A. Gervais, MD - 2012 Honored Educator
Susanna I. Lee, MD, PhD - 2013 Honored Educator
SSQ10-08
Cystic Adnexal Lesions Analyzed by International Ovarian Tumor Analysis (IOTA) Criteria in Routine
Clinical Practice
Participants
Claire E. Beaumont, MD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Jessica B. Robbins, MD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Mark A. Kliewer, MD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Lisa Barroilhet, MD, Madison, WI (Abstract Co-Author) Nothing to Disclose
Laura Huffman, MD, Madison, WI (Abstract Co-Author) Nothing to Disclose
GlaxoSmithKline plc
PURPOSE
The simple rules developed by the IOTA group direct management of adnexal cysts based on sonographic imaging features. The
diagnostic performance of these criteria in routine practice has not been formally evaluated since the original study was published
in 2010. The goal of our research is to determine how well the IOTA simple rules criteria perform in stratifying cystic lesions and
detecting ovarian cancer in routine radiology practice.
Patient consent was waived for this IRB approved retrospective review of transvaginal US studies on non-pregnant post-menarchal
women performed between January-March 2011. Adnexal cysts larger than 3 cm were evaluated according to the IOTA rules. The
incidence of benign adnexal lesions, borderline tumors and ovarian carcinoma was calculated. Surgical pathology, resolution on
follow-up imaging and/or normal gynecological pelvic examination at 2 years were the accepted end points.
RESULTS
108 lesions in 104 women met inclusion criteria. Mean age=41±14 years; range=13-84. 3 lesions (2.8%) met simple rule 1
(malignant): 30% (1/3) were cystadenomas and 30% (1/3) carcinoma, with no borderline tumors. 95 lesions (88%) met simple rule
2 (benign): 10.5% (10/95) were benign ovarian neoplasms (dermoids=2; cystadenomas=8), with no borderline tumors or
carcinomas. 10 lesions (9.2%) met simple rule 3 (indeterminate): 20% (2/10) were benign ovarian neoplasms, 20% (2/10) borderline
tumors, and 10% (1/10) carcinoma. Thus, the IOTA rules gave a definitive (non-indeterminate) result in 98/108 (90.7%) of cases
and correctly triaged 100% of borderline and malignant neoplasms either to further imaging evaluation or surgery.
CONCLUSION
The results of this pilot study indicate that the IOTA rules successfully detect borderline and malignant neoplasms. However, the
vast majority of lesions in routine practice are benign in both sonographic appearance and clinical behavior. Full and nuanced
evaluation of diagnostic performance in routine clinical practice will require a larger number of cancers, to be evaluated in our
ongoing research.
The IOTA simple rules were able to detect borderline and malignant ovarian neoplasms in our clinical practice and aided in directing
women with such lesions to oncologic specialists.
Honored Educators
SSQ10-09
MR Imaging and Semi-automated Texture analysis for Differentiating Atypical Appearing Uterine
Leiomyomas from Leiomyosarcomas
Participants
Yuliya Lakhman, MD, New York, NY (Presenter) Nothing to Disclose
Joshua L. Chaim, DO, New York, NY (Abstract Co-Author) Nothing to Disclose
Harini Veeraraghavan, New York, NY (Abstract Co-Author) Nothing to Disclose
Diana S. Feier, MD, Cluj-Napoca, Romania (Abstract Co-Author) Nothing to Disclose
Robert Soslow, New York, NY (Abstract Co-Author) Nothing to Disclose
Nadeem Abu-Rustum, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate whether qualitative magnetic resonance (MR) imaging features and texture analysis (TA) can distinguish between
atypical appearing uterine leiomyomas (ALM) and leiomyosarcomas (LMS)
Forty-one women with ALM (n=22) or LMS (n=19) at histopathology and MRI between January 1, 2007 and December 31, 2013
were included in this retrospective study. Two readers (R1 and R2), blinded to histopathologic diagnoses, independently evaluated
all cases. R2 manually segmented each tumor on axial T2-weighted image. Intensity based gray scale correlation matrix (GLCM)
textures and Gabor edge based GLCM textures were computed for each segmented tumor. Relationships between clinical
characteristics, imaging features, and histopathology were tested with Fisher's exact test. Each tumor was assigned a score of 0
to 4 based on the total number of most statistically significant features present. Diagnostic accuracy with exact 95% confidence
intervals was calculated for each feature and score. Texture features were analyzed with a random forest (RF) classifier to
automatically distinguish ALM from LMS. RF classifier was optimized by varying the number of decision trees and its performance
was tested with five-fold cross validation.
RESULTS
Nodular borders, hemorrhagic foci, "T2 dark" areas, and central (±peripheral) unenhanced area(s) were significant predictors of LMS
(p<0.0001 for each feature and reader). Sensitivity and specificity of each feature for LMS were 0.84/0.74 and 0.91/0.86 for
nodular borders, 0.95/1.0 and 0.82/0.95 for hemorrhagic foci, 0.84/0.79 and 0.86/0.86 for "T2 dark" areas, and 0.95/1.0 and
0.73/0.68 for central (±peripheral) unenhanced area(s) for R1/R2, respectively. When any 3 of these features were detected in a
lesion, the sensitivities and specificities were 1.0/0.95 and 0.95/1.0 for R1/R2, respectively. The best classification accuracy of
computer-generated image features was achieved with 25 decision trees (AUC=0.86, sensitivity=0.95, specificity=0.69). The Gabor
edge-based texture features were more relevant than the intensity based texture features for the classification.
CONCLUSION
Presence of certain qualitative MRI features can reliably distinguish ALM from LMS. Texture analysis as a semi-automated adjunct
may add certainty to the diagnosis of LMS.
MR imaging and semi-automated texture analysis are useful in distinguishing atypical appearing leiomyomas from leiomyosarcoma.
Honored Educators
MSRT54
ASRT@RSNA 2015: Renal and Urographic CT Imaging
Thursday, Dec. 3 11:45AM - 12:45PM Location: N230
GU
CT
Participants
Robert C. Chatelain, RT, Ottawa, ON (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To identify normal anatomy and its variants demonstrated by CT of the urinary system. 2) To explain the value of having specific
dedicated protocols for the renal and urographic imaging. 3) To differentiate renal and urographic pathologies by origin (congenital,
neoplastic, vascular etc.)
ABSTRACT
The urinary system is subject to a wide variety of pathological processes and anatomical variants. Fortunately, it lends itself well to
being imaged by a range of modalities. This presentation will focus on the imaging of the urinary system using Computed
Tomography (CT). Due to high spatial resolution, CT is an excellent tool to evaluate stones, masses, traumatic injuries and
infections. Non contrast CT is the procedure of choice to evaluate kidney stones. CT is also used to differentiate malignant from
nonmalignant renal masses, to evaluate the local spread of a renal malignancy and CT angiography (CTA) is an excellent tool to
define the anatomy of the renal arteries and veins.
GUS-THA
Genitourinary Thursday Poster Discussions
Thursday, Dec. 3 12:15PM - 12:45PM Location: GU/UR Community, Learning Center
GU
Participants
Sub-Events
GU246-SDTHA1
Volumetric Stone Burden Measurement by 3D Reconstruction on NCCT is not a more Accurate
Predictor of Stone Free Status after PCNL than 2D Stone Burden Measurements
Station #1
Participants
Brandon Nadeau, MD, London, ON (Presenter) Nothing to Disclose
Thomas Tailly, London, ON (Abstract Co-Author) Nothing to Disclose
Philippe Violette, London, ON (Abstract Co-Author) Nothing to Disclose
Yige Bao, London, ON (Abstract Co-Author) Nothing to Disclose
Justin Amann, MD, London, ON (Abstract Co-Author) Nothing to Disclose
Hassan Razvi, London, ON (Abstract Co-Author) Research Consultant, Olympus Corporation; Research Consultant, HistoSonics, Inc ;
Royalties, Cook Group Incorporated ; ; ;
John D. Denstedt, MD, London, ON (Abstract Co-Author) Royalties, Cook Group Incorporated
PURPOSE
Stone burden has been reported as an independent predictor of post-operative outcomes for percutaneous nephrolithotomy (PCNL).
We aimed to identify the optimal method for imaging quantification of stone burden to predict residual stone at 3 months post
percutaneous nephrolithotomy (PCNL).
We identified 246 patients from a prospective database of PCNL procedures performed at a single tertiary center between January
2006 and December 2013. Pre-operative stone burden was assessed by three different methods on reformatted coronal CT images:
1) estimated elliptical surface area (SA) calculated as longest perpendicular diameter * π /4; 2) manual surface area measurement
with digital calipers; 3) 3D volume rendering using automated CT software. SA's were reported in increments of 500mm². Logistic
regression, receiver operative characteristics (ROC) curve analysis and area under the curve (AUC) were used to evaluate the
predictive value of each method. Primary outcome was stone-free status (SFS) at discharge. Secondary outcomes included SFS at
3 months post-procedure, and operative time.
RESULTS
Our cohort had a mean age of 55.7 years, was 40.9% female and had an 19.2% incidence of residual stone. All measurement
methods accurately predicted stone-free status at discharge; OR1: 1.47, CI 1.16-1.86; OR2: 1.51, CI 1.12-2.05, OR3: 1.20, CI:
1.04-1.38 respectively. Areas under the curve of ROC analysis were 0.661, 0.658 and 0.662 respectively, demonstrating almost
equivalent predictive value of each measurement method. Similar results were seen for predicting stone-free rate at 3 months postprocedure.
CONCLUSION
Our results indicate that the use of complex techniques to measure pre-operative stone burden on CT including manually-derived
surface area or 3D volumetric reformations provide no added value in predicting post-operative outcomes for PCNL when compared
to traditional 2D measurements based on maximum diameter.
Volumetric measurement of renal stone burden on CT by automated 3D rendering provides no added value in predicting operative
outcomes for percutaneous nephrolithotomy compared to traditional 2D measurements.
GU248-SDTHA3
Detecting the Main Composition of Urinary Stones with Dual-source Dual-energy Computed
Tomography in Vivo
Station #3
Participants
Gu Mu Yang Zhang, MD, Beijing, China (Presenter) Nothing to Disclose
Hao Sun, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Huadan Xue, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
Zheng Yu Jin, MD, Beijing, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the accuracy of dual-source dual-energy computed tomography (DSDECT) in predicting the main composition of urinary
calculi in vivo
Patients with suspected urolithiasis from March of 2014 to Februrary of 2015 underwent DSDECT for urinary stone composition
analysis before percutaneous nephrolithotomy or ureterorenoscopy. All patients were scanned by DSDECT using the dual-energy
renal stone protocol. Material-specific chromatic images were made using dedicated post-processing software. Two radiologists
interpreted the images and analyzed the composition of stones independently. The final determination of the composition of stones
was made by fourier transform infrared spectrometry postoperatively. The accuracy of DSDECT in evaluating stone composition was
analyzed.
RESULTS
A total of 81 urinary calculi from 67 patients(50 male, 17 female, mean age: 50 years) were included in this study. There are 43
stones with single composition (uric acid n=5, cystine n=2, hydroxylapatite n=5, calcium oxalate n=31) and 38 stones with mixed
composition(uric acid/calcium oxalate n=4, cystine/hydroxylapatite n=1, calcium oxalate/hydroxylapatite n=33). The accuracy for
detecting uric acid, cystine, hydroxylapatite and calcium oxalate were 77.8%(7/9), 100%(3/3), 97.4%(38/39) and 98.5%(67/68).
As for detecting the main composition of stones, DSECT correctly identified 7 of the 9 calculi mainly composed of uric acid and all
the rest of 64 calculi mainly composed of calcium oxalate, 3 calculi mainly composed of cystine and 5 calculi mainly composed of
hydroxylapatite. The overall accuracy of DSDECT in predicting the main composition of stones was 97.5%(79/81).
CONCLUSION
DSDECT could accurately distinguish the four stone composition and accurately predict the main composition of urinary calculi.
DSDECT could facilitate the optimization of clinical management of urolithiasis by accuratley predicting the main composition of
stones in vivo
GU235-SDTHA6
Prostate Imaging Reporting and Data System Version 2 Improves Diagnostic Performance of
Multiparametric MR Imaging of the Prostate for Experienced and Unexperienced Reader
Station #6
Participants
Moritz Kasel-Seibert, Jena, Germany (Presenter) Nothing to Disclose
Rene Aschenbach, MD, Jena, Germany (Abstract Co-Author) Nothing to Disclose
Marcus Horstmann, Jena, Germany (Abstract Co-Author) Nothing to Disclose
Marc-Oliver Grimm, Jena, Germany (Abstract Co-Author) Nothing to Disclose
Ulf K. Teichgraeber, MD, Jena, Germany (Abstract Co-Author) Research Consultant, W. L. Gore & Associates, Inc; Research
Consultant, Siemens AG; Research Consultant, CeloNova BioSciences, Inc ; Research Consultant, General Electric Company;
Tobias Franiel, Jena, Germany (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study evaluates the diagnostic performance of the multiparametric magnetic resonance imaging (mpMRI) based Prostate
Imaging Reporting and Data System (PI-RADS) version 2, in comparison to version 1.
138 lesions in 82 consecutive patients with elevated PSA and at least one negative transrectal ultrasound guided systematic biopsy
were retrospectively evaluated and scored according to PI-RADS V1 and V2 by an experienced and unexperienced blinded reader.
All patients underwent endorectal mpMRI (T2-weighted imaging + diffusion weighted imaging + dynamic contrast enhanced MRI) at
1.5T. Results of targeted in-bore MRI guided biopsy were used as reference standard. Diagnostic parameters were calculated on a
per lesion basis.
RESULTS
For the experienced reader scoring with PI-RADS V2 and a threshold of ≥ 4 increased specificity (0.81 vs. 0.67), positive predictive
value (0.63 vs. 0.48) and negative predictive value (0.90 vs. 0.88) while maintaining sensitivity of 0.77 in comparison to PI-RADS
V1. For the unexperienced reader all diagnostic parameters improved respectively as follows: sensitivity 0.79 vs. 0.67, specificity
0.78 vs 0.68, positive predictive value 0.60 vs. 0.46, negative predictive value 0.90 vs. 0.84. The use of PI-RADS V2 with a
threshold of ≥ 3 resulted in 39 more lesions for the experienced and 9 more lesions for the unexperienced reader which would have
been correctly classified as benign. Inter-reader agreement improved for PI-RADS V2 (κ=0.51) compared to V1 (κ=0.25).
CONCLUSION
PI-RADS V2 compared to PI-RADS V1 led to an improvement of diagnostic parameters. Inter-reader agreement between
experienced and unexperienced reader increased from fair to moderate.
PI-RADS V2 compared to V1 improves diagnostic accuracy for the detection of prostate cancer while higher inter-reader reliability
suggests a more replicable and understandable reporting system.
UR133-EDTHA7
Scrotal Ultrasound versus MRI: The Ball is in your Court
Station #7
Awards
Participants
Ian Mills, MD, New Haven, CT (Presenter) Nothing to Disclose
Steffen Huber, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Magnetic resonance (MR) interpretation of scrotal pathology can present a unique challenge for the unintiated, particularly since
ultrasound (US) is often the first, and many times the only, imaging study that is required. Nevertheless, MR imaging is useful in this
setting, potentially serving as a problem solving tool for indeterminate lesions seen on US. The purpose of this exhibit is to
showcase the MR imaging appearance of a variety of neoplastic and non-neoplastic conditions of the scrotum. Specific imaging
features which facilitate differentiation of these conditions will be discussed and MR/US imaging correlatation will be emphasized.
MRI technique and indications Normal anatomy Non-neoplastic conditions Epididymo-orchitis (including TB) Testicular hematoma
Tubular ectasia of the rete testis Polyorchidism Cryptorchidism Hydrocele, hematocele/pyocele Epididymal cyst, spermatocele Focal
testicular infarct Adrenal rests Testicular prosthesis Extra-testicular lipoma Inguinal hernia Neoplastic conditions Seminoma Mixed
germ cell tumor Lymphoma Adenomatoid tumor of the epididymis Spermatic cord sarcoma Summary/Conclusion
GUS-THB
Genitourinary Thursday Poster Discussions
Thursday, Dec. 3 12:45PM - 1:15PM Location: GU/UR Community, Learning Center
GU
FDA
Participants
Sub-Events
GU230-SDTHB1
Innovative Single Acquisition Split Bolus Dual Energy CT (SBDECT) Protocol for Comprehensive
Evaluation of Renal Masses: Preliminary Results of Prospective Randomized Trial
Station #1
Awards
Participants
Dinesh Manoharan, MBBS, New Delhi, India (Presenter) Nothing to Disclose
Sanjay Sharma, MD, FRCR, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Chandan J. Das, MD, MBBS, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Rajeev Kumar, MD,MChir, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Geetika Singh, MBBS, MD, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Pratik Kumar, MSc, PhD, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Arun K. Gupta, MBBS, MD, New Delhi, India (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the diagnostic accuracy of single acquisition SBDECT compared to standard triple phase MDCT in evaluation of
suspected renal masses.
The study was approved by institutional review board. Eighty consenting adults (>18y, 52M,28F) from April 2014 to March 2015,
with suspected renal mass(es) on ultrasound requiring further evaluation by CT were randomly assigned into two groups: single
acquisition SBDECT (n=41, Gp A) or standard triple phase MDCT (n=39, Gp B). Patients were scanned in Siemens Somaton Definition
Flash 2x128 slice scanner. Gp A protocol consisted of 40 ml iodinated IV contrast hand injected at 0s, 45ml @ 4ml/s at 820s and
60ml @ 3.5ml/s at 852s with single dual energy CT image acquisition after the end of third bolus. Gp A scan parameters tube
potential/ref mAs were 100kVp/230mAs and Sn140kVp/178mAs). In Gp B protocol, single energy CT images were acquired in non
contrast (0s), corticomedullary (28s), nephrographic (80s) and delayed (15min) phase. Histopathology /FU were used as the
reference standard. Two readers in consensus qualitatively rated vascular, parenchymal enhancement and urinary tract
opacification. Effective radiation dose was calculated.
RESULTS
Overall 169 masses (36 malignant, 133 benign) were analyzed in Gp A. All 36 malignant and 130/133 of benign masses (sens 100%,
spec 97.74%, PPV 92.31% , NPV 100%, Acc 98.22%) were correctly diagnosed. Three were false positive. In Gp B, total 93 masses
(28 malignant, 65 benign) were analyzed. It diagnosed correctly 26/28 malignant and 64/65 benign masses (sens 92.86%, spec
98.46%, PPV 96.29% and NPV 96.96%, Acc 96.72%). Two were false negative and one was false positive. Arterial and venous
enhancement was excellent in 88% and 86% respectively. Renal parenchymal enhancement was excellent in 69%. Intrarenal
collecting system and upper ureter showed complete opacification in 72%. Mean effective dose was 8.7 mSv and 23.9 mSv in Gp A
and Gp B respectively (p<0.05).
CONCLUSION
The accuracy of single acquisition SBDECT is comparable to the standard triple phase MDCT in characterizing renal masses. It is a
dose efficient protocol providing adequate image quality of renal parenchyma, vascular anatomy and pelvicalyceal system.
Proposed CT protocol can be effectively used for routine evaluation of renal masses with much lower radiation dose to a patient.
GU254-SDTHB3
Prostate Cancer: Correlation of Intravoxel Incoherent Motion MR Parameters with Gleason Score
Station #3
Participants
Dal Mo Yang, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Hyun Cheol Kim, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sang Won Kim, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Geon-Ho Jahng, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Ye Na Son, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Woo Jin Yang, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
PURPOSE
To evaluate the potential of IVIM imaging to predict histologic prognostic parameters by investigating whether IVIM parameters
correlate with Gleason score.
A total of 41 patients with histologically-proven prostate cancer who underwent prostate MR imaging using a 3T MRI machine were
included in this study. For the eight DWI b-values (0, 10, 20, 50, 100, 200, 500, and 800 sec/mm2), the spin-echo echo-planar
imaging (EPI) sequence was performed. The D, f, D*, and ADCfit values were compared between three different groups of prostate
cancer: Gleason score 6 (n = 9), Gleason score 7 (n = 16), and Gleason score 8 or higher (n = 16). Receiver operating
characteristic (ROC) curves were generated for D, f, D*, and ADCfit to assess the ability of each parameter to distinguish cancers
with low Gleason scores from cancers with intermediate or high Gleason scores.
RESULTS
Pearson's coefficient analysis revealed significant negative correlations between the Gleason score and ADCfit (r = -0.490, P =
0.001) and the Gleason score and D values (r = -0.514, P = 0.001). On the other hand, the Gleason score was poorly correlated
with the f (r = 0.168, P = 0.292) and D* values (r = -0.108, P = 0.500). The ADCfit and D values of prostate cancers with Gleason
scores of 7 or ³ 8 were significantly lower than those of prostate cancers with a Gleason score of 6 (P < 0.05). ROC curves were
constructed to assess the ability of the IVIM parameters to discriminate prostate cancers with a Gleason score of 6 from those
with Gleason scores of 7 or ³ 8. The areas under the curve (AUCs) ranged from 0.671 to 0.974. ADCfit and D yielded the highest Az
value (0.960-0.956), whereas f yielded the lowest Az value (0.633).
CONCLUSION
The pure molecular diffusion parameter, D, was the best IVIM parameter for discriminating prostate cancers with low Gleason scores
from prostate cancers with intermediate or high Gleason scores.
The accurate assessment of prostate cancer aggressiveness is important for deciding the most appropriate initial treatment
strategy. We believe Intravoxel incoherent motion (IVIM) imaging may provide information about tumor aggressiveness without
prostate biopsy determination.
GU255-SDTHB4
Characterization of Renal Masses in MR Reporting: Pathologic Correlation as Part of a Performance
Quality Review at an Academic Center
Station #4
Participants
Helen S. Xu, BA, Boston, MA (Presenter) Nothing to Disclose
Leo L. Tsai, MD, PhD, Boston, MA (Abstract Co-Author) Co-founder, Agile Devices Inc; Stockholder, Agile Devices Inc; Research
Consultant, Agile Devices Inc;
Eric U. Yee, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Maryellen R. Sun, MD, Boston, MA (Abstract Co-Author) Research Grant, Glaxo SmithKline plc
PURPOSE
To evaluate the accuracy of MR diagnosis of renal masses through retrospective review of MRI reports from an academic medical
center with pathologic correlation as gold standard.
A retrospective review of MRI reports from MR renal mass examinations performed at a single site was correlated with pathological
diagnosis. 100 renal masses were assessed with dedicated contrast-enhanced renal mass protocol MR examinations prior to
biopsy/surgical resection from August 2013-November 2014. All imaging was performed on-site and reported by abdominal imaging
radiologists with fellowship training in body MRI. Pathologic diagnoses included clear-cell renal cell carcinoma (ccRCC) (n=62),
papillary RCC (n=11), chromophobe RCC (n=6), RCC with papillary and oncocytic features (n=1), unclassified RCC (n=1),
oncocytoma (n=13), oncocytic neoplasm with papillary features (n=1), AML (n=4) and AML with papillary adenoma (n=1). The
leading diagnosis, differential diagnoses, and descriptors (such as T2 signal intensity and enhancement pattern) from the MR
reports were compared to the pathological diagnosis of each lesion.
RESULTS
The sensitivity and specificity of a primary MRI diagnosis of ccRCC was 83% and 58%, for papillary RCC 91% and 98%, and for
angiomyolipoma 75% and 99%, respectively. Only 8% of oncocytomas were primarily diagnosed on MRI, with the remainder
prospectively reported as likely ccRCC. No chromophobe RCC was the primary diagnosis on MRI, with only 1 (17%) included in the
differential. 50% of ccRCCs and 77% of oncocytomas were described as T2-hyperintense with 65% and 69% respectively having
enhancement similar-to or greater-than the renal cortex. 73% of papillary RCCs were described as T2-hypointense, and 73% were
hypoenhancing.
CONCLUSION
Papillary RCCs were diagnosed with the greatest accuracy, likely due to its unique MR characteristics. Lower specificity for ccRCC is
due in part to overlap of MR characteristics with other lesions, posing a particular diagnostic challenge for less-common lesions
such as oncocytomas and chromophobe RCC.
While MRI can accurately diagnose many renal masses to aid treatment planning, challenges remain in differentiating lesions that
have similar MR features as ccRCC, in particular oncocytic neoplasms.
GU256-SDTHB5
Imaging Features of Abdominal Wall Endometriosis
Station #5
Participants
Gail Yarmish, MD, New York, NY (Presenter) Nothing to Disclose
Robert Soslow, New York, NY (Abstract Co-Author) Nothing to Disclose
Yuliya Lakhman, MD, New York, NY (Abstract Co-Author) Nothing to Disclose
PURPOSE
To assess the utility of various morphologic and quantitative CT features in differentiating abdominal wall endometriosis from other
masses of the abdominal wall.
Institutional review board approval and waiver of informed consent were obtained for this HIPAA compliant study. CT studies of 105
female patients with histologically evaluated abdominal wall masses were reviewed (median age of 41 years with range: 21 - 55
years); 24.8% (26/105) had histologically proven endometriosis. The other most common diagnoses included desmoid (13.3%;
14/105), leiomyosarcoma (7.6%; 8/105), adenocarcinoma (5.7%; 6/105), clear cell adenocarcinoma (4.8%; 5/105), serous
cystadenocarcinoma (3.8%; 4/105) and fibromatosis (2.9%; 3/105). Two radiologists blinded to the final histopathologic diagnosis
independently evaluated all cases and recorded their CT imaging features: size, number, location, density, enhancement,
heterogeneity, presence of calcifications, associated scars, intraperitoneal disease, and the newly described "comet-tail" sign.
Histopathologic specimens served as a gold standard. Associations between CT features and endometriosis were tested using the
Fisher exact and the Wilcoxon Rank Sum tests. P-values were adjusted for multiple testing using the false discovery rate approach.
Inter-reader concordance was also calculated.
RESULTS
The CT features significantly associated with endometriosis were location below the umbilicus (p=0.0264), homogeneity (p=0.0264),
and "comet tail" sign (p<0.0001). Inter-reader agreement ranged from slight for mass enhancement (k=0.20) to almost perfect on
calcifications (k=0.85), comet tail sign (k=0.97), cystic density (k=0.85), position above or below umbilicus (k=0.97), intraperitoneal
disease (k=0.97), multiple abdominal wall masses (k=0.94), association with scar (k=0.88), mass heterogeneity (k=0.90), and mass
location (k=0.90).
CONCLUSION
CT features are helpful in distinguishing abdominal wall endometriosis from other abdominal wall soft tissue masses.
Abdominal wall endometriosis is often misinterpreted when encountered on CT, however there are discriminating imaging features
which can assist the radiologist in making this diagnosis.
Honored Educators
GU257-SDTHB6
Virtual Non-contrast Imaging for CT Urography with Third-generation Dual-source Dual-energy CT
Scanner
Station #6
Participants
Kazuhiro Kitajima, MD, Nishinomiya, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
Virtual non-contrast (VNC) imaging with dual energy CT has been expected to replace true non-contrast imaging. In the excretory
phase of CT urography (CTU), however, VNC images are of suboptimal quality because of the densely opacified urine in the
collecting system, even with 2nd generation dual source CT (DSCT) scanner. The purpose of this study is to investigate the ability
of VNC imaging in CTU with 3rd generation DSCT compared with those with 2nd generation scanner.
We retrospectively compared 33 consecutive patients who underwent CTU with 192-slice 3rd generation DSCT scanner using a
dual-energy combination of 100 & 150Sn kV, with 19 historical controls with 128-slice 2nd generation DSCT scanner using a 100 &
140Sn kV. CT values of the renal pelvis and the urinary bladder were measured on both mixed images and VNC images of excretory
phase CTU. On mixed images, CT values of the area with suboptimal iodine suppression (any pixel that showed >40 HU on VNC
images) were compared between 2nd and 3rd generation DSCT. Subjective assessment of the ability of iodine suppression on VNC
was scored on a 5-point scale. The ability of detecting urinary stones was also compared. Radiation dose (CTDIvol) was recorded in
each case.
RESULTS
There were no statistically significant differences in CT values of the renal pelvis and the urinary bladder between 2nd and 3rd
generation DSCTU on mixed images (renal pelvis, 528 HU vs. 756 HU; urinary bladder, 282 HU vs. 273 HU), as well as VNC images
(renal pelvis, 44 HU vs. 42 HU; urinary bladder, 20 HU vs. 8.8 HU). However, mean CT values of the area with suboptimal iodine
suppression were lower with 2nd generation (457±177 HU) than 3rd generation DSCT (686±161 HU; p<.0001). No statistically
significant differences were found between subjective assessments of VNC with 2nd and 3rd generation DSCT. Renal stones greater
than 2-mm in diameter were detected on VNC with both 2nd and 3rd generation DSCT. CTDIvol of the excretory phase CTU was
significantly greater with 2nd generation DSCT than 3rd generation (2nd, 10.4±2.0 mGy; 3rd, 7.7± 1.7 mGy; p<.0001).
CONCLUSION
3rd generation DSCT could provide more optimal iodine suppression on VNC for the excretory phase CT urography.
VNC imaging with 3rd generation DSCT is effective for suppressing iodine attenuation of densely opacified urinary tract in CT
urography.
UR156-EDTHB7
Male Factor Infertility: Role of Imaging
Station #7
Awards
Participants
Pardeep K. Mittal, MD, Atlanta, GA (Presenter) Nothing to Disclose
Peter A. Harri, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Nima Kokabi, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Matthew S. Hartman, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
Courtney A. Coursey Moreno, MD, Suwanee, GA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
-Demonstrate role of imaging to identify correctable causes of male infertility.-Describe imaging is critically important in diagnosis of
pre-testicular, testicular and post-testicular conditions causing infertility in males as well as assessment of obstructive causes of
azoospermia.-Demonstrate basic concepts in male reproduction, differential diagnosis and clinical evaluation.
Infertility failure to conceive after regular unprotected sexual intercourse in the absence of known reproductive pathology over a
period of 1-2 years. According to WHO 20% causes of infertility are due to male factors where as 27% abnormalities are found in
both partners thus male factors are almost in 50% of casesMale factors:Pretesticular: hypogonadism, pituitary failure, estrogen
excess, cortisol excess/ deficiency. Testicular: varicocele, rete testis, cryptorchidism, tumors, granulomatous disease
etc.Posttesticular: congenital absence of vas deferens, utricular / Müllerian duct cyst, ejaculatory duct obstruction
etc.Abnormalities causing testicular failure and impaired spermatogensis cannot be corrected whereas obstructive processes are
potentially correctableSummary: Radiologists should be familiar with evaluation of infertility and common radiological findings and
disease processes associated with male factor infertility
MSCA51
Case-based Review of the Abdomen (An Interactive Session)
Thursday, Dec. 3 1:30PM - 3:00PM Location: S406A
GI
GU
OB
ER
Participants
Douglas S. Katz, MD, Mineola, NY, (dkatz@winthrop.org) (Director) Nothing to Disclose
LEARNING OBJECTIVES
1) To review a series of clinically relevant, abdominal imaging cases, with audience participation. 2) To review important concepts
and potential pitfalls of: the liver on sonography; the acute abdomen on US, CT, and MR; liver transplants on multi-modality
imaging; genitourinary imaging; and trauma imaging 3) To provide take home points for the audience based on specific actual case
material which was instructional or problematic for the presenters.
ABSTRACT
Sub-Events
MSCA51A
Hepatic Tumor Imaging
Participants
Puneet Bhargava, MD, Shoreline, WA (Presenter) Editor, Reed Elsevier
LEARNING OBJECTIVES
1) Review imaging appearances of common hepatic tumors. 2) Review key imaging findings that aid in differential diagnosis.
ABSTRACT
Honored Educators
Puneet Bhargava, MD - 2015 Honored Educator
MSCA51B
Abdominal Trauma Imaging
Participants
Savvas Nicolaou, MD, Vancouver, BC (Presenter) Institutional research agreement, Siemens AG
LEARNING OBJECTIVES
1) Review the technique and protocols, with an emphasis on MDCT, for imaging of blunt and penetrating abdominal and pelvic
trauma. 2) Demonstrate examples of the spectrum of injuries and the accompanying management associated with abdominal
trauma, including hepatic and hepatobiliary (gallbladder) injuries, bowel and mesenteric injuries, and pelvic injuries including bladder
and vascular injuries. 3) Demonstrate significance of arterial and portal venous phase imaging in the setting blunt abdominal and
pelvic trauma, and the utility of whole body imaging. 4) Review new imaging applications and techniques such as iterative
reconstruction and dual-energy CT, which can help better image abdominal and pelvic injuries post-trauma.
ABSTRACT
MSCA51C
Acute Abdomen Imaging
Participants
Stephan W. Anderson, MD, Boston, MA (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) The participant will be exposed to the current literature related to imaging of acute abdominal pain using CT. 2) The participant
will be able to apply an evidence-based approach to CT protocol development in the imaging of acute abdominal pain. 3) The
participant will be able to independently evaluate the published literature in this area in a critical fashion and continue to apply
recent developments to their own practice.
RC707
GU Ultrasound 2015: The Expert's Update on Kidney, Gynecologic and Testicular US
Thursday, Dec. 3 4:30PM - 6:00PM Location: N227
GU
OB
US
Participants
John J. Cronan, MD, Providence, RI (Coordinator) Nothing to Disclose
Mindy M. Horrow, MD, Philadelphia, PA, (horrowm@einstein.edu) (Presenter) Spouse, Director, Merck & Co, Inc
Paula J. Woodward, MD, Salt Lake City, UT (Presenter) Vice President, Reed Elsevier
LEARNING OBJECTIVES
1) The learner will be made aware of the importance of acute kidney injury (AKI) and associated ultrasound findings. 2) Ultrasound
criteria of cystic adnexal masses will be reviewed. 3) Testicular and scrotal pathology and the importance of ultrasound will be
explained.
ABSTRACT
Ultrasound has taken on new importance in the evaluation of the kidney, female pelvis and the scrotum/ testicles. We will explain
the ultrasound findings of acute kidney injury (AKI), the evaluation of pelvic masses and the necessary follow-up. Finally, a review
of the testicle and ultrasound findings will complete the course.
Honored Educators
Mindy M. Horrow, MD - 2013 Honored Educator
RC807
GYN and Pelvic Floor 2015: Latest Imaging Guidelines and Angles Simplified!
Friday, Dec. 4 8:30AM - 10:00AM Location: N227
GU
CT
MR
US
Participants
Mark E. Lockhart, MD, Birmingham, AL, (mlockhart@uabmc.edu) (Coordinator) Nothing to Disclose
Reena C. Jha, MD, Washington, DC (Presenter) Nothing to Disclose
Maitray D. Patel, MD, Phoenix, AZ (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Describe current best practice recommendations for management of adnexal asymptomatic, incidental, and/or potentially
physiologic findings on pelvic US, CT, and MR based on lesion characteristics and patient clinical factors. 2) Understand the
reference lines and angles in pelvic MRI that are used in the evaluation of pelvic floor disorders. 3) Understand the typical imaging
characteristics of the endometrium and myometrium according to patient age and stage of the reproductive cycle, and review
associated benign pathology.
ABSTRACT
This session will present on topics related to pelvic imaging. At the conclusion of the three presentations, the participants should
have an improved understanding of imaging characteristics of the ovaries and uterus, including endometrium. Also, the imaging
parameters used in evaluation of pelvic floor abnormalities such as organ prolapse and structural abnormalities related to
incontinence will be reviewed. In each lecture, the imaging characteristics of a variety of disease processes will be covered.
Active Handout:Maitray D. Patel
http://abstract.rsna.org/uploads/2015/14000842/RC807.pdf
RC808
Emergency Ultrasound Pitfalls (An Interactive Session)
Friday, Dec. 4 8:30AM - 10:00AM Location: E353C
GI
GU
OB
US
ER
Participants
Sub-Events
RC808A
Pitfalls in Right Upper Quadrant Ultrasound
Participants
Mindy M. Horrow, MD, Philadelphia, PA, (horrowm@einstein.edu) (Presenter) Spouse, Director, Merck & Co, Inc
LEARNING OBJECTIVES
1) Describe technical factors that may improve visualization of cholelithiasis including appropriate frequency transducer and
identification of gallbladder neck. 2) Identify non biliary causes of gallbladder wall thickening. 3) Recognize causes for nonvisualization of a fluid filled gallbladder and how to differentiate the gallbladder from other fluid filled structures in the right upper
quadrant. 4) Describe situations in which color Doppler is essential to detect renal causes of right upper quadrant pain.
Honored Educators
Mindy M. Horrow, MD - 2013 Honored Educator
RC808B
Pediatric Abdominal Ultrasound Pitfalls
Participants
Susan D. John, MD, Houston, TX (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Use optimal protocols for performing abdominal US in infants and children. 2) Avoid diagnostic errors in pediatric gastrointestinal
US caused by common artifacts and variables in exam performance. 3) Recognize variations in pathology and important secondary
findings that are helpful for the diagnosis of acute or emergent conditions in the pediatric abdomen.
ABSTRACT
RC808C
Non-obstetrical Gynecologic Ultrasound Pitfalls
Participants
Ana P. Lourenco, MD, Providence, RI, (alourenco@lifespan.org) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Recognize commonly encountered gynecological ultrasound pitfalls. 2) Describe strategies to avoid these pitfalls.
ABSTRACT
This session will review common pitfalls encountered in gynecologic ultrasound and highlight strategies for avoiding such pitfalls.
Case-based presentations will illustrate the varied presentations of ovarian torsion, non-gynecologic etiologies for acute pelvic pain
including ureteral calculi and acute appendicitis, and a variety of uterine, ovarian and adnexal abnormalities. The benefits and
limitations of transabdominal and transvaginal imaging, as well as color Doppler, will be highlighted with examples to demonstrate
the utility of each technique.
Active Handout:Ana P. Lourenco
RC808D
First Trimester Ultrasound Pitfalls
Participants
Mariam Moshiri, MD, Seattle, WA (Presenter) Consultant, Reed Elsevier; Author, Reed Elsevier
LEARNING OBJECTIVES
1) To review the relatively recent report of the Society of Radiologists in Ultrasound, on new ultrasound criteria for evaluation of
first trimester pregnancy. 2) To demonstrate potential pitfalls of sonographic performance and interpretation in the first trimester of
pregnancy, and to discuss how to avoid them. 3) To review other relevant, very recent literature on first trimester pregnancy
ultrasound performance and interpretation.
Honored Educators
Mariam Moshiri, MD - 2013 Honored Educator
Mariam Moshiri, MD - 2015 Honored Educator
RC818
Global Cancer Imaging-Insights from Overseas
Friday, Dec. 4 8:30AM - 10:00AM Location: E261
GU
MI
MR
OI
FDA
Participants
Sub-Events
RC818A
Functional and Molecular Imaging at Oxford University
Participants
Fergus V. Gleeson, MBBS, Oxford, United Kingdom (Presenter) Consultant, Alliance Medical Limited; Consultant, Blue Earth
Diagnostics Limited; Consultant, Polarean, Inc;
LEARNING OBJECTIVES
1) To learn about the functional and molecular imaging research being conducted within the Radiology Department of Oxford
University Hospitals NHS Trust.
ABSTRACT
There is increasing functional and molecular imaging being performed in medicine. The Radiology department at the Churchill Hospital
in Oxford is conducting a number of trials in these areas, and has designed these trials around interventions to measure the effect
of these new techniques. It has also taken the opportunity to raise the profile of Radiology within the University, to promote
greater collaboration with basic scientists, attracting increased funding, and opportunities for scientists and physicians.
RC818B
Lessons Learned from the National Irish Breast Screening Program: The First 12 years-One Million
Mammograms On
Participants
Michelle M. McNicholas, MD, Dublin, Ireland (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To review the results of the Irish National Breast Screening Program following 12 years of screening with over 1,000,000
mammograms performed. 2) To understand the essential components of setting up and maintaining a national breast screening
program in Ireland. This includes the rationale for the decisions made at the outset, such as age range, frequency of screens,
centralisation of service and responsibility of the screening process to the end of primary surgery. 3) To understand the need for
and the mechanism of developing a national registry of eligible women in the absence of a national unique identifier. 4) To
understand the need for a client charter which sets out client guarantees, objectives and goals around issues of consent,
timeliness of screening results and recall to assessment, biopsy results and admission for surgery and further treatment where
indicated. 5) To understand the necessity of national guidelines, annual reports and external accreditation. 6) To demonstrate the
essential need for ongoing review of key performance indicators (recall rate, biopsy rate, cancer detection rate, DCIS rate, open
biopsy rate, false negative rate, interval cancer rate) as surrogates of program success. 7) To understand the importance of
communication and feedback to clients, units, practitioners and media in maintaining uptake. 8) To understand the reporting
structure and the composition of various roles within the multidisciplinary medical and surgical teams. 9) To understand the
requirements for ongoing training and education of all staff - physicians, technologists, nurses, physicists, administrative staff. 10)
To understand the factors affecting radiation dose to the screened population and the over-riding responsibility of the ALARA
principle, such as: role of physics team, mammographic technique, equipment choice, technologist expertise and training, quality
assessment. 11) To understand the operational issues of different screening units, double reading, discrepancy cases, dealing with
interval cancers, dealing with outliers in key performance parameters. 12) To understand the positive spinoff s from the program
including increased awareness, improving national standards in the screening and the symptomatic population and the contribution
to improved diagnostic and treatment options. 13) To understand how the program achieved, maintained, and monitored
performance and how it adapted to changes in practice as issues or controversies arose. 14) To discuss whether this population
screening program has been a successful and cost effective health care initiative for Ireland. 15) Ultimately, to understand whether
the Irish National Breast Screening Program has led to improved survival in women with breast cancer in Ireland.
RC818C
MRI of Pelvic Malignancy-The View from Down Under
Participants
Nicholas J. Ferris, MBBS, Clayton, Australia, (nicholas.ferris@monashhealth.org) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To learn about the local availability and funding of MRI in investigating pelvic malignancy that is unique to Australia.2) To
understand the current usage of Pelvic MRI in investigating pelvic malignancy in the Australian population.3) To review some typical
examples of Pelvic MRI in Oncology that illustrate the advantages of MRI in the assessment of pelvic malignancies and impact MRI
has on patient management in the multidisciplinary setting.
ABSTRACT
Most medical imaging tests in Australia are heavily subsidized by the Federal government as part of the 'Medicare' national health
insurance system.Prostate cancer is a common problem in Australian men, and MRI appears to be a very useful tool in its
assessment and management, however it remains unfunded in the Medicare system. To remedy this, a group of clinicians has made
application to the Medicare Services Advisory Committee (MSAC) for inclusion of the test on the Medicare Benefits Schedule. Steps
in the recently revised MSAC procedure will be reviewed, with reference to the current application for prostate MRI.The impact of
its current unfunded status on the uptake of prostate MRI will be briefly reviewed.Despite the lack of government support, there
has been considerable experience with the technique 'Down Under', leading to some important publications in the international
literature about the role of MRI in selection of patients for biopsy, and the choice of biopsy target.
RC818D
Imaging of HCC-A Korean Perspective
Participants
Byung Ihn Choi, MD, PhD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To learn recent imaging techniques for the qualitative and quantitative diagnosis, selection of treatment methods, and
evaluation of monitoring after treatment for HCC. 2) To understand the imaging findings of hepatocarcinogenesis from regenerate
nodule going through low and high grade dysplastic nodule, early HCC and finally to advanced HCC. 3) To review current clinical
practice guidelines including role of imaging for the diagnosis and treatment for HCC with focus on recent change of guidelines by
rapid progression of imaging biomarkers.
ABSTRACT
RC829
Body MRI: Clinical Challenges (An Interactive Session)
Friday, Dec. 4 8:30AM - 10:00AM Location: E450A
GI
GU
MR
OI
Participants
Sub-Events
RC829A
Imaging Perianal Fistulae
Participants
Damian J. Tolan, MBBCh, FRCR, Leeds, United Kingdom, (damian.tolan@nhs.net) (Presenter) Speaker, Bracco Group; Speaker, Merck
& Co, Inc
LEARNING OBJECTIVES
1) To understand how to describe the different types of fistula. 2) To learn how to perform, interpret and report MRI for the initial
assessment of fistula in ano. 3) To learn the implications of MR findings in planning surgical treatment.
RC829B
Pelvic Endometriosis
Participants
Evan S. Siegelman, MD, Philadelphia, PA (Presenter) Consultant, BioClinica, Inc; Consultant, ICON plc; Consultant, ACR Image
Metrix
LEARNING OBJECTIVES
1) Review the theories concerning the pathogenesis of endometriosis. 2) Discuss the clincial indications that may indicate the use
of pelvis imaging to diagnose endometriosis. 3) Assess the current MR techniques used in the detection and characterization of
endometriosis. 4) Describe the imaging features of endometriomas and deeply infiltrative endometriosis.
ABSTRACT
Endometriosis is defined as the presence of ectopic endometrial glands and stroma outside the uterus. Endometriosis is a common
cause of pelvic pain and infertility, affecting as many as 10% of premenopausal women. Radiologists should be familiar with the
various imaging manifestations of endometriosis, especially those that allow its differentiation from other pelvic lesions. The MR
'pearls' offered here apply to the detection and characterization of pelvic endometriosis. The inclusion of T1-weighted fatsuppressed sequences is recommended for all MR examinations of the female pelvis because such sequences facilitate the detection
of small endometriomas and aid in their differentiation from mature cystic teratomas. Benign endometriomas can exhibit restricted
diffusion and should not be confused with ovarian cancer. Although women with endometriosis are at risk for developing clear cell
and endometrioid epithelial ovarian cancers (ie, endometriosis-associated ovarian cancers), imaging findings such as enhancing
mural nodules should be confirmed before a diagnosis of ovarian malignancy is suggested. The presence of a dilated fallopian tube,
especially one containing hemorrhagic content, is often associated with pelvic endometriosis. Deep (solid infiltrating) endometriosis
can involve the pelvic ligaments, anterior rectosigmoid colon, bladder, uterus, and cul-de-sac, as well as surgical scars; the lesions
often have poorly defined margins and T2 signal hypointensity as a result of fibrosis. The presence of subcentimeter foci with T2
hyperintensity representing ectopic endometrial glands within these infiltrating fibrotic masses may help establish the diagnosis.
Honored Educators
Evan S. Siegelman, MD - 2013 Honored Educator
RC829C
Cholangiocarcinoma Diagnosis and Staging: What the Surgeon Needs to Know
Participants
Eduard E. De Lange, MD, Charlottesville, VA, (delange@virginia.edu) (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) To learn about staging cholangiocarcinoma. 2) To understand how the tumor is classified surgically. 3) To get insight into the
various surgical procedures for tumor resection. 4) To understand the importance of vascular involvement for determining tumor
resectability.
ABSTRACT
Active Handout:Eduard E. De Lange
http://abstract.rsna.org/uploads/2015/15002799/RC829C.pdf
Handout:Eduard E. De Lange
http://abstract.rsna.org/uploads/2015/15002799/Course RC829C- de Lange EE - Cholangiocarcinoma - What the surgeon needs to
know.xps
RC851
Imaging in Practice: DWI in the Abdomen and Pelvis
Friday, Dec. 4 8:30AM - 10:00AM Location: S406A
GI
GU
MR
Participants
Sub-Events
RC851A
How to Perform DWI - Principles and Protocol
Participants
Shreyas S. Vasanawala, MD, PhD, Palo Alto, CA (Presenter) Research collaboration, General Electric Company; Consultant, Arterys;
Research Grant, Bayer AG;
LEARNING OBJECTIVES
1) Understand basic principles of contrast formation in diffusion weighted MRI. 2) Understand sources of artifacts in diffusion
weighted MRI. 3) Know techniques to reduce artifacts to produce diagnostic quality diffusion weighted images.
ABSTRACT
Diffusion-weighted imaging is being used with increasing frequency in body MRI. The basic mechanism of contrast generation is the
use of large motion-sensitizing gradients such that water molecules undergoing random motion are dephased, resulting in signal
loss. Tissues and lesions with high cellularity have reduced diffusive motion of water, which results in relatively high signal.
However, a number of issues make diffusion-weighted imaging in the body challenging relative to neurological applications. First, the
vast majority of clinical DWI is performed with an echo-planar technique, which suffers from image distortions due to field
inhomogeneity. These become problematic particularly where there are gas-tissue interfaces, such as at the dome of the liver and
near gas-filled bowel. The presentation will discuss methods to minimize these distortions. Second, the T2 relaxation rates of
abdominal tissues are less than that of pelvic viscera and much less than that of the brain, whereas normal water diffusivity is
higher; as the choice of diffusion sensitivity (b value) heavily influences the echo time, lower b values must be used. Third, motion
from cardiac pulsations, respiration, and peristalsis produce artifacts, some of which are easily recognizable, and others which can
subtly hide pathology. Techniques to minimize these pitfalls will be presented. Finally, issues of reproducibility that affect the
practical clinical use of DWI for lesion characterization in body MRI will be discussed, along with approaches to improve reliability.
RC851B
Interpretation of DWI - How to Create and Use ADC Maps in Your Practice
Participants
Thomas A. Hope, MD, San Francisco, CA, (thomas.hope@ucsf.edu) (Presenter) Advisory Committee, Guerbet SA; Research Grant,
General Electric Company
LEARNING OBJECTIVES
1) Understand the principles of calculating ADC. 2) Understand the effect of b-value selection and weighting on diffusion
calculations. 3) Explore the value of IVIM and other parameters.
ABSTRACT
In order to incorporate diffusion weighted imaging into clinical practices, it is important to understand how diffusion data is
evaluated. Qualitatively, one can simply say that lesions are "bright" on diffusion, but intensity on high b-value imaging is not
always equal to a lesion that has reduced diffusion. The understanding and implementation of quantitative analysis is therefore
critical for both research and everyday clinical practice. The first step is the calculation of the apparent diffusion coefficient (ADC)
map, which is used to help tease out the differences in intrinsic T2 hyperintensity and diffusivity. The calculation of the ADC map is
greatly affected by the methodology used as well as the selection of b-values acquired. The ADC of a tissue describes how quickly
signal decreases as the b-value is increased. Those lesions with high diffusivity will have high ADC values, while those lesions with
reduced diffusion will have lower ADC values. In addition to ADC, other parameters have been describe that affect the measured
diffusivity. The most commonly discussed is intravoxel incoherent motion (IVIM) that is thought to represent the random movement
of blood within the capillary system, often called pseudodiffusion. This parameter has its greatest effect on diffusion weighted
images at low b-values.
URL
RC851C
Applications of DWI in Clinical Practice - When It Does and Doesn't Help
Participants
Frank H. Miller, MD, Chicago, IL (Presenter) Nothing to Disclose
LEARNING OBJECTIVES
1) Demonstrate the utility of diffusion weighted imaging in the abdomen. 2) Show advantages and limitations of diffusion weighted
imaging in the abdomen.
ABSTRACT
Diffusion weighted imaging (DWI) has been used in neuroimaging for many years. It has only more recently become feasible in the
abdomen. The objective of this talk is to emphasize the important role that diffusion-weighted imaging can have in your practice
and that it can be used routinely without difficulty in the abdomen and pelvis. DWI potentially can detect additional lesions and
direct the radiologist to lesions that are not as well seen on conventional imaging. DWI helps in characterization of lesions but does
have limitations in specificity which will be discussed. Qualitative and quantitative evaluation can be performed and the applications
of these techniques clinically will be described. The strengths and limitations of DWI in multiple organs including the liver, pancreas,
adrenal gland, kidney, and evaluation for metastases and infections will be discussed. DWI is especially helpful for identify lymph
node and peritoneal metastases. Emerging techniques include the use of diffusion weighted imaging to assess response to therapy
following liver-directed therapy will also be discussed. In summary, DWI should be used routinely if not being used at your
institution. This talk will show benefits and limitations of DWI in a number of organs in the body.
Honored Educators
SST07
Genitourinary (MR and CT of the Urothelium)
Friday, Dec. 4 10:30AM - 12:00PM Location: E351
GU
CT
MR
FDA
Participants
David D. Childs, MD, Clemmons, NC (Moderator) Research Grant, Endocare, Inc
Sub-Events
SST07-01
Quantitative Assessment of Voxel-wise Apparent Diffusion Coefficient using K-means Clustering to
Predict and Assess Chemotherapeutic Response in Bladder Cancer
Participants
Huyen T. Nguyen, PhD, Columbus, OH (Abstract Co-Author) Nothing to Disclose
Amir Mortazavi, MD, Columbus, OH (Abstract Co-Author) Nothing to Disclose
Kamal S. Pohar, MD, Columbus, OH (Abstract Co-Author) Nothing to Disclose
Zarine K. Shah, MD, Columbus, OH (Abstract Co-Author) Nothing to Disclose
Guang Jia, PhD, Baton Rouge, LA (Abstract Co-Author) Nothing to Disclose
Michael V. Knopp, MD, PhD, Columbus, OH (Abstract Co-Author) Nothing to Disclose
Debra Zynger, MD, Columbus, OH (Abstract Co-Author) Nothing to Disclose
Hendrik Von Tengg-Kobligk, MD, Bern, Switzerland (Presenter) Research Grant, W. L. Gore & Associates, Inc
PURPOSE
To evaluate the value of k-means clustering of voxel-wise Apparent Diffusion Coefficient (ADC) in the assessment of
chemotherapeutic response in bladder cancer.
10 bladder cancer patients who received neoadjuvant chemotherapy were included in this initial study. Patients were scanned on a
3T multi-transmit system (Achieva, Philips Healthcare) using a 32-channel phased-array surface coil. Each patient had a baseline
(before chemotherapy) MRI and a post-chemotherapy MRI, followed by radical cystectomy. High resolution T2W imaging was
performed prior to DWI. DWI data were processed on in-house software written in IDL (Exelis, VIS) to acquire voxel-wise ADC for
each tumor. The k-means clustering was implemented to segment each tumor in three clusters (labeled as clusters 1, 2, 3 with low,
intermediate, high ADC). The volume fractions (VFs) of three clusters in a tumor at baseline and post-chemotherapy were
correlated with the tumor response. P<0.05 was considered to be statistically significant. Color cluster maps were overlaid on ADC
maps to visualize the cluster distribution.
RESULTS
Using pathological findings and radiologic volume estimation of bladder tumors, 6 patients were defined as responders and 4 as nonresponders. At baseline, responders showed a significantly higher VF of cluster 1 and lower VF of cluster 2 (all P<0.04) than nonresponders (Figure 1). In contrast with resistant cases, responsive tumors showed a decrease in VF of cluster 1 and an increase in
that of cluster 3 after chemotherapy. These differences in the post-chemotherapy changes of cluster VFs were found to be
statistically significant (all P<0.04) between responders and non-responders.
CONCLUSION
As ADC characterizes the micro-cellularity in body tissues, the heterogeneity of tumor micro-cellularity can be quantified using kmeans clustering of voxel-wise ADC to enable the early assessment and predication of chemotherapeutic response in bladder
cancer.
k-means clustering of voxel-wise ADC can be useful in predicting chemotherapeutic response at baseline and assessing
chemotherapy-induced changes of micro-cellularity in bladder cancer.
SST07-02
MDCT Urography Using a 320-detector Row Scanner: Comparison of the Wide Volume (W-V) Scan
Mode and Conventional Helical Scan Mode in Terms of Radiation Dose and Image Quality
Participants
Catherine Roy, MD, Strasbourg, France (Presenter) Nothing to Disclose
Raphael Quin, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Mickael Ohana, MD, MSc, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Guillaume Alemann, MD, MS, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Aissam Labani, MD, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Pierre G. Leyendecker, MD, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
To prospectively compare the conventional helical scan mode and W-V scan mode in CT Urography examinations using a 320-
detector row scanner in terms of image quality, radiation dose and accuracy of the automatic stitching for alignment of ureteral
segments in the W-V scan mode.
A cohort of 70 patients underwent a multiphasic CT Urography examination using a 320-detector CT scanner (Aquilion ONE, Toshiba
Medical Systems) including a medullary phase using the helical scan mode(collimation:80x0.5mm, rotation:0.5s,1mm/0.8mm,
acquisition time:4-6s) and an excretory phase using the W-V scan mode (collimation:200x0.5mm, rotation:0.5s,1mm without
overlapping and 4 to 5 volumes to cover the entire urinary tract, acquisition time:6-7s). Adaptative blending was used to stitch the
wide volumes. Both scans modes were performed at 120kVp with the same FOV, length of coverage and iterative reconstruction
(AIDR 3D). The Body Mass Index (BMI) of each patient and the dose-length product (DLP) was also recorded.For the quantitative
analysis, the signal to noise ratio (SNR) was calculated in the iliopsoas muscle. For qualitative analysis, two independent
experienced readers were asked to subjectively assess the presence of motion artefacts as well as the quality of the volumes
matching by analysis the continuity of the ureter on the excretory phase, using a four-point scale.
RESULTS
The mean DLP was significantly lower for the W-V acquisition than for the helical acquisition (136.8+/-28mGy·cm vs 232.8+/41mGy·cm,respectively) equal to 42.53% (p<0.05), regardless of the patient's BMI. The SNR was quite similar with W-V and helical
scan mode (15.3+/-1.9 vs 17.3+/-2.5, respectively). No significant difference was noted for the presence of motion artifacts
between both modes.In 85% of cases, there was no disruption of the continuity of the ureter with the W-V scan mode after
stitching of the volumes. In 12% of cases, there was minimal discontinuity of one segment and in 3% of cases there was an
inadequate matching of the volumes.
CONCLUSION
Wide Volume scanning using a 320-MDCT allows a significant radiation dose reduction (42%) while preserving image quality in
comparison to helical scanning. The lack of overranging with minimal overbeaming explain those results.
Wide volume scanning allows a significant reduction of radiation dose with a perfect continuity of the ureter and an excellent image
quality .
SST07-03
Comparison between Conventional Cystourethrography and MRI with Voiding MRcystourethrography in the Evaluation of Male Urethral Strictures
Participants
Marco Di Girolamo, MD, Rome, Italy (Presenter) Nothing to Disclose
Ines Casazza, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Simone Mariani, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Francesco Carbonetti, MD, Rome-Roma, Italy (Abstract Co-Author) Nothing to Disclose
Giulia Francione, Rome, Italy (Abstract Co-Author) Nothing to Disclose
Vincenzo David, MD, Rome, Italy (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the accuracy of conventional retrograde and voiding cystourethrography and MRI together with voiding MRcystourethrography in the evaluation of male urethral strictures.
We evaluated 39 male patients with urethral strictures diagnosed with urine flow velocity recording and conventional retrograde and
voiding cystourethrography. All these patients underwent MRI and voiding MR-cystourethrography using a 1.5T superconductive
magnet. The patients had urine-filled bladders and high-resolution sagittal TSE T2-weighted scans were performed (TR:6250ms;
TE:90ms;sl.thick.:3mm; acq.time:3'38"). Voiding MR-cystourethrography was performed with T1-weighted spoiled 3D gradient-echo
acquisitions on sagittal plane (TR:12ms; TE:2,7ms; flip-angle:40°; sl.thickness: 2mm; acq.time:12s) after the filling of bladder
lumen with contrast-material-enhanced urine obtainded by the i.v administration 20 mg of furosemide followed by ¾ of the normal
dose of a paramagnetic contrast agent (Magnevist, Bayer Pharma, Germany). After micturition high-resolution coronal TSE T2weighted scans were performed at the level of the stenosis. Two radiologists in consensus evaluated the morphology and length of
the urethral stenosis with the two modalities and with MRI the entity and the site of spongio-fibrosis was assessed.
RESULTS
3 patients were not able to perform voiding MR-cystourethrography. In 36 patients evaluated with two imaging modalities 32 single
and 4 double urethral strictures were detected. The measurement of the stenosis length was equal or superior with voiding MR
cystourethrography and the analysis of 3D sagittal scans allowed a better evaluation of the morphology of the urethral strictures in
comparison with conventional cystourethrography. Spongio-fibrosis was found in 30 patients (83%). The site of spongio-fibrosis
was always assessed with MRI (dorsal, ventral, dorsal and ventral and circular fibrosis).
CONCLUSION
MRI with voiding MR-cystourethrography shows the morphology and the length of the urethral strictures better than conventional
cystourethrography and allows the detection and site of spongio-fibrosis, avoiding radiation exposure to the gonads and urinary
catheterization.
MRI could be proposed as all-in-one technique for the evaluation of urethral stenosis, allowing their detection and length
assessment and determining the presence and site of spongiofibrosis.
SST07-04
Efficiency of Diffusion-weighted (DW) MRI to Evaluate the Excreto Urinary Wall Lesions: A
Prospective Study of 95 Patients
Participants
Catherine Roy, MD, Strasbourg, France (Presenter) Nothing to Disclose
Aissam Labani, MD, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Mickael Ohana, MD, MSc, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Guillaume Alemann, MD, MS, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Guillaume Bierry, MD, PhD, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
Herve Lang SR, MD, Strasbourg, France (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose was to investigate the reliability of DW-MRI in differentiating malignant from benign thickening or masses of the entire
urinary excretory wall.
We prospectively evaluated 95 patients referred for 52 upper urinary tract (UUT) and 43 bladder (Bl) lesions during a period of 5
years (from january 2010 to january 2015) . MR examinations were performed on a 3T unit (Achieva, Philips Medical System)
including to our conventional protocol using T2 and T1 sequence before and after contrast media injection an axial DWI (TR/TE :
7000/55, FOV : 250-300, ETL : 53, slice thickness : 4 mm, acquisition time : 4 min, Sense factor : 2, b =0 and 1000 mm2/sec)
under free breathing with a respiratoy compensatory device (navigator echo) for UUT. The final diagnosis and standard of reference
was the pathological analysis performed after MR examination, obtained either after surgery (74 cases) or by selective cytology and
endoscopic biopsy (21 cases) with a follow up imaging (at least one year) for 11 of them. Mann-Whitney test and Student -t test
were used to determine the efficiency of the mean ADC value.
RESULTS
Maximal axial diameter was 34±24mm for malignant (39 UUT; 33 Bl) and 15±5mm for benign lesions (13 UUT; 10 Bl), respectively.
For UUT, the mean ADC value in the malignant lesions was significantly lower than that in the benign lesions: 0.99+0.27 x103mm2/s against 1.54+0.43 x10-3mm2/s, respectively (p=0.0005). Thirty-three malignant lesions had an ADC value inferior to 1 x103mm2/s and only one benign lesion. There was a significant difference among the mean ADC values of different grades of malignant
tumors, corresponding to 0.84 ± 0.12 x10-3mm2/s-1 and 1.0 ± 0.20 x10-3mm2s-1 (p<0.01) in high-grade and low-grade excretory
epithelioma, respectively For bladder, the mean ADC value in the malignant lesions was not significantly inferior to that of benign
lesions (1.22 ± 0.3 x10-3mm2/s against 1.32± 0.2x10-3mm2/s, p=0.41)
CONCLUSION
DW-MRI is efficient in the differentiation between benign from malignant lesion located on the upper urinary tract. It does not seem
according those data reliable for bladder tumors. DW sequence must be included in MR protocols for exploration of upper urinary
tract.
DW must be included in MR protocols for exploration of upper urinary tract. DW-MRI is efficient in the differentiation between benign
from malignant lesion only in the upper urinary tract.
SST07-05
ADC as a Novel Biomarker to Predict the Local Stage and Tumor Grade of Bladder Cancer
Participants
Chandan J. Das, MD, MBBS, New Delhi, India (Presenter) Nothing to Disclose
T. Razik, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Sanjay Sharma, MD, FRCR, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Deepnarayan Srivastava, Delhi, India (Abstract Co-Author) Nothing to Disclose
Amlesh Seth, MBBS, MCHIR, New Delhi, India (Abstract Co-Author) Nothing to Disclose
Arun K. Gupta, MBBS, MD, New Delhi, India (Abstract Co-Author) Nothing to Disclose
PURPOSE
To evaluate the role of ADC as a novel biomarker to predict the local stage and tumor grade of bladder cancer using histopathology
(of post TURBT/cystectomy specimen) as the gold standard.
The study was approved by the local institutional ethics committee. MRI of 25 patients were performed in a 3 Tesla imaging system
(Achieva, Philips). Routine T1W and T2W images were obtained, followed by Diffusion Weighted Imaging in four b values (b0, 500,
1000, and 1500). All the patients had their surgery done within 1 month of performing MRI. Tumour staging was assessed with the
criteria used byTakeuchi et al,( 2009). For the tumour grade, freehand ROI values were obtained from the ADC map and their mean
calculated. Images were reviewed by two experienced radiologists in consensus, both blinded to the histopathology report.
Subsequently, the sensitivity, specificity, positive and negative predictive values were assessed using standard statistical tests.
Results were compared with the histopathology.
RESULTS
DWI had a sensitivity of 76.9% in detecting muscle invasion with a high specificity of 91.7%. The positive and negative predictive
values were 90.9 and 78.6% respectively. The ADC values were (0.786 + 0.045) x 10-3 for high grade lesions and (1.049 + 0.113) x
10-3 for low grade lesions, with a significant difference between the two (p< 0.05). We could not found any additive value of T2
weighted imaging when combined with DWI. DWI images acquired in coronal and sagiital plane were better for evaluation of bladder
dome lesion whereas axial plane DWI were best for rest of the lesions.
CONCLUSION
DWI showed a high specificity and positive predictive value in identifying muscle invasion. ADC values showed significant correlation
with the tumor grade and can be used as novel imaging biomarker for predicting redict the local stage and tumor grade of bladder
cancer..
ADC can be used as a noninvasive tool to evaluate bladder tumor and may avoid repeated cystoscopy or biopsy during follow up of
low grade lesions following TURBT. DWI at 3T is superior to T2WI for evaluating the T stage of bladder cancer, particularly in
differentiating T1 tumors from those T2 or higher, and in detecting stalks of papillary bladder tumors.
SST07-06
Detection of Urothelial Carcinomas: Comparison of Reduced-dose Based Iterative Reconstruction
with Standard-Dose Filtered Back Projection
Participants
See Hyung Kim, Daegu, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Jung Hee Hong, Daegu, Korea, Republic Of (Presenter) Nothing to Disclose
PURPOSE
To retrospectively assess radiation dose, image quality and diagnostic performance of CT urography detecting urothelial carcinomas
for performing reduced-dose with iterative reconstruction (IR) in comparison to standard-dose with filtered back projection (FBP).
Institutional review board approved this study. 2163 patients (age range, 28-81years; 1452 male) at high-risk for urothelial
carcinomas randomly underwent standard-dose scanning with FBP (120kVp for >80kg, 100kVp for 50-80kg) or reduced-dose
scanning with IR (100kVp for >80kg, 80kVp for 50-80kg) according to the body weight. Objective and subjective image quality
between the two groups with same weight scope was compared, using two-way analysis. The predictive accuracy detecting
urothelial carcinomas were also calculated by using as standard reference.
RESULTS
Mean effective dose was 26% (15.5mSv vs. 11.1mSv) and 30% (7.91mSv vs. 5.01mSv) lower with the reduced-dose scanning.
Objective image noise had no significant difference, except for 120kVp with FBP and 80kVp with IR (ranging from 7.2 to 7.9 vs. 9.4
to 9.9, P <.0102). SNR and CNR had no significant difference. Subjective image quality had no significant difference in visual image
noise, artifacts, ureter depiction and overall image quality, except for artifacts in 100kVp with FBP and 80kVp with IR (5 [4-5] vs. 4
[3-4]) (P >.05). Diagnostic accuracies on lesion level were 89.6% (89/98, 120kVp with FBP), 91.3% (105/115, 100kVp with FBP),
92.9% (79/85, 100kVp with IR) and 88.8% (111/125, 80kVp with IR), respectively.
CONCLUSION
Reduced-dose images with IR showed radiation dose reduction and equivalent image quality with ensuring diagnosis detecting
urothelial carcinomas as compared with standard-dose images with FBP, thus these robust capabilities may use in clinical practice.
Reduced-dose images with IR could be of help to reduce radiation dose with equivalent image quality for detecting urothelial
carcinomas as compared with standard-dose images with FBP.
SST07-07
Recurrence Patterns in Transitional Cell Carcinoma of the Upper Urinary Tract
Participants
Betsa Parsa, Boston, MA (Presenter) Nothing to Disclose
Vishala Mishra, MBBS, Boston, MA (Abstract Co-Author) Nothing to Disclose
Sandeep S. Hedgire, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Yun Mao, MD, Chongqing, China (Abstract Co-Author) Nothing to Disclose
Duangkamon Prapruttam, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE
This study included patients diagnosed with UT-TCC who underwent nephroureterectomy between 2003-2008. Tumor location,
morphology, TNM staging and histologic grade were recorded based on radiological examinations . The pattern and timing of
recurrence was evaluated at 3, 6, 12, 24, 36 and 60 months in a five-year imaging and clinical follow up period (2008-2013).
This included patients diagnosed with UT-TCC who underwent nephroureterectomy between 2003-2008. Tumor location,
morphology, TNM staging and histologic grade were recorded based on radiological examinations and clinical notes. The pattern and
timing of recurrence was evaluated at 3, 6, 12, 24, 36 and 60 months in a five year follow up period (2008-2013).
RESULTS
68 patients with an average age of 77.5 yrs were included in this study. At initial work-up, renal, ureteric and renal plus ureteric
lesions were present in 34, 25 and 9 patients respectively. Of 59 patients for whom tumor morphology was available, 34 had massforming lesions and 25 were seen as filling defects. The majority of patients had a T-stage of Ta (n=28) or T3 (n=23), while nodal
involvement was mostly absent. Tumors were grade 3 in 44.1% and grade 2 in 33.8%.Most recurrences were noted at 3 and 24
months. Patients with bilateral tumors had a higher recurrence rate at 3, 12, and 24-month follow-ups while for unilateral tumors
the chance was higher at 36-month follow-up. Recurrence rate was also higher in patients with T2, N1 and pathologic grade 3 and
in patients with T2, N1 and N2 at 3- and 12-month follow-ups, respectively. Pathological grade 1 tumors showed late recurrence at
5-yr follow up. Overall, recurrence occurred in 20 cases during the 5-yr follow-up, which was commonly located in lymph nodes,
bladder. Multivariate analysis showed T-stage and location of primary tumor were independent predictors of tumor-free survival
(p=0.021, 0.038 respectively). Average tumor-free survival time was 56.5 months.
CONCLUSION
Nodal, bladder, hepatic and bone metastasis are common in UT-TCC with most of them occurring at 3 and 24 months. T-stage and
location are independent predictors of tumor-free survival. Tumors confined to either kidney or ureter, lower T, N stage and
histologic grade were associated with longer survivals.
Information on the pattern of recurrence in UT-TCC patients can lead to more effective planning of imaging surveillance strategy.
SST07-08
The Incremental Value of Diffusion-Weighted MR Images in the Tumor Detection and the Staging of
Preoperative T Categorization in Renal Pelvic Carcinoma: Effect of Reader Experience
Participants
Rika Yoshida, MD, Izumo, Japan (Presenter) Nothing to Disclose
Takeshi Yoshizako, MD, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
Hiroshi Mori, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
Minako Maruyama, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
Takashi Katsube, Izumo City, Japan (Abstract Co-Author) Nothing to Disclose
Shinji Andou, MD, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
Tomonori Nakamura, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
Nobuko Yamamoto, MD, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
Megumi Nakamura, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
Hajime Kitagaki, MD, Izumo, Japan (Abstract Co-Author) Nothing to Disclose
PURPOSE
The purpose of this study is to retrospectively assess the incremental value of diffusion-weighted MRI (DWI) to T2-weighted image
(T2WI) in the tumor detection and the staging of preoperative T categorization in renal pelvic carcinoma by readers of different
experience levels.
Thirty-two urothelial carcinoma in 32 patients underwent preoperative MRI examination, including T2WI and DWI (b=0, 800 s/mm)
and contrast-enhanced imaging (CEI). All patients had total nephrectomy within 1 month of MRI. Two radiologists (reader 1 had 5
years and reader 2 had 18 years of experience) independently reviewed three image sets (T2WI alone, T2WI plus DWI, and T2WI
plus CEI) regarding tumor detection and the discrimination of locally advanced tumors.
RESULTS
The pathologic T category was T1 in 5 (15.6%), T2 in 6 (18.8%), T3a in 9 (28.1%), T3b in 11 (34.4%), and T4 in 1 (3.1%).T2WI
plus DWI enabled a high detection rate (97%, 31/32) without significant differences.In reader 1, for the diagnosis of T3 or higher
categories, the accuracies were relatively low in all three image sets (75.0% each for T2WI alone and T2WI plus CEI and 71.9% for
T2WI plus DWI). For discriminating tumors with macroscopic renal invasion from those with microscopic renal invasion or less, T2WI
plus DWI (90.6%) was significantly more accurate than T2WI alone (68.8%) (p < 0.05), with with areas under receiver operating
characteristic curves (AUC) of 0.82 and 0.73, respectively.In reader 2, for the diagnosis of T3 or higher categories, the accuracies
were relatively low in all three image sets (each sets were 71.9%). For discriminating tumors with macroscopic renal invasion from
those with microscopic renal invasion or less, the accuracies were relatively high in all three image sets (84.3% for T2WI alone,
94.8% for T2WI plus CEI and 90.6% for T2WI plus DWI), with AUC of 0.88, 0.95, and 0.93, respectively.For the diagnosis of T
categorization, T2WI added DWI improved interobserver agreement from fair (κ = 0.21, 0.32) to substantial (κ = 0.60, 0.73).
CONCLUSION
DWI improved the tumor detection rate and the diagnostic performance for T categorization of renal pelvic cancer without contrast
material, especially for the relatively inexperienced reader.
DWI improved the tumor detection rate and the diagnostic performance for T categorization of renal pelvic cancer without contrast
material.
SST07-09
Organ Confined Urinary Bladder Carcinoma: A Comparative Analysis for "Submucosa Linear
Enhancement" Sign on Early Phase of DCE-MRI and the "Inchworm" Sign on DWI
Friday, Dec. 4 11:50AM - 12:00PM Location: E351
Participants
Huanjun Wang, MD, GuangZhou, China (Presenter) Nothing to Disclose
Jian Guan, MD, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
Yan Guo, MD, Guangzhou, China (Abstract Co-Author) Nothing to Disclose
PURPOSE
To investigate the pathogenetic mechanism of "submucosa linear enhancement" and to further evaluate its application value in
preoperative staging of organ confined bladder carcinoma.
The examination protocol was approved by the institutional medical ethics committee and informed consent was obtained from all
patients. 59 patients with suspected or confirmed urothelial bladder cancer and no renal function impairment were enrolled in the
study. All patients underwent MRI within 2-weeks before surgery. Two image sets of T2WIandDW-MRI and T2WIandDCE-MRI were
independently interpreted by two readers at 2-week intervals by analyzing whether there were "inchworm" sign on DWI and
"submucosa linear enhancement" sign on early phase of DCE-MRI, which were further comparatively analyzed with pathology. Tumor
size was also compared.
RESULTS
92 carcinomas (79 T1, 13 T2) were analyzed. 58 presented "submucosa linear enhancement" on early phase of DCE-MRI which
manifested three types as follow: continuous linear enhanced submucosa gathering toward into the center of tumor (39),
continuous straight and no gathering linear enhanced submucosa(14) and interrupted linear enhanced submucosa(5) respectively,
and the remaining 34 lesions presented no significant linear enhanced submucosa. 42 carcinomas (38 T1, 4 T2) presented
"inchworm" sign on DWI, with the remaining 50 lesions (41 T1, 9 T2) shown not. Statistical significance were found for tumor size
between carcinomas presented "inchworm" sign and those without, which had a median of 21.5mm for the former, and 13.0mm for
the latter.
CONCLUSION
Presentation of "submucosa linear enhancement" under the tumor base on DCE-MRI is a significant imaging sign which can be
applied in preoperative staging of organ confined bladder carcinoma. Presentation of either straight or gathered continuous
"enhanced submucosa line" often suggests bladder muscle wall have not been involved.
DCE-MRI and DWI can supply us an optimal imaging tool for preoperative staging of organ confined bladder carcionoma and is highly
recommended.

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