19 sponsoren en exposanten Bayer Healthcare Biomedic Bracco Imaging Europe C.R. Bard Netherlands Sales ChipSoft GE Healthcare Guerbet Nederland Interact Medical Klinipath Mermaid Medical Oldelft Benelux ScoVas Medical Siemens Nederland Toshiba Medical Systems Nederland Tromp Medical programma & abstracts - 19E nederlandse radiologendagen - 11 en 12 september 2014 Hoofdsponsoren radiologendagen 2014 19 programma & abstracts RADIOLOGENDAGEN Sexy secties ‘Eye Candy?’ 11 - 12 SEPTEMBER 2014 1931 Congrescentrum Brabanthallen ’s-Hertogenbosch Travel Grant RSNA abstracts www.radiologen.nl www.congresscompany.com RADIOLOGENDAGEN 2014 Sexy secties Geachte collega’s, Wij wensen u heel veel plezier op de radiologendagen 2014. De continue wisselwerking (en bijscholing) tussen de radioloog met een deelspecialisatie en de op dat onderdeel algemene radioloog is de grote pijler van de radiologendagen. De secties zijn daarbij het kloppende hart van de radiologendagen. Elke sectie heeft een lid in het wetenschappelijke comité welke de bijdrages vanuit het deelgebied coördineert zoals refresher courses etc. Dit jaar besteden we nog explicieter aandacht aan de secties zoals het thema Sexy Secties al aangeeft. Meerdere secties houden dit jaar op de donderdagmiddag een sectie vergadering. Verschillende secties hebben zich al aangemeld voor 2015 dus dit gaat een nieuwe traditie worden! Graag wil ik ook uw aandacht vestigen op de misser/complicatie sessie op de vrijdag welke de radiologendagen 2014 met een knal zal afsluiten! Iedereen (sprekers, sponsors etc.) die een bijdrage levert aan de radiologendagen 2014 willen we hierbij bedanken. Het Organisatie Comité van de Radiologendagen 2014, Jeroen Hendrikse, Sebastiaan Jensch, Ingrid Bruijnzeel-Koster, Otto Elgersma, Marieke Sprengers Het uitgebreide programma en de omschrijving en de leerdoelen van de Refresher courses vindt u op pagina 2 t/m 16. Foyer Limousin 1 Limousin 2 Limousin 3 Dexter 15-16 Dexter 11-14 Dexter 21-24 Dexter 25-26 08:00 – 08:30 Ontvangst & registratie 08:30 – 09:30 Refresher course: Refresher course: Maligne lymfomen De (schedel)basis in acute/ levensbedreigende setting 09:30 – 10:00 Missers & veiligheidscultuur 10:00 – 10:30 Cognitieve errors in radiology 10:30 – 10:45 Complicatie registratie 10:45 – 11:15 Koffie/theepauze 11:15 – 12:30 Parallelsessie 7: Parallelsessie 8: Parallelsessie 9: Parallelsessie 10: Parallelsessie 11: MSK Mammoradiologie Forensische Radiologie Educatief & Onderwijs Miscellaneous III 12:35 – 13:00 Prijzensessie Philipsprijs Best Abstract Prijs Travel Grant 13:00 – 14:00 Lunch 14:00 – 14:30 Missers: Acute Radiologie 14:30 – 15:00 Missers: Kinderradiologie 15:00 – 15:30 Missers: Thoraxradiologie 15:30 – 16:00 Complicaties: Interventie Rad. 16:00 Sluiting door de voorzitter 16:05 Afsluitende borrel Vrijdag 12 september 2014 Foyer Limousin 1 Limousin 2 Limousin 3 Dexter 15-16 Dexter 11-14 Dexter 21-24 Dexter 25-26 08:00 – 09:00 Ontvangst & registratie 09:00 – 09:05 Opening door voorzitter Openingssessies 09:05 – 10:15 10:15 – 10:45 Koffie/theepauze 10:45 – 11:45 Refresher course: Refresher course: De postoperatieve knie Diagnose en behandeling levermetastasen 11:55 – 13:10 Parallelsessie 2: Parallelsessie 1: Parallelsessie 3: Parallelsessie 4: Parallelsessie 5: Parallelsessie 6: Cardiovasculair Abdomen Neuroradiologie Interventieradiologie Miscellaneous I Miscellaneous II 13:10 – 14:10 Lunch 14:10 – 14:40 NVvR en de federatie 14:40 – 14:55 Laudatie Prof.dr. J.S. Lameris 15:00 – 16:00 Parallel sectiemiddag: Refresher course: Refresher course: Parallel sectiemiddag: Parallel sectievergadering: Mamma diagnostiek Coronair CT voor elke KNO MSK Abdomen radioloog afwijkende eindtijd: 16:30 uur alleen toegankelijk voor leden afwijkende eindtijd: 17:30 uur anno 2014 16:00 – 16:30 Koffie/theepauze 16:30 – 17:30 Speciale sessie AIOS: Refresher course: Refresher course: Werken in buitenland The Great Mimickers De geschiedenis in Chest Radiology van de Radiologie 17:30 – 18:15 Quiz 18:15 Sluiting door de voorzitter 18:15 Borrel met aansluitend diner & feest Orangerie Donderdag 11 september 2014 programma & abstracts voorwoord 19E RADIOLOGENDAGEN 2014 Organisatie Organisatie Comité Dr. J. Hendrikse, voorzitter Organisatie Comité Dr. S. Jensch, voorzitter Wetenschappelijk Comité Mw. I.M. Bruijnzeel-Koster Mw. Dr. M.E.S. Sprengers Dr. O.E.H. Elgersma WETENSCHAPPELIJK COMITÉ Mw. Dr. M. Brink Dr. E.F.W. Courrech Staal N. de Graaf Mw. Dr. I.J.C. Hartmann Dr. B. de Keizer Mw. Dr. W.M. Klein Dr. P.J. van Laar Mw. M.J. Lamers Dr. M.B.I. Lobbes Prof. dr. M. Maas Dr. M.R. Meijerink Dr. E.H.G. Oei G.F.A.J. van Tilborg Dr. C.J.L.R. Vellenga Mw. Dr. B.K. Velthuis CONGRESSECRETARIAAT Postbus 2428 5202 CK ‘s-Hertogenbosch Tel 073 700 3500 Fax 073 700 3505 [email protected] www.congresscompany.com 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 1 programma & abstracts programma donderdag Donderdag 11 september 2014 08:00 – 09:00 FOYER ONTVANGST & REGISTRATIE 09:00 – 09:05 LIMOUSIN 2 OPENING VOORZITTER ‘SEXY SECTIES’ Dr. J. Hendrikse, UMC Utrecht, Utrecht Dagvoorzitters: Dr. J. Hendrikse, UMC Utrecht, Utrecht Dr. S. Jensch, St. Lucas Andreas Ziekenhuis, Amsterdam 09:05 – 09:35 WAT IS ALGEMENE EN WAT IS SPECIALISTISCHE RADIOLOGISCHE KENNIS? Mw. Dr. C.M. Schaefer-Prokop, Meander Ziekenhuis, Amersfoort 09:35 – 10:15 HONORY LECTURE: ‘X-RAYS AND GENERATION Y’ Prof. dr. T. Roeren, Kantonsspital, Aarau, Switzerland 10:15 – 10:45 FOYER KOFFIE/THEEPAUZE 10:45 – 11:45 REFRESHER COURSES 10:45 – 11:45 10:45 – 11:00 11:00 – 11:15 11:15 – 11:35 10:45 – 11:45 10:45 – 11:10 11:10 – 11:35 LIMOUSIN 2 Diagnose en behandeling van levermetastasen van colorectaal carcinoom anno 2014 Omschrijving en leerdoelen: pagina 15 Voorzitter: Drs. G.F.A. van Tilborg, Elisabeth Ziekenhuis, Tilburg Behandeling levermetastasen colorectaal carcinoom, oncologisch perspectief Mw. Dr. E. van Meerten, Erasmus MC, Rotterdam Behandeling levermetastasen colorectaal carcinoom, chirurgisch perspectief Dr. M.H.A. Bemelmans, MUMC, Maastricht Beeldvorming bij levermetastasen colorectaal carcinoom, diagnose en follow up Dr. M.S. van Leeuwen, UMC Utrecht, Utrecht LIMOUSIN 1 De postoperatieve knie Omschrijving en leerdoelen: pagina 15 Voorzitter: Drs. R.E. Westerbeek, Deventer Ziekenhuis, Deventer Evaluatie van gewricht sparende procedures Dr. J.J. Visser, Erasmus MC, Rotterdam Evaluatie van gewricht vervangende procedures Drs. S.M. van Raak, Albert Schweitzer Ziekenhuis, Dordrecht 11:45 – 11:55 Zaalwisseling 11:55 – 13:10 KORTE EDUCATIEVE EN WETENSCHAPPELIJKE VOORDRACHTEN LIMOUSIN 2 Sessie 1: Abdomen Abstracts: vanaf pagina 17 Voorzitters: Dr. M.J. Lahaye, MUMC, Maastricht Mw. Prof. dr. R.G.H. Beets-Tan 11:55 – 12:10 Keynote lecture: Rectal Cancer Dr. M.J. Lahaye, MUMC, Maastricht 12:10 – 12:20 Tumour volumetry on diffusion-weighted MRI for identification of complete tumour responders O01.01 to preoperative chemoradiotherapy in rectal cancer: a multicenter validation study D.M.J. Lambregts1, S. Sassen1,3, S.-X. Rao3, M.H. Martens1, L.A. Heijnen1, M. Sosef2, G.L. Beets1, R.G.H. Beets-Tan1, R.F.A. Vliegen2 1 MUMC, Maastricht 2 Atrium Medisch Centrum, Heerlen 3 Fudan University, Shanghai, China 2 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 19E RADIOLOGENDAGEN 2014 Vervolg donderdag 11 september 2014 12:20 – 12:30 O01.02 Remaining malignant lymph nodes in good responders after chemoradiotherapy for rectal cancer: where are they located? M.J. Lahaye1, D.M.J. Lambregts1, L.A. Heijnen1, T. van Nijnatten1, S.-X. Rao2, M.H. Martens1, G.L. Beets1, R.G.H. Beets-Tan1 1 MUMC, Maastricht 2 Zhongshan Hospital, Shanghai, China 12:30 – 12:40 Value of Dynamic Contrast Enhanced MRI and Fusion with T2-weighted O01.03 Imaging for Local Staging of Recurrent Rectal Cancer: Correlation with Surgery and Histopathology of Resected Specimen R.M. van Waardhuizen, R.S. Dwarkasing, W.J. Alberda, M. Doekas, M.A.J. de Ridder, J.J.M.E. Nuyttens, C. Verhoef, F.E.J.A. Willemssen Erasmus MC, Rotterdam 12:40 – 12:50 Gecombineerde blanco (3T) MRI van rectum en bovenbuik bij screening O01.04 van patiënten met rectumcarcinoom J.M.F. van Wagenberg, D. Bouman, R. Bezooijen, C. Klazen Medisch Spectrum Twente, Enschede 12:50 – 13:00 MRI as a potential ‘one-stop-shop’ staging tool for colon cancer: can it O01.05 replace CT for local staging? - preliminary results M.J. Lahaye, D.M.J. Lambregts, F.C. Bakers, L.A. Heijnen, M.H. Martens, G.L. Beets, R.G.H. Beets-Tan MUMC, Maastricht 13:00 – 13:10 Head-to-head comparison of mDIXON and proton density liver fat fraction (PDFF) O01.06 maps with ¹H-MRS as reference value for diagnosing hepatic steatosis J.H. Runge, A.J. Nederveen, J. Verheij, U.H. Beuers, J. Stoker AMC Amsterdam, Amsterdam LIMOUSIN 1 Sessie 2: Cardiovasculair Abstracts: vanaf pagina 20 Voorzitters: Mw. Dr. A.M. Spijkerboer, AMC, Amsterdam Mw. Dr. B.K. Velthuis, UMC Utrecht, Utrecht 11:55 – 12:10 Keynote lecture: Dual-energy, CARE kV and reduced contrast medium volume in O02.01 CTA of the abdominal aorta: A comparative analysis of image quality and radiation dose W.H. Nijhof1, E.J.M. Baltussen2, I.M.J. Kant2, G.J. Jager1, M.J. Rutten1 1 Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 2 Universiteit Twente, Enschede 12:10 – 12:20 Stress Myocardial Perfusion Imaging Versus Fractional Flow Reserve: Meta-Analysis O02.02 R.A.P. Takx, B.A. Blomberg, P.A. De Jong, T. Leiner UMC Utrecht, Utrecht 12:20 – 12:30 Multidetector-row CT for prosthetic heart valve evaluation can replace invasive O02.03 coronary angiography in selected patients D. Suchá, W. Tanis, E.M. Laufer, J. Habets, L.A. Van Herwerden, P. Symersky, S. Chamuleau, R.P.J. Budde UMC Utrecht, Utrecht 12:30 – 12:40 Contrast media reduction in CT angiography using low kV settings O02.04 M. Kok, C. Mihl, A. Seehofnerova, S. Altintas, B.L.J.H. Kietselaer, J. Turek, J.E. Wildberger, M. Das MUMC, Maastricht 12:40 – 12:50 High flow contrast media injection protocol in comprehensive pre-TAVI assessment. Initial results O02.05 J. Turek, M. Kok, C. Mihl, B. Kietselear, J.E. Wildberger, M. Das MUMC, Maastricht 12:50 – 13:00 Evaluation of image quality in different kV settings using different reconstruction O02.06 algorithms in CT angiography of the aorta C. Mihl, M. Kok, J. Turek, J.E. Wildberger, M. Das MUMC, Maastricht 13:00 – 13:10 Is automated kV selection for radiation dose reduction independent from contrast O02.07 media concentration in CT angiography? M. Kok1, C. Mihl1, A. Seehofnerova1, J. Turek1, G. Jost2, U. Haberland3, J.E. Wildberger1, M. Das1 1 MUMC, Maastricht 2 Bayer Pharma AG, Berlin, Germany 3 Siemens AG, Forchheim, Germany Vervolg op pagina 4 Het schematische programmaoverzicht vindt u achterin deze syllabus rechts naast pagina 64. 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 3 programma & abstracts programma donderdag Vervolg donderdag 11 september 2014 LIMOUSIN 3 Sessie 3: Neuroradiologie Abstracts: vanaf pagina 24 Voorzitters: Dr. P.J. van Laar, UMC Groningen, Groningen Dr. S.C.A. Steens, Radboudumc, Nijmegen 11:55 – 12:10 Keynote lecture: Validation of the NEXUS-criteria for CT O03.01 R.S. Smit, J.B. Egbers, A.F. Hoogerwaard, J.J. van Netten, D. van der Velde, M. Kraai, J.W. op den Akker Ziekenhuisgroep Twente, Almelo/Hengelo 12:10 – 12:20 The added diagnostic value of CT-perfusion in detection and localization of O03.02 ischemia in patients suspected of acute posterior circulation stroke E.J.R.J. van der Hoeven1, J.W. Dankbaar2, J.M. Niesten3, I.C. van der Schaaf2, J.A. Vos1, W.J. Schonewille1, L.J. Kappelle2, B.K. Velthuis2 1 St. Antonius Ziekenhuis, Nieuwegein 2 UMC Utrecht, Utrecht 3 OLVG, Amsterdam 12:20 – 12:30 Predictors of reperfusion in acute ischemic stroke patients O03.03 A.D. Horsch1, J.W. Dankbaar1, Y. Van der Graaf2, W.P.T.M. Mali1, B.K. Velthuis1 1 UMC Utrecht, Utrecht 2 Julius Centrum, Utrecht 12:30 – 12:40 Visualization of deep brain stiumulation targets in patients with Parkinson’s O03.04 disease at 1.5-, 3- and 7-T MRI P.J. van Laar, J.M.C. van Dijk, E.K.L. de Graaf, A.L.J. van Hulzen, L.C. Meiners, M.J. Staal UMC Groningen, Groningen 12:40 – 12:50 Carotid intraplaque hemorrhage progression in asymptomatic subjects: O03.05 A follow-up study using serial magnetic resonance imaging Q.J.A. van den Bouwhuijsen, M. Selwaness, T.A.N.G. Hui, W.J. Niessen, A. Hofman, G.P. Krestin, O.H. Franco, A. van der Lugt, M.W. Vernooij Erasmus MC, Rotterdam 12:50 – 13:00 CTA derived from CT perfusion data obviates the need for separate cranial CTA in Acute Stroke O03.06 E.J. Ewoud1,2, E.J. Vonken1, F.J.A. Meijer2, J.W. Dankbaar1, A.D. Horsch1, B. Ginneken2, B.K. Velthuis1, I. van der Schaaf1, M. Prokop2 1 UMC Utrecht, Utrecht 2 Radboudumc, Nijmegen 13:00 – 13:10 White matter degenerates over time, a longitudinal diffusion MRI analysis O03.07 L.G.M. Cremers, M. de Groot, A. Hofman, G. Krestin, A. van der Lugt, W. Niessen, M. Ikram, M. Vernooij Erasmus MC, Rotterdam DEXTER 15-16 Sessie 4: Interventieradiologie Abstracts: vanaf pagina 28 Voorzitters: Dr. M.R. Meijerink, VUmc, Amsterdam Dr. J. Futterer, Radboudumc, Nijmegen 11:55 – 12:10 Keynote lecture: Beeldgestuurde tumorablatie uitdagingen en mogelijkheden voor de interventie radioloog van de toekomst Dr. M.R. Meijerink, VUmc, Amsterdam 12:10 – 12:20 Survival and recurrence rates after radiofrequency ablation and combined O04.01 radiofrequency and drug-eluting bead transarterial chemoembolization in inoperable hepatocellular carcinoma J.J. Schaapman, M.C. Burgmans, B. Ortega, R. Wolterbeek, C.S.P. van Rijswijk, S. Osanto, A.F.M. Schaapherder, M.J. Coenraad, A.R. Van Erkel LUMC, Leiden 12:20 – 12:30 Percutane CT-geleide cryoablaties van niertumoren; een veilige en effectieve behandeling O04.02 G.A.H. Kock, A.D. Montauban van Swijndregt, B.W. Lagerveld OLVG, Amsterdam 12:30 – 12:40 Antegrade ureteral stenting as an alternative for the retrograde approach: O04.03 indications, succes rate and complications R.W. van der Meer1, J. Verdult2, S. Weltings2, A. van Erkel1, H. Roshani2, H.W. Elzevier1, L. van Dijk2, H. van der Overhagen2 1 LUMC, Leiden 2 HagaZiekenhuis, Den Haag 12:40 – 12:50 4D CTA for the evaluation of arteriovenous malformations - a pilot study O04.04 P.B. Veendrick, R. Mann, C.J.M. van der Vleuten, F.J.A. Meijer, D.J.O. Ulrich, B. Verhoeven, M.H.W.A. Wijnen, W.M.H. Busser, F. de Lange, L.J. Schultze Kool Radboudumc, Nijmegen 4 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 19E RADIOLOGENDAGEN 2014 Vervolg donderdag 11 september 2014 12:50 – 13:00 Fusion imaging in image guided interventions. A systematic review O04.05 C. Klink, R. te Riele, T. van Walsum, M. Hunink, A. Moelker Erasmus MC, Rotterdam 13:00 – 13:10 MRI with a weak albumin binding contrast agent has additional value for the detection O04.06 of endoleaks in patients with enlarging aneurysm after endovascular repair J. Habets1,2, H. Zandvoort1, F.L. Moll1, E.P.A. Vonken1, L.W. Bartels3, J.A. Herwaarden1, T. Leiner1 1 UMC Utrecht, Utrecht 2 Gelre Ziekenhuizen, Apeldoorn 3 Imaging Science Institute, Utrecht DEXTER 11-14 Sessie 5: Miscellaneous I Abstracts: vanaf pagina 31 Voorzitters: Dr. B. de Keizer, UMC Utrecht, Utrecht Dr. J. Hendrikse, UMC Utrecht, Utrecht 11:55 – 12:10 Keynote lecture: Wat zijn prognostische factoren voor de effectiviteit van O05.01 barbotage bij tendinits calcarea van de rotator cuff? S.B.A van der Valk1, B.W. Oudelaar2, A.J.H. Vochteloo2, R. Huis in ‘t Veld2, E.M. Ooms2, R. Schepers-Bok1 1 MRON, Ziekenhuisgroep Twente, Almelo en Hengelo 2 OCON, Hengelo 12:10 – 12:20 Patients at risk for contrast induced nephropathy and mid-term effects after O05.02 contrast administration. A prospective cohort study S.I. Moos, G. Nagan, R.S. de Weijert, D.N.H. van Vemde, J. Stoker, S. Bipat AMC Amsterdam, Amsterdam 12:20 – 12:30 Contrast Induced Nephropathy Prevention regimens for patients undergoing O05.03 intravenous Contrast Enhanced Computed Tomography: A meta-analysis S.I. Moos, R.S. de Weijert, J. Stoker, S. Bipat AMC Amsterdam, Amsterdam 12:30 – 12:40 Contrast induced nephropathy and adverse events in the long term after O05.04 intravenous contrast enhanced computed tomography. A meta-analysis S.I. Moos, D.N.H. van Vemde, J. Stoker, S. Bipat AMC Amsterdam, Amsterdam 12:40 – 12:50 Imaging of the whole spine: differentiating (early) spondyloarthritis and O05.05 degenerative changes F. de Bruin, D. van der Heijde, J.L. Bloem, M. Reijnierse LUMC, Leiden 12:50 – 13:00 Degenerative Changes of the Spine on MRI in Patients with Inflammatory Back O05.06 Pain from the DESIR Cohort F. de Bruin1, M.O. Treyvaud2, J.L. Bloem1, M. Dougados2, L. Gossec2, A. Feydy2, D. van der Heijde1, M. Reijnierse1 1 LUMC, Leiden 2 Hopital Chocin, Parijs, France 13:00 – 13:10 Association of tracheal index on chest computed tomography with COPD, lung O05.07 function, emphysema and airway wall thickness E. Pompe, L. Gallardo Estrella, B. van Ginniken, H.J. de Koning, M. Oudkerk, E.M. Van Rikxoort, F.A.A. Mohamed Hoesein, J.W.J. Lammers UMC Utrecht, Utrecht DEXTER 21-24 Sessie 6: Miscellaneous II Abstracts: vanaf pagina 35 Voorzitters: Dr. R.E. van Gelder, HagaZiekenhuis, Den Haag M. Thomeer, Erasmus MC, Rotterdam 11:55 – 12:10 Keynote lecture: Hepatocellular adenoma: to treat or not to treat? O06.01 A comprehensive analysis of the current literature D.C. Bijdevaate, M. Thomeer Erasmus MC, Rotterdam 12:10 – 12:20 Histology of hypodense parafissural pseudolesions in the liver O06.02 L.J.P. Sonnemans, N. Köster, J.A. van der Laak, P.J. Slootweg, M. Prokop, W.M. Klein Radboudumc, Nijmegen Vervolg op pagina 6 Het schematische programmaoverzicht vindt u achterin deze syllabus rechts naast pagina 64. 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 5 programma & abstracts programma donderdag Vervolg donderdag 11 september 2014 12:20 – 12:30 O06.03 12:30 – 12:40 O06.04 12:40 – 12:50 O06.05 12:50 – 13:00 O06.06 13:00 – 13:10 O06.07 Whole liver CT texture analysis: effect of the presence of metastatic disease on the remaining ‘non-diseased’ liver parenchyma. D.M.J. Lambregts1, S.-X. Rao1,2, R. Schnerr1, W. van Ommen1,3, L.A. Heijnen1, M.H. Martens1, R.F.A. Vliegen4, G.L. Beets1, R.G.H. Beets-Tan1 1 MUMC, Maastricht 2 Fudan University, Shanghai, China 3 Catharina Ziekenhuis, Eindhoven 4 Atrium Medisch Centrum, Heerlen Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: A meta-analysis C.A.J. Puylaert, J.A.W. Tielbeek, S. Bipat, J. Stoker AMC Amsterdam, Amsterdam Klinische waarde van verbeterde detectie door digitale borst tomosynthese en het gesynthetiseerde 2D mammogram bij borstkanker E.J.B. van Dijk, M.C.J.M. Kock Albert Schweitzer Ziekenhuis, Dordrecht Screening outcome at subsequent digital screening mammography in the south of the Netherlands R.J.P. Weber1, J. Nederend1, L.E.M. Duijm2 1 Catharina Ziekenhuis, Eindhoven 2 Canisius Wilhelmina Ziekenhuis, Nijmegen Detection of bone marrow edema after irradiation with Dual-Energy CT (DE-CT) and virtual non-calcium images A.A. Postma1, A.A.R. Stadler1, R.A. Bockmann1, F. Hoebers2, P. Kessler1, L.J. Poort1 1 MUMC, Maastricht, 2 Maastro, Maastricht FOYER 13:10 – 14:10 LUNCH 6 14:10 – 14:40 LIMOUSIN 2 NVVR EN DE FEDERATIE - KRACHTEN BUNDELEN MET BEHOUD IDENTITEIT Mw. Dr. H.C. Holscher, HagaZiekenhuis, Den Haag 14:40 – 14:55 LAUDATIE PROF. DR. J.S. LAMERIS Prof. dr. J. Stoker, AMC Amsterdam, Amsterdam 14:55 – 15:00 Zaalwisseling 15:00 – 16:00 REFRESHER COURSES 15:00 – 16:00 15:00 – 15:25 15:25 – 15:50 15:00 – 16:00 15:00 – 15:30 15:30:16:00 LIMOUSIN 2 Mammadiagnostiek anno 2014: voor iedereen of slechts de ‘happy few’? Omschrijving en leerdoelen: pagina 15 Voorzitter: M. Logtenberg, Gelre Ziekenhuizen, Apeldoorn De BI-RADS lexicon anno 2014 Mw. Dr. H.M. Zonderland, AMC, Amsterdam MRI-geleide mammabiopten: ‘how I do it’ Mw. M.A. Fernandez-Gallardo, AMC, Amsterdam LIMOUSIN 3 Coronair CT voor elke radioloog Omschrijving en leerdoelen: pagina 15 Voorzitter: Mw. Dr. B.K. Velthuis, UMC Utecht, Utrecht Coronair CT scan protocol en medicatie. Normale anatomie en coronair anomalieen. Kalkscore en plaque typering. Dr. R.P.J. Budde, UMC Utrecht, Utrecht Beoordeling van de coronairen aan de hand van cases Drs. J.J. Kardux, Gelre Ziekenhuizen, Apeldoorn 15:00 – 17:30 PARALLEL SECTIE VERGADERING ABDOMEN, KNO EN MSK 15:00 – 17:30 15:00 – 15:05 LIMOUSIN 1 Sectiemiddag Abdomen Opening door dagvoorzitter k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 19E RADIOLOGENDAGEN 2014 Vervolg donderdag 11 september 2014 15:05 – 15:15 Mededelingen Sectiebestuur 15:15 – 15:35 SKMS Project Standaardisatie van CT en MRI Abdomen protocolllen Update project en voorbeelden – M. Lahaye, MUMC, Maastricht 15:35 – 15:50 Leveradenomen: beelvorming en beleid – T. Meulman, ASZ Dordrecht 15:50 – 16:20 New insights in the diagnosis of early-stage HCC – Prof. dr. V. Vilgrain, Paris, France 16:20 – 16:45 Casus presentaties differentianten en fellows Abdomen 16:45 – 17:15 HCC in the non-cirrhotic liver – Prof. dr. V. Vilgrain, Paris, France 17:15Sluiting DEXTER 15-16 15:00 – 16:30 Sectiemiddag KNO DEXTER 21-24 15:00 – 16:00 Sectievergadering MSK Enkel toegankelijk voor leden FOYER 16:00 – 16:30KOFFIE/THEEPAUZE LIMOUSIN 2 16:30 – 17:30 SPECIALE SESSIE VOOR AIOS – WERKEN IN HET BUITENLAND Voorzitters: Mw. Dr. M.E.S. Sprengers, AMC, Amsterdam Dr. E.F.W. Courech Staal, OLVG, Amsterdam In- en uitstroom, de feiten Dr. P.J. Roscam Abbing, Diakonessenhuis, Utrecht Werken in het buitenland en alles wat daarbij vooraf komt kijken Mw. L. Klop-Hendrikx, BKV Groep, Nederland Werken in het buitenland na je opleiding, ervaringen uit Denemarken. F. Meijer, Regionshospitalet Herning, Denemarken 16:30 – 17:30 REFRESHER COURSES 16:30 – 17:30 16:30 – 16:50 16:50 – 17:10 17:10 – 17:30 16:30 – 17:30 16:30 – 17:30 LIMOUSIN 3 The Great Mimickers in Chest Radiology Omschrijving en leerdoelen: pagina 16 Voorzitter: Mw. Dr. I.J.C. Hartmann, Maasstad Ziekenhuis, Rotterdam Sarcoidose Mw. Dr. I.J.C. Hartmann, Maasstad Ziekenhuis, Rotterdam Organizerende pneumonie Mw. M. Spee-Dropková, Antonius Nieuwegein, Nieuwegein Lymfoom Mw. M.M. Snoeren, Radboudumc, Nijmegen DEXTER 25-26 De geschiedenis van de radiologie Omschrijving en leerdoelen: pagina 16 Voorzitter: Dr. C.J.L.R. Vellenga, emeritus Het soft tissue probleem en de evolutie van de beeldvormende techniek in de jaren 1950-1975 Prof. dr. E.S. Houwaart, Maastricht University, Maastricht 17:30 – 17:35 Zaalwisseling LIMOUSIN 2 17:35 – 18:15QUIZZ Mw. Dr. A.A. Jacobi-Postma, MUMC, Maastricht U.C. Lalji, MUMC, Maastricht 18:15 SLUITING DOOR DE VOORZITTER Dr. J. Hendrikse, UMC Utrecht, Utrecht FOYER 18.15 – 19.00 BORREL IN 1931 CONGRESCENTRUM BRABANTHALLEN ORANGERIE 19:30 – 00:00 AANVANG DINER & FEEST IN DE ORANGERIE TE DEN BOSCH MET GASTOPTREDEN HANS DULFER Het schematische programmaoverzicht vindt u achterin deze syllabus rechts naast pagina 64. 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 7 programma & abstracts programma vrijdag Vrijdag 12 september 2014 FOYER 08:00 – 08:30 ONTVANGST & REGISTRATIE Dagvoorzitters: Mw Dr. M.E.S. Sprengers, AMC, Amsterdam Mw. I.M. Bruynzeel-Koster, ASZ, Dordrecht 08:30 – 09:30 REFRESHER COURSES 08:30 – 09:30 08:30 – 08:50 08:50 – 09:10 09:10 – 09:30 08:30 – 09:30 08:30 – 08:50 08:50 – 09:10 09:10 – 09:30 LIMOUSIN 3 De (schedel)basis in de acute en/of levensbedreigende setting Omschrijving en leerdoelen: pagina 16 Voorzitter: Mw. M.J. Lamers, UMC Groningen, Groningen Anatomie schedel(basis)-sphenoid Dr. F.A. Pameijer, UMC Utrecht, Utrecht Pathologie gecentreerd rondom sella-sphenoid benaderd vanuit intracraniële hoek Dr. P. de Graaf, VUmc, Amsterdam Pathologie gecentreerd rondom sella-sphenoid benaderd vanuit extracraniële hoek B.J. Emmer, LUMC, Leiden LIMOUSIN 2 Maligne lymfomen Omschrijving en leerdoelen: pagina 16 Voorzitter: Dr. R.A.J. Nievelstein, UMC Utrecht, Utrecht Maligne lymfoom. Klinische achtergrond, stadiering Mw. Prof. dr. J. Zijlstra Ct beeldvorming en metingen Dr. R.A.J. Nievelstein, UMC Utrecht, Utrecht of PET/CT scanning Prof. O. Hoekstra 09:30 – 10:00 LIMOUSIN 2 MISSERS EN VEILIGHEIDSCULTUUR, THINKING HIGH EN LOW IN LUCHTVAART EN RADIOLOGIE M. Haerkens, Wings of Care, ‘s-Hertogenbosch 10:00 – 10:30 COGNITIVE ERRORS IN RADIOLOGY Dr. G.J. Jager, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 10:30 – 10:45 COMPLICATIE REGISTRATIE Prof. dr. M.W de Haan, MUMC, Maastricht FOYER 10:45 – 11:15KOFFIE/THEEPAUZE 11:15 – 12:30 ABSTRACTS & EDUCATIONALS LIMOUSIN 1 Sessie 7: Musculoskeletale Radiologie Abstracts: vanaf pagina 39 Voorzitters: Dr. P.R. Kornaat, Bronovo Ziekenhuis, Den Haag Dr. E.H.G. Oei, Erasmus MC, Rotterdam 11:15 – 11:30 Keynote lecture: Traumatic Hip Dislocation O07.01 P.H. Ousema, R.E. Westerbeek Deventer Ziekenhuis, Deventer 11:30 – 11:40 Opposed-phase gradient echo MR imaging improves image quality and O07.02 visualization of erosions in arthritis W. Stomp, J.L. Bloem, T.W.J. Huizinga, A.H.M. van der Helm-van Mil, M. Reijnierse LUMC, Leiden 8 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 19E RADIOLOGENDAGEN 2014 Vervolg vrijdag 12 september 2014 11:40 – 11:50 O07.03 Quantitative CT arthrography of the human knee to measure cartilage biochemical composition: results of an in-vivo validation study against ex-vivo reference standards J. van Tiel, M. Siebelt, M. Reijman, P.K. Bos, E. Waarsing, J.A.N. Verhaar, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus MC, Rotterdam 11:50 – 12:00 T2 relaxation times of knee articular cartilage in osteoarthritis patients are not O07.04 influenced by gadolinium contrast agent J. Verschueren, J. van Tiel, M. Reijman, E.E. Bron, S. Klein, J.A.N. Verhaar, S.M.A. Bierma-Zeinstra, G.P. Krestin, G. Kotek, E.H.G. Oei Erasmus MC, Rotterdam 12:00 – 12:10 Osteoporosis Screening with Computed Tomography: Contrast Media Significantly O07.05 Affects Bone Signal E. Pompe1, M.J. Willemink1, G. Dijkhuis2, H.J.J. Verhaar1, F.A.A. Mohamed Hoesein1, P.A. de Jong1 1 UMC Utrecht, Utrecht 2 St. Antonius ziekenhuis, Nieuwegein 12:10 – 12:20 Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is superior to T1rhoO07.06 mapping in measuring cartilage glycosaminoglycan content: results of an in-vivo validation study against ex-vivo reference standards for cartilage composition J. van Tiel, G.P. Kotek, M. Reijman, P.K. Bos, E.E. Bron, S. Klein, J.A.N. Verhaar, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus MC, Rotterdam 12:20 – 12:30 Evaluating MRI-detected tenosynovitis of the hand and wrist in early arthritis O07.07 W.P. Nieuwenhuis, A. Krabben, W. Stomp, T.W.J. Huizinga, J.L. Bloem, A.H.M. Van der Helm-Van Mil, M Reijnierse LUMC, Leiden LIMOUSIN 2 Sessie 8: Mammoradiologie Abstracts: vanaf pagina 43 Voorzitters: A.M.Th. Schmitz, UMC Utrecht, Utrecht Dr. R.M. Pijnappel, UMC Utrecht, Utrecht 11:15 – 11:30 Association Between Rim Enhancement of Breast Tumors in Dynamic ContrastO08.01 Enhanced MRI and Outcome of Patients With Invasive Breast Cancer A.M.T.h. Schmitz1, C.E. Loo2, K.G.A. Gilhuijs1 1 UMC Utrecht, Utrecht 2 Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam 11:30 – 11:40 7T Breast MR Imaging for Preoperative Characterization of Breast Cancer using O08.02 One-stop-shop Dynamic Contrast Enhancement, Diffusion-weighted Imaging, and Phosphorus MR Spectroscopy A.M.T.h. Schmitz1, W.B. Veldhuis1, M.B.E. Menke-Pluijmers2, W.J.M. van der Kemp1, T.A. van der Velden1, M.C.J.M. Kock2, P.J. Westenend2, D.W.J. Klomp1, K.G.A. Gilhuijs1 1 UMC Utrecht, Utrecht 2 Albert Schweitzer Hospital, Dordrecht 11:40 – 11:50 Association between parenchymal enhancement of the contralateral breast in O08.03 DCE-MRI and outcome of patients with unilateral breast cancer B.H.M. van der Velden1, I. Dmitriev1, C.E. Loo2, K.G.A. Gilhuijs1 1 UMC Utrecht, Utrecht 2 Antoni van Leeuwenhoek, Amsterdam 11:50 – 12:00 Ultrasound guided breast-conserving surgery for palpable and non-palpable early O08.04 stage invasive breast cancer: Results from a general hospital W.A. Slijkhuis, K.E. Droogh-de Greve, J.L.M. de Win, J.W.C. Gratama Gelre Ziekenhuizen Apeldoorn, Apeldoorn 12:00 – 12:10 Stralingdosis van contrast-enhanced spectral mammography vergeleken met full O08.05 field digital mammografie U.C. Lalji1, C. Jeukens1, E. Meijer2, B. Bakija1, R. Theunissen1, J.E. Wildberger1, M. Lobbes1 1 MUMC, Maastricht 2 Maxima medisch centrum, Veldhoven 12:10 – 12:20 De diagnostische waarde van T2- en diffusie-gewogen axillaire MRI voor O08.06 okselklierstadiëring bij borstkanker M. Paiman1, R.J. Schipper1, R.G.H. Beets-Tan1, P.J. Nelemans1, B. de Vries1, E.M. Heuts1, K.K.B.T. van de Vijver2, K.B.M.I. Keymeulen1, B. Brans1, M.L. Smidt1, M.B.I. Lobbes1 1 MUMC, Maastricht 2 Nederlands Kanker Instituut - Antoni van Leeuwenhoek, Amsterdam Vervolg op pagina 10 Het schematische programmaoverzicht vindt u achterin deze syllabus rechts naast pagina 64. 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 9 programma & abstracts programma vrijdag Vervolg vrijdag 12 september 2014 12:20 – 12:30 Diffusion weighted imaging of breast lesions: a systematic review and meta O08.07analysis M.D. Dorrius, H. Dijkstra, M. Oudkerk, P.E. Sijens UMC Groningen, Groningen LIMOUSIN 3 Sessie 9: Forensische Radiologie Abstracts: vanaf pagina 47 Voorzitter: Mw. Dr. W.M. Klein, Radboudumc, Nijmegen 11:15 – 11:30 Keynote lecture: Stand van zaken in de postmortem radiologie Mw. Dr. W.M. Klein, Radboudumc, Nijmegen 11:30 – 11:40 Forensic safety of MRI in gunshot victims. O09.01 P.A.M. Hofman1, M. Luijtne2, W. van Lohuizen2, J. Kroll1, R.S. Schnerr1, I.I.H. Haest1 1 MUMC, Maastricht 2 Nationale Politie, Heerlen 11:40 – 11:50 Comparison between radiologist and pathologist in determining trajectories in O09.02 gunshot victims. R.A.T. van Kan1, B. Kubat2, I.I.H. Haest3, W. van Lohuizen1, J. Kroll3, M.J. Lahaye3, A.A. Postma3, P.A.M. Hofman3 1 Nationale Politie, Heerlen 2 Netherlands Forensic Institute, Den Haag 3 MUMC, Maastricht 11:50 – 12:00 Postmortem interval estimation: value of postmortem cerebral CT O09.03 A.R. Bayat, K. Kamphuis, D. Koopmanschap, W.M. Klein Radboudumc, Nijmegen 12:00 – 12:10 Leeftijdsbepaling van subdurale hematomen met CT en MRI: een systematische review O09.04 F.A.M. Postema, T. Sieswerda-Hoogendoorn, D. Verbaan, C.B. Majoie, R.R. van Rijn AMC Amsterdam, Amsterdam 12:10 – 12:20 Leeftijdsbepaling van subdurale hematomen; enquete onder radiologen O09.05 F.A.M. Postema, T. Sieswerda-Hoogendoorn, C.B. Majoie, R.R. van Rijn AMC Amsterdam, Amsterdam 12:20 – 12:30 Post-mortem CT imaging with biopsies as an alternative to autopsy in the O09.06 diagnosis of cause of death in the intensive care unit: initial observations F.C.H. Bakers, P.A.M. Hofman, J. Kroll, R. Prevos, B. de Vries, B. Latten, I.I.H. Haest, M.J. Lahaye MUMC, Maastricht DEXTER 11-14 Sessie 10: Educatief & Onderwijs Abstracts: vanaf pagina 50 Voorzitters: Prof. dr. M. Maas, AMC, Amsterdam 11:15 – 11:30 Radiologisch onderwijs/kennisniveau blijkt onder de maat O10.01 A. van der Plas Medisch Centrum Alkmaar, Alkmaar 11:30 – 11:40 Authentic radiology progress tests (voortgangstoetsen) in postgraduate medical O10.02 education with volume datasets A. van der Gijp, C.J. Ravesloot, C.A. Tipker, K. de Crom, D.R. Rutgers, M. van der Schaaf, K.L. Vincken, M Maas, J.P.J. van Schaik UMC Utrecht, Utrecht, 11:40 – 11:50 Wat is een goed radiologisch verslag? Overzicht van de richtlijnen O10.03 S. Jacobs, J. Bakker Albert Schweitzer Ziekenhuis, Dordrecht 11:50 – 12:00 TraIT: Een duurzame IT infrastructuur in Nederland voor translationeel onderzoek O10.04 A.L.A.J. Dekker, J. van Soest, S. Klein, W. Niessen, A. van der Lugt MAASTRO Clinic, Maastricht 12:00 – 12:10 Radiologische bevindingen bij patienten met sikkelcelanemie; wat te zien en waarom? O10.05 L.E.M. Smagge1, R.E. Westerbeek1, J.L.E. Tai2 1 Deventer Ziekenhuis, Deventer 2 St. Elisabeth Ziekenhuis, Willemstad, Curaçao 12:10 – 12:20 Non-diagnostic results of fine needle aspiration cytology of thyroid nodules. O10.06 S. Jacobs Albert Schweitzer Ziekenhuis, Dordrecht, 12:20 – 12:30 Computed tomography observer agreement in malignant lymphoma O10.07 A.H. de Jong UMC Utrecht, Utrecht 10 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 19E RADIOLOGENDAGEN 2014 Vervolg vrijdag 12 september 2014 11:15 – 11:30 O11.01 11:30 – 11:40 O11.02 11:40 – 11:50 O11.03 11:50 – 12:00 O11.04 12:00 – 12:10 O11.05 12:10 – 12:20 O11.06 12:20 – 12:30 O11.07 DEXTER 21-24 Sessie 11: Miscellaneous III Abstracts: vanaf pagina 54 Voorzitter: Dr. B. de Keizer, UMC Utrecht, Utrecht De voorspellende waarde van CT-hersenen bij een licht traumatisch schedel/hersenletsel in een niet-academisch ziekenhuis. J.J.G. Slangen, N. Pernot, D. Rijpsma, C. Meeuwis Rijnstate Ziekenhuis, Arnhem Is reperfusion mandatory for hemorrhagic transformation occurrence after rtPA treatment in patients with acute ischemic stroke? A.D. Horsch1, J.W. Dankbaar1, Y. van der Graaf2, W.P.T.M. Mali1, B.K. Velthuis1 1 UMC Utrecht, Utrecht 2 Julius Centrum, Utrecht Bone marrow FDG-PET/CT cannot replace bone marrow biopsy in diffuse large B-cell lymphoma H.J.A. Adams, T.C. Kwee, R. Fijnheer, S.V. Dubois, R.A.J. Nievelstein, J.M.H. de Klerk UMC Utrecht, Utrecht Diffusely increased bone marrow FDG uptake in treatment-naive lymphoma: incidence and relevance H.J.A. Adams, T.C. Kwee, R. Fijnheer, S.V. Dubois, R.A.J. Nievelstein, J.M.H. de Klerk UMC Utrecht, Utrecht Appearance of the synovium on contrast-enhanced MRI of the knee in asymptomatic controls compared to juvenile idiopathic arthritis patients C.M. Nusman1, R. Hemke1, M.A. Benninga2, A. Kindermann2, M.A.J. Van Rossum1, T.W. Kuijpers2, M. Maas1 1 AMC Amsterdam, Amsterdam 2 Emma Kinderziekenhuis AMC, Amsterdam Cerebral perfusion from infant till adolescence assessed with MR pseudo continuous ASL M. Lequin, T. Compagnoni EMCR, Nederland High resolution non-pressure MRI for preoperative work-up in anorectal malformation during the neonatal period: a prospective study comparing with X-ray fluoroscopic imaging using surgical findings as reference standard. N. de Graaf, M.G. Thomeer, A. Devos, M.L. Lequin, C.J.H.M. Meeussen, I. de Blaauw, C.E.J. Sloots Erasmus MC, Rotterdam 12:30 – 12:35 Zaalwisseling LIMOUSIN 2 12:35 – 13:00PRIJZENSESSIE Voorzitters: Mw. Dr. M.E.S. Sprengers, AMC, Amsterdam Mw. I.M. Bruijnzeel-Koster, Albert Schweitzer Ziekenhuis, Dordrecht Philipsprijs Best Abstract Prijs Travel Grant FOYER 13:00 – 14:00LUNCH 14:00 – 15:30 14:00 – 14:30 14:30 – 15:00 15:00 – 15:30 LIMOUSIN 2 MISSERS SESSIES Voorzitters: Mw. Dr. M.E.S. Sprengers, AMC, Amsterdam Mw. I.M. Bruijnzeel-Koster, Albert Schweitzer Ziekenhuis, Dordrecht Sectie Acute Radiologie Mw. Dr. M. Brink, Radboudumc, Nijmegen J.W. Op den Akker, MRON loc. ZGT, Almelo Sectie Kinderradiologie Prof. dr. S.G.F. Robben, MUMC, Maastricht Sectie Thoraxradiologie Mw. M.M. Snoeren, Radboudumc, Nijmegen Mw. R. Verhees, Catharina Ziekenhuis, Eindhoven 15:30 – 16:00 COMPLICATIE SESSIE (VASCULAIR EN NON-VASCULAIR) SECTIE INTERVENTIE RADIOLOGIE Dr. M.R. Meijerink, VUmc, Amsterdam 16:00 SLUITING DOOR DE VOORZITTER Dr. J. Hendrikse, UMC Utrecht, Utrecht FOYER 16:05 AFSLUITENDE BORREL Het schematische programmaoverzicht vindt u achterin deze syllabus rechts naast pagina 64. 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 11 programma & abstracts genomineerden Genomineerde abstracts voor de Best Abstract Prijs 2014 12 O03.06 CTA derived from CT perfusion data obviates the need for separate cranial CTA in Acute Stroke E.J. Ewoud1, E.J. Vonken1, F.J.A. Meijer2, J.W. Dankbaar1, A.D. Horsch1, B. Ginneken2, B.K. Velthuis1, I. van der Schaaf1, M. Prokop2 1 UMC Utrecht, Utrecht 2 Radboudumc, Nijmegen O03.07 White matter degenerates over time, a longitudinal diffusion MRI analysis L.G.M. Cremers, M. de Groot, A. Hofman, G. Krestin, A. van der Lugt, W. Niessen, M. Ikram, M. Vernooij Erasmus MC, Rotterdam O04.01 Survival and recurrence rates after radiofrequency ablation and combined radiofrequency and drug-eluting bead transarterial chemoembolization in inoperable hepatocellular carcinoma J.J. Schaapman, M.C. Burgmans, B. Ortega, R. Wolterbeek, C.S.P. van Rijswijk, S. Osanto, A.F.M. Schaapherder, M.J. Coenraad, A.R. Van Erkel LUMC, Leiden O07.06 Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is superior to T1rho-mapping in measuring cartilage glycosamino- glycan content: results of an in-vivo validation study against ex-vivo reference standards for cartilage composition J. van Tiel, G.P. Kotek, M. Reijman, P.K. Bos, E.E. Bron, S. Klein, J.A.N. Verhaar, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus MC, Rotterdam O07.07 Evaluating MRI-detected tenosynovitis of the hand and wrist in early arthritis W.P. Nieuwenhuis, A. Krabben, W. Stomp, T.W.J. Huizinga, J.L. Bloem, A.H.M. van der Helm-Van Mil, M. Reijnierse LUMC, Leiden k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 19E RADIOLOGENDAGEN 2014 Genomineerde abstracts voor de NVvR Travel Grant 2014 O01.03 Value of Dynamic Contrast Enhanced MRI and Fusion with T2-weighted Imaging for Local Staging of Recurrent Rectal Cancer: Correlation with Surgery and Histopathology of Resected Specimen R.M. van Waardhuizen, R.S. Dwarkasing, W.J. Alberda, M. Doekas, M.A.J. de Ridder, J.J.M.E. Nuyttens, C. Verhoef, F.E.J.A. Willemssen Erasmus MC, Rotterdam O02.03 Multidetector-row CT for prosthetic heart valve evaluation can replace invasive coronary angiography in selected patients D. Suchá, W. Tanis, E.M. Laufer, J. Habets, L.A. Van Herwerden, P. Symersky, S. Chamuleau, R.P.J. Budde UMC Utrecht, Utrecht O03.03 Predictors of reperfusion in acute ischemic stroke patients A.D. Horsch1, J.W. Dankbaar1, Y. van der Graaf2, W.P.T.M. Mali1, B.K. Velthuis1 1 UMC Utrecht, Utrecht 2 Julius Centrum, Utrecht O04.06 MRI with a weak albumin binding contrast agent has additional value for the detection of endoleaks in patients with enlarging aneurysm after endovascular repair J. Habets1,2, H. Zandvoort1, F.L. Moll1, E.P.A. Vonken1, L.W. Bartels3, J.A. Herwaarden1, T. Leiner1 1 UMC Utrecht, Utrecht 2 Gelre Ziekenhuizen, Apeldoorn 3 Imaging Science Institute, Utrecht O05.03 Contrast induced nephropathy and adverse events in the long term after intravenous contrast enhanced computed tomography. A meta-analysis S.I. Moos, R.S. de Weijert, J. Stoker, S. Bipat AMC Amsterdam, Amsterdam 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 13 programma & abstracts genomineerden Vervolg O06.04 Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: A meta-analysis C.A.J. Puylaert, J.A.W. Tielbeek, S. Bipat, J. Stoker AMC Amsterdam, Amsterdam O07.04 T2 relaxation times of knee articular cartilage in osteoarthritis patients are not influenced by gadolinium contrast agent J. Verschueren, J. van Tiel, M. Reijman, E.E. Bron, S. Klein, J.A.N. Verhaar, S.M.A. Bierma-Zeinstra, G.P. Krestin, G. Kotek, E.H.G. Oei Erasmus MC, Rotterdam O07.06 Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is superior to T1rho-mapping in measuring cartilage glycosami noglycan content: results of an in-vivo validation study against ex-vivo reference standards for cartilage composition J. van Tiel, G.P. Kotek, M. Reijman, P.K. Bos, E.E. Bron, S. Klein, J.A.N. Verhaar, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus MC, Rotterdam O07.07 Evaluating MRI-detected tenosynovitis of the hand and wrist in early arthritis W.P. Nieuwenhuis, A. Krabben, W. Stomp, T.W.J. Huizinga, J.L. Bloem, A.H.M. van der Helm-Van Mil, M. Reijnierse LUMC, Leiden O08.01 Association Between Rim Enhancement of Breast Tumors in Dynamic Contrast-Enhanced MRI and Outcome of Patients With Invasive Breast Cancer A.M.T.h. Schmitz1, C.E. Loo2, K.G.A. Gilhuijs1 1 UMC Utrecht, Utrecht 2 Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam O11.05 Appearance of the synovium on contrast-enhanced MRI of the knee in asymptomatic controls compared to juvenile idiopathic arthritis patients C.M. Nusman1, R. Hemke1, M.A. Benninga2, A. Kindermann2, M.A.J. Van Rossum1, T.W. Kuijpers2, M. Maas1 1 AMC Amsterdam, Amsterdam 2 Emma Kinderziekenhuis AMC, Amsterdam 14 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 19E RADIOLOGENDAGEN 2014 Refresher Courses Donderdag 11 september, 10:45 – 11:45 uur Diagnose en behandeling van levermetastasen van colorectaal carcinoom anno 2014 Leerdoel(en) 1. Doelgroep is de algemeen radioloog of de abdominaal geïnteresseerd / gespecialiseerd radioloog die niet in een ‘levercentrum’ werkt. Een radioloog die dus wel een rol speelt in de screening op levermetastasen, de opwerking van de patiënt met levermetastasen voor eventuele behandeling en een rol speelt in de follow up na behandeling, maar die de betrokkenheid bij de behandeling zelf mist. Niettemin is deze betrokkenheid wel heel belangrijk om zijn/haar rol vooraf en achteraf kwalitatief invulling te kunnen geven; 2. Kennis over de behandeling levermetastasen van CRC actualiseren; 3. Kennis over optimale diagnostische strategie bij levermetastasen van CRC actualiseren; 4. Kennis over radiologische beelden na behandeling (problemen en pitfalls) van levermetastasen van CRC actualiseren. De postoperatieve knie Leerdoel(en) 1. Kennis krijgen van de meest verrichte chirurgische technieken voor het kniegewricht; 2. Inzicht krijgen in de radiologische evaluatie na gewrichtssparende procedures, zoals kruisband- en meniscusoperaties; 3. Inzicht krijgen in de radiologische evaluatie na gewrichtsvervangende procedures (protheses); 4. Kennisnemen van de nucleair geneeskundige evaluatie van gewrichtsvervangende procedures (protheses). Refresher Courses Donderdag 11 september, 15:00 – 16:00 uur Mammadiagnostiek anno 2014: voor iedereen of slechts de ‘happy few’? Leerdoel(en) 1. Overzicht van de correcte terminologie in mammografische verslaglegging; 2. Veranderingen in de nieuwe editie van de BI-RADS lexicon; 3. Overzicht van de praktische uitvoering van MRI-geleide biopten van de mamma; 4. Indicaties en contra-indicaties voor MRI-geleide biopten van de mamma. 1 9 E Coronair CT voor elke radioloog Leerdoel(en) 1. Inzicht krijgen in de coronair CT scan protocol en medicatie; 2. Bekend worden met de normale anatomie met segment indeling van de coronairen, en coronair anomalieen; 3. Bekend worden met coronair kalkscore en plaque typering 4. Beoordeling van de kalkscore, coronair plaque en stenose graad aan de hand van cases. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 15 programma & abstracts omschrijving en leerdoelen Refresher Courses Donderdag 11 september, 16:30 – 17:30 uur The Great Mimickers in Chest Radiology Leerdoel(en) 1. Bekend raken met de klassieke kenmerken van deze aandoeningen 2. De meer atypische uitingsvormen van deze aandoeningen leren (her)kennen 3. Inzicht krijgen in de differential diagnosen van deze aandoeningen. De geschiedenis van de radiologie Het soft tissue probleem en de evolutie van de beeldvormende techniek in de jaren 1950-1975 Naarmate de kennis en de technische mogelijkheden in de radiologie zich in de jaren twintig, dertig en veertig van de twintigste eeuw zich verder ontwikkelden, werden ook de beperkingen van de röntgendiagnostiek van zachte weefsels steeds duidelijker. Na 1950 ging men spreken van het ‘soft tissue problem’ waarvoor maar geen oplossing leek te kunnen worden gevonden. In de gynaecologie-obstetrie, de neurologie en ook in de oncologie, zochten medici, technici en ook fabrikanten naarstig naar nieuwe benaderingen in de medische beeldvorming in het algemeen en in de radiologie in het bijzonder. Daarbij kwam het soms vanuit een verrassende hoek tot innovaties. De evolutie van de beeldvormende techniek na 1960 was bovendien onderhevig aan professionele competitie tussen radiologen en andere medische specialismen. Refresher Courses Vrijdag 12 september, 08:30 – 09:30 uur De (schedel)basis in de acute en/of levensbedreigende setting Leerdoel(en) 1. Beoordeling van de schedelbasis- sphenoid begint bij voldoende kennis van de anatomie. Deze zal gestructureerd worden besproken; 2.Ter adequate beoordeling van de schedelbasis zullen de correcte imaging technieken en protocollen van afwijkingen thv de schedelbasis worden besproken; 3.Bekend raken met klinische en radiologische differentiaal diagnose van acute en levensbedreigende afwijkingen thv de schedelbasis- keypoints en ‘need to know’ feiten voor zowel de algemeen als gespecialiseerd radioloog; casebased behandeld; 4. Adequate verslaglegging van relevante bevindingen: ‘what the surgeon needs to know’. 16 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l Maligne lymfomen Leerdoel(en) 1. Bekend raken met HOVON en kliniek en stadiering van maligne lymfomen; 2.Bekend raken met de cheson /Lugano CT respons criteria van lymfomen; 3.Geïnformeerd raken over de plaats van PET/CT bij de diagnostiek van het maligne lymfoom; 4. Bekend raken met beoordeling van F-18-FDG PET/CTs. 1 abdomen Sessie 1 Abdomen Donderdag 11 september, 11:55 – 13:10 uur O01.01 Tumour volumetry on diffusionweighted MRI for identification of complete tumour responders to preoperative chemoradiotherapy in rectal cancer: a multicenter validation study D.M.J. Lambregts1, S. Sassen2, S.X. Rao3, M.H. Martens1, L.A. Heijnen1, M Sosef2, G.L. Beets1, R.G.H. Beets-Tan1, R.F.A. Vliegen2 1 MUMC, Maastricht 2 Atrium MC, Heerlen 3 Fudan University, Shanghai, China Purpose: Retrospective studies have shown that diffusionweighted (DWI) tumour volumetry can identify rectal cancer patients with a complete tumour response after chemoradiotherapy (CRT). This study aims to prospectively validate the diagnostic value of these previous retrospective results in a larger and multicenter study. Methods: 112 rectal cancer patients (2 centres) underwent rectal MRI at 1.5T including standard T2W-MRI and DWI, both pre- and post-CRT. Two experienced readers determined pre-CRT and post-CRT tumour volumes on T2WMRI and DWI by means of free-hand tumour delineation on O01.02 Remaining malignant lymph nodes in good responders after chemoradiotherapy for rectal cancer: where are they located? M.J. Lahaye1, D.M.J. Lambregts1, L.A. Heijnen1, T. van Nijnatten1, S.-X. Rao2, M.H. Martens1, G.L. Beets1, R.G.H. Beets-Tan1 1 MUMC, Maastricht 2 Zhongshan Hospital, Shanghai, China Purpose: When considering local excision or wait-and-see’ after CRT in rectal cancer, nodal status is crucial. In spite of a good tumour response, any remaining N+ recurrence. 1 9 E each tumour-containing slice. Tumour volume reduction rates (?volume) after CRT were calculated. Previously determined T2W and DWI-thresholds for pre-volume, post-volume and ?volume were tested to prospectively assess their diagnostic value in identifying patients with a complete response. Results: Twenty-one patients had a complete response (yT0). Areas under the ROC-curve (mean measurements of two readers) for the pre-/post-/?-volumes were 0.73/0.82/0.78 for T2W-MRI and 0.83/0.92/0.86 for DWI. For T2W-volumetry prospectively calculated sensitivity/ specificity were 55%/74% for the pre-volumes, 60%/69% for the post-volumes and 60%/86% for ?volume. For DWIvolumetry sensitivity/specificity were 65%/76% for the pre- volumes, 70%/98% for the post-volumes and 70%/93% for ?volume. Interobserver agreement was excellent pre-CRT (ICC 0.92 for T2W and 0.81 for DWI) and good after CRT (ICC 0.75 and 0.72). Conclusions: Previously determined DWI volume thresholds can be reproduced with good results in a prospective and multicenter setting.- Post-CRT DWIvolumetry provides the best result for discriminating complete responders with an AUC of 0.92 and prospectively tested - sensitivity of 70% and specificity of 98%. Knowledge on the presence and location of these remaining N+ help guide treatment intensification (e.g. boost radiotherapy or targeted nodal excision). Aim of this study was to investigate patterns in the location of remaining N+ responders after CRT. Methods and Materials: 229 locally advanced rectal cancer patients underwent CRT, which resulted in a good response (downstaging to ypT0-2) in 145 patients. Fourtynine patients were excluded (no surgery or lesion-bylesion histology results). This left 96 ypT0-2 patients who constituted the final study group. For the patients with a ypT0-2N+ status, a detailed lesion-by-lesion comparison between restaging-MRI and histology was performed on the location of the individual N+ nodes. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 17 1 programma & abstracts Abstracts Results: 8/96 patients (8%) had a ypT0-2N+ status (total of 8 N+ nodes): 33% of the N+ nodes was located at the level of the tumour, 67% was located proximal from the tumour (at a median distance of 4 cm (range 1.2-6.5 cm) above the tumour level). In axial plane, 72% of the nodes was located at the ipsilateral side of the tumour, at a median distance of 0.6 cm (range 0-2.1 cm) from the tumour/rectal lumen. Conclusions: The incidence of remaining N+-nodes in case of good tumour response is very low. Remaining N+-nodes are solely located at the same level or proximal to the tumour. The majority of N+ nodes are located near the tumour/lumen. O01.03 Value of Dynamic Contrast Enhanced MRI and Fusion with T2-weighted Imaging for Local Staging of Recurrent Rectal Cancer: Correlation with Surgery and Histopathology of Resected Specimen R.M. van Waardhuizen, R.S. Dwarkasing, W.J. Alberda, M. Doekas, M.A.J. de Ridder, J.J.M.E. Nuyttens, C. Verhoef, F.E.J.A. Willemssen Erasmus MC, Rotterdam determine limits of agreement for measurements between two readers, performed on T2W and DCE MRI; and to assess agreement between measurements on T2W,DCE MRI of LRRC and histopathology-analysis. Purpose: The aim of this study was to evaluate the value of dynamic contrast enhanced(DCE) MRI, using visual analysis and image post-processing tools, for staging of locally recurrent rectal cancer(LRRC). Furthermore, the value of MRI for predicting surgical outcome was assessed. Method: This retrospective study included patients with surgically resected LRRC from 2003 till 2012. Patients had MRI (T1W, T2W, DCE-series) on 1.5T. Image interpretation by R1 (experienced reader) was compared with postprocessing image evaluation by R2 (inexperienced reader). MRI was correlated with surgery and histopathology(PA) of the resected specimen. Bland-Altman plots were used to O01.04 Gecombineerde blanco (3T) MRI van rectum en bovenbuik bij screening van patiënten met rectumcarcinoom J.M.F. van Wagenberg, D. Bouman, R. Bezooijen, C. Klazen Medisch Spectrum Twente, Enschede Doel: Evaluatie van MRI zonder contrast als mogelijk alternatief ten opzichte van een MRI-rectum met CTabdomen bij screening van patiënten met rectumcarcinoom. Methoden: Prospectieve dubbelblinde pilotstudie bij tien patiënten met rectumcarcinoom. Alle patiënten kregen volgens protocol een portaal-veneuze CT scan van het abdomen en een 3T-MRI van het rectum. De MRI-rectum werd gecombineerd met een blanco-MRI van de bovenbuik (Axiale-T2, T2-lange-TE, T1 in- en uit-fase, DWI[B0, 80, 400, 800] en coronale-T2).Twee ervaren abdomenradiologen 18 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l Results: 47 patients with a total of 51 lesions were included. 30(59%) tumors were radically resected (R0-resection). Lesions adhesive to the pelvic side walls or presacral fascia (n=28) resulted in 10(36%) R0-resections; non-adhesive lesions (n=23) resulted in 20(87%) R0-resections (P=0.001). Tumor dimensions measured on DCE showed better agreement than T2W (R1,R2). Tumor dimensions on DCE had better agreement with PA than T2W (R1). For R2; T2W/DCE fusion images showed best agreement with PA. Imaging characteristics of LRRC on DCE include: arterial,persistent enhancement (100%);peripheral rim-enhancement (59%);heterogeneous mosaic enhancement (21%). Conclusion: DCE MRI is more consistent for tumor dimensions than T2W and has typical imaging characteristics for LRRC. RO-resections were achieved in 36% of adhesive and 87% of non-adhesive tumors to the pelvic side walls or presacral fascia. beoordeelden de scans met een focus op eventuele lymfadenopathie en focale leverlaesies, die werden gescoord als benigne, maligne of onbeslist. Resultaten: De extra MRI van de bovenbuik werd goed doorstaan door alle patiënten. Er werden 54% meer leverlaesies gevonden bij MRI in vergelijking met CT (20 versus dertien). Er was consensus bij negentien van de 20 laesies. Een lesie op MRI werd zowel maligne als onbeslist gescoord. Vijf van de dertien laesies op CT waren onbeslist, waarvan er vier op MRI als benigne werden gekarakteriseerd. Bij een patint werden meerdere metastasen gevonden met op CT onenigheid over een laesie, waarbij op MRI geen afwijkingen werden gevonden. Waarschijnlijk betrof dit een perfusievariant. Additionele laesies in de milt, nieren, longen en wervel werden beter opgemerkt op MRI. Lymfeklieren werden gelijkmatig beoordeeld. 1 abdomen Conclusie: Bij stagering van rectumcarcinoom is een onestop-shop 3T-MRI zonder contrast een mogelijk alternatief ten opzichte van MRI-rectum in combinatie met een portaalveneuze CT-abdomen. Het is een patiëntvriendelijk en waarschijnlijk ook kosteneffectief alternatief. Kleine leverlaesies zijn beter te karakteriseren, zonder ioniserende straling en nefrotoxisch contrast. O01.05 MRI as a potential ‘one-stop-shop’ staging tool for colon cancer: can it replace CT for local staging? preliminary results M.J. Lahaye, D.M.J. Lambregts, F.C. Bakers, L.A. Heijnen, M.H. Martens, G.L. Beets, R.G.H. Beets-Tan MUMC, Maastricht undergoing [1] MRI (1.5T) including T2TSE, BTFE and DWI sequences of the whole abdomen and [2] contrast-enhanced CT (including PVP of the whole abdomen). An experienced reader independently analyzed MR and CT examinations and scored the tumor location (cecum, proximal/distal ascendens, transversum, descendens, sigmoid), T-stage and N-stage. Surgical and histopathological findings served as reference standard. Purpose: CT is nowadays routinely used for both local and distant staging of colon cancer. In the revised Dutch guidelines MRI is recommended as primary liver staging tool because of its superiority to CT. It would be beneficial to also perform local staging using MRI to provide a onestop-shop staging tool with the added benefit of limiting radiation. The purpose of this prospective study was tot evaluate the performance of MRI with diffusion-weighted imaging (DWI) versus CT for local staging of colon cancer. Results: Using MRI, tumor location, T-stage and N-stage were correctly predicted in 100%, 78% and 78% of cases, respectively. T-stage was over- and under estimated in 11%. N-stage was overestimated in 22% and underestimated in 11%. Using CT the corresponding results were 100% for location, 78% for T-stage and 22% for N-stage. T-stage was over- and under estimated in 11%. N-stage was overestimated in 56% and underestimated in 22%. Conclusion: Our pilot data suggests that MRI is not inferior to CT staging, and especially potentially better for nodal staging. Material and methods: In an ongoing pilot study we prospectively included nine patients with colon cancer, O01.06 Head-to-head comparison of mDIXON and proton density liver fat fraction (PDFF) maps with ¹H-MRS as reference value for diagnosing hepatic steatosis J.H. Runge, A.J. Nederveen, J. Verheij, U.H. Beuers, J. Stoker AMC Amsterdam, Amsterdam Purpose: Liver fat fractions (FF) are important in the workup of patients with liver disease. MRI allows accurate FF measurement. The mDIXON protocol enables single breath-hold acquisition of high resolution water- and fatonly images, but is biased due to a single fat peak model. Proton density fat fraction (PDFF) maps have lower spatial resolution but do apply a multipeak model. We compared mDIXON- and PDFF-determined FF with 1H-MRS-determined FF. Method and materials: Data from 24 patients with suspected steatosis/steatohepatitis were used. All gave written informed consent. Voxel-wise division of fat by 1 9 E fat+water mDIXON images resulted in mDIXON FF maps. Gradient Echo images at six TEs were used to reconstruct PDFF maps. Finally, multi-echo STEAM 1H-MRS was performed to obtain 1H-MRS FF. Fat maps were co-localized to the 1H-MRS voxel and Bland-Altman and Spearman’s correlation analyses were performed. Results: Median (IQR) FF values were 10.9 (4.3-18.3), 15.5 (6.4-23.1) and 11.6 (3.6-19.6) for 1H-MRS, mDIXON and PDFF, respectively. Correlations between 1H-MRS and mDIXON and PDFF were near perfect at 0.97 and 0.99, respectively. Mean paired differences between 1H-MRS and mDIXON and PDFF values were -3.7% and -0.38%. Linear regression analysis showed a non-zero slope for PDFF of -0.15 (95%CI:-0.23-0.06, P=0.0025) but not for mDIXON of 0.003 (95%CI:-0.11-0.12, P=0.96). Conclusion: While both mDIXON and PDFF showed near perfect correlation with 1H-MRS, Bland-Altman analysis revealed that only PDFF values showed excellent agreement with 1H-MRS FF with a mean difference of -0.38%. Hence, PDFF is preferable over mDIXON for diagnosing steatosis. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 19 2 programma & abstracts Abstracts Sessie 2 Cardiovasculair Donderdag 11 september, 11:55 – 13:10 uur O02.01 Dual-energy, CARE kV and reduced contrast medium volume in CTA of the abdominal aorta: A comparative analysis of image quality and radiation dose W.H. Nijhof1, E.J.M. Baltussen2, I.M.J. Kant2, G.J. Jager1, M.J. Rutten1 1 Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 2 Universiteit Twente, Enschede Objective: The purpose of this study is to determine the effect of reduced tube voltage, with Combined Applications to Reduce Exposure (CAREkV) CT and dual energy CT (DECT), and a minimal amount of contrast medium on the radiation dose and image quality of CTAs of the abdominal aorta. Results: Quantitative assessment showed that the mean intravascular contrast enhancement was significantly higher in the 80 kV acquisitions compared to the 100 kV and 120 kV acquisitions (P=0.038 and P=0.018, respectively). The image quality of the 80 kV acquisitions in both protocols was superior compared to the 100 kV, 120 kV or 140 kV. In the subgroup of patients undergoing CTA at 80 kV the effective dose reduced with 60% compared to the standard protocol employing 120 kV CTA. Study design: For this technical efficacy study 30 patients, who were referred for a CTA examination of the abdominal aorta, were included. Randomly, 15 patients were assigned to undergo the CAREkV protocol and fifteen patients were assigned to undergo the DECT protocol. In both protocols Conclusion: The findings of this study support the concept that the lower kilo-voltage can be used to reduce the radiation dose and contrast medium volume without compromising image quality. O02.02 Stress Myocardial Perfusion Imaging Versus Fractional Flow Reserve: MetaAnalysis R.A.P. Takx, B.A. Blomberg, P.A. de Jong, T. Leiner UMC Utrecht, Utrecht inclusion and exclusion criteria. Only studies using invasive coronary angiography combined with FFR for intermediate coronary stenoses as the reference standard were included. The QUADAS-2 criteria were used for quality appraisal. Metaanalysis was used to compute pooled sensitivity, specificity, likelihood ratios, and the diagnostic odds ratio (DOR). Analyses were performed on vessel and patient levels. Purpose: Myocardial perfusion imaging (MPI) is a technique that allows for detection myocardial ischemia. This metaanalysis determined the diagnostic accuracy of the different MPI techniques compared to fractional flow reserve (FFR) for the diagnosis of hemodynamically significant coronary artery stenosis. Materials and Methods: This meta-analysis was performed in adherence with the PRISMA statement recommendations. Two reviewers systematically searched PubMed, EMBASE and Web of Science electronic databases, using predefined 20 a test bolus injection of 10 mL ioversol 350 was used, followed by 20 mL of 1:1 with saline diluted contrast medium (ioversol 350). Quantitative analysis comprised determination of the mean attenuation (measured in Hounsfield Units), SNR, CNR, and radiation dose. Qualitative analysis was performed by 5 radiologists. k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l Results: In total, 36 studies (4250 vessels/1926 patients) satisfied the predefined inclusion criteria. At vessel level, MRI (pooled DOR 67.1 95%-CI 43.5-103.7) performed similar to PET (pooled DOR 58.9 95%-CI 6.3-547.4) and better than CT (pooled DOR 30.8 95%-CI 11.8-80.9) and SPECT (pooled DOR 7.5 95%CI 4.8-11.8). On a patient level MRI (pooled DOR 50.9 95%-CI 32.5-80.0) performed similar to CT (pooled DOR 57.7 95%-CI 21.6-154.4) and PET (pooled DOR 47.3 95%-CI 4.2-536.3), in contrast to SPECT (pooled DOR 10.1 95%-CI 4.4-23.5) and ECHO (pooled DOR 11.0 95%-CI 4.6-25.9). 2 cardiovasculair Conclusions: MPI, when using MRI, CT, or PET, allows for accurate detection of hemodynamically significant coronary artery stenosis as compared to invasive coronary angiography in combination with FFR. O02.03 Multidetector-row CT for prosthetic heart valve evaluation can replace invasive coronary angiography in selected patientsS D. Suchá, W. Tanis, E.M. Laufer, J. Habets, L.A. Van Herwerden, P. Symersky, S. Chamuleau, R.P.J. Budde UMC Utrecht, Utrecht CAD (group-II). MDCT-images were scored for presence/ absence of significant(>50%) coronary artery stenosis. In group-II, coronary bypasses were assessed for significant stenosis. CAG was the reference test. Introduction: Multidetector-row computed tomography(MDCT) is increasingly performed in patients with suspected prosthetic heart valve(PHV) dysfunction before reoperation. For evaluation of coronary artery stenosis requiring bypass surgery, additional invasive coronary angiography(CAG) is required. In PHV-dysfunction patients this may cause distant embolization of present vegetations or thrombi. We assessed whether MDCT can replace CAG in PHV-patients to rule out significant coronary artery stenosis. Methods: We included PHV patients with available retrospectively-ECG-gated MDCT and CAG imaging. Based on medical history, patients were divided into two groups; unknown coronary artery disease (CAD; group-I) and known O02.04 Contrast media reduction in CT angiography using low kV settings M. Kok, C. Mihl, A. Seehofnerova, S. Altintas, B.L.J.H. Kietselaer, J. Turek, J.E. Wildberger, M. Das MUMC, Maastricht Using lower kV in CT angiography (CTA) will result in higher attenuation values. This bares the potential to reduce contrast media (CM) volume. The purpose of this study was to investigate how to reduce CM volume in lower kV while keeping attenuation values diagnostically sufficient. CM (300mg Iodine/ml) was used and injected in a circulation phantom (BP 120/80mmHg, HR 60bpm). Serial CT scans were performed: 128x0.6mm coll., mAs 142, cycletime 0.43s, gantry rot.time 0.28s, delay 10s slice thickness 1mm/0.7mm and kernel B30f. Initially, the same injection protocol (volume=40ml, flow rate=5.3ml/s, Iodine delivery 1 9 E Results: Fifty-one patients(53 PHVs) were included: 38 in group-I and 13 in group-II, including 19 bypass-grafts. Mean time between MDCT and CAG was 8156days. In group-I, MDCT accurately ruled out significant stenosis in 19/38(50%) patients, but could not replace CAG in 19/38(50%) patients due to significant stenosis detection (n=3) and non-diagnostic image quality (n=16). In all group-II patients, MDCT correctly found =1 significant stenosis. For bypass grafts, MDCT accurately identified 3/3(100%) nonpatent grafts and 13/16(81%) patent grafts. Non-diagnostic MDCT image quality hampered evaluation of the remaining 3/16(19%) grafts. Conclusion: MDCT can replace invasive CAG for significant coronary artery stenosis rule out in approximately half of the PHV-patients without a CAD history. Patients with known CAD still require CAG, however MDCT may be used to assess bypass graft patency in most of these patients. [Hartstichting-2009B014] rate (IDR)=1.6g I/s and total iodine=12g I) was used for each kV setting (120 - 70kV). After that, IDR was decreased by steps of 0.2g I/s until diagnostically insufficient attenuation values (<325HU) were reached. Iodine load was consecutively reduced to keep injection time constant (7.5s). Attenuation values were measured and compared in the ascending aorta (AA), descending aorta (DA) and left main coronary artery (LM). Using identical injection parameters for each kV, attenuation values (HUSD) were: 3262 (120 kV); 4063 (100 kV); 5243 (80 kV); 6514 (70 kV). Minimal IDR and iodine load for lower kV settings were: 1.4g I/s and 10.5g I (100 kV); 1.0g I/s and 7.5g I (80 kV); 0.8g I/s and 6.0g I (70 kV). Iodine load and CM volume could be reduced by 12.5%, 37.5% and 50% in 100, 80 and 70 kV respectively compared to 120 kV. This could play an important role in terms of patient safety (CIN) and lowering costs. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 21 2 programma & abstracts Abstracts O02.05 High flow contrast media injection protocol in comprehensive pre-TAVI assessment. Initial results J. Turek, M. Kok, C. Mihl, B. Kietselear, J.E. Wildberger, M. Das MUMC, Maastricht Purpose: In pre-TAVI assessment a combined protocol with retrospective ECG-gated aortic root imaging and peripheral CTA requires special contrast bolus design. Thus the purpose of this study was to assess the feasibility of a high flow contrast media (CM) protocol in pre-TAVI evaluation. Materials and methods: 27 consecutive patients underwent pre-TAVI MDCT assessment following this protocol: Retrospective ECG gated dual energy MDCT of the aortic root, directly followed by a high pitch non-ECG gated CTA (100kV) of the aorta and peripheral arteries facilitating one CM bolus. CM bolus consisted of 90 ml of Results: No injection or flow related problems occurred in all patients. Assessment of aortic root diameters as well as peripheral access route was possible in all patients. Mean attenuations were: ascending aorta 497HU (SD50) (DE 120kV mix phase) and 641 (SD69) (DE 100kV), descending aorta 323HU (SD111), abdominal aorta 381HU (SD125), left femoral artery 538HU (SD137), and right femoral artery 531 (SD150) (high pitch CTA 100kV). Conclusions: Use of high flow rates/IDR is feasible and allows comprehensive assessment of the aortic root and peripheral arteries. High enhancement values may facilitate future CM bolus optimization. O02.06 Evaluation of image quality in different kV settings using different reconstruction algorithms in CT angiography of the aorta C. Mihl, M. Kok, J. Turek, J.E. Wildberger, M. Das 1 MUMC, Maastricht rate=4.7ml/s; volume=62ml; saline flush=14ml) was used (scan delay: test bolus technique). Image reconstruction: 2mm/1.4mm slice thickness using FBP (B30f) and IR (I30f, strength 3). Attenuation values (HU) as well as image noise (SD) were measured at four different anatomical levels. Signal-to-noise ratio (SNR) of both reconstruction algorithms was compared using an independent t-test. Purpose: Lower kV settings result in lower radiation dose while attenuation increases. Iterative reconstruction (IR) proved beneficial in reducing image noise compared to filtered back protection (FBP). Purpose was to evaluate image quality at lower kV settings and reconstruction with IR and FBP in CTA. Results: FBP image noise and SNR were: 15.21.3HU and 24.22.7(120kV); 20.11.9HU and 24.73.1(100kV); 38.42.9HU and 18.91.8(80kV); 58.35.5HU and 15.42.0(70kV). IR image noise and SNR were: 11.71.1HU and 32.73.7(120kV); 15.21.2HU and 32.63.2(100kV); 28.52.3HU and 25.22.3(80kV); 45.13.8HU and 20.92.6(70kV). Between FBP 120kV and IR 100kV, comparable image noise (15.21.3vs.15.21.2HU) and significant increased SNR (24.42.7vs.32.63.2) were found (p<0.03). Comparable SNR was obtained between FBP 100kV vs. IR 80kV (24.73.1vs.25.22.3) and between FBP 80kV and IR 70kV (18.91.8vs.19.92.6), p>0.10.Conclusion:The use of IR does facilitate lower kV settings, as IR shows same image quality compared to FBP at higher kV settings. Methods and materials: Contrast media (Iopromide 300mg/ml) was injected in a circulation phantom. A CTA of the thoraco-abdominal aorta with a fat ring simulating abdominal profile was obtained using different kV settings (120/100/80/70). Scan protocol was as follows: 128x0.6mm coll., pitch 0.75, mAsref 210, rot.time 0.28s. A standard injection protocol (iodine delivery rate=1.4gI/s; flow 22 CM (300 mg/ml) followed by 60 ml of 50% CM and 40 ml of NaCl, all injected at a flow rate of 9 ml/s (Iodine load 36 g, IDR=2.7gI/s). Start delay was assessed by test bolus technique at the level of the ascending aorta. Attenuation values were measured at four different anatomical levels of the aorta. k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 2 cardiovasculair O02.07 Is automated kV selection for radiation dose reduction independent from contrast media concentration in CT angiography? M. Kok1, C. Mihl1, A. Seehofnerova1, J. Turek1, G. Jost2, U. Haberland3, J.E. Wildberger1, M. Das1 1 MUMC, Maastricht 2 Bayer Pharma AG, Berlin, Germany 3 Siemens AG, Forchheim, Germany Significant radiation dose reduction can be achieved using automated tube voltage selection. The purpose of this study was to evaluate radiation dose reduction in CT angiography (CTA) of the aorta and to evaluate whether contrast media (CM) concentration influences dose reduction. A circulation phantom with thoracic-abdominal vasculature was used. Four different CM concentrations (300 - 350 370 - 400mg I/ml) were administered maintaining identical Iodine delivery rates (1.8g I/s) and total iodine dose (20g). Three different CTA scan protocols were used. A: No dose modulation; B: CAREDose4D; C: CAREkV. Other scan 1 9 E parameters were kept constant: 128x0.6mm coll., pitch 0.9, 120kV, qual. reff. mAs 210, rot. time 0.5s, slice thickness 2mm/1.4mm and kernel B31f. Dose-length product was documented to calculate effective dose and attenuation values (HU) in 6 predefined intravascular sites were measured. All values were analysed in SPSS 20 using Kruskal-Wallis test and were considered to be significant when p-values<0.05. Reduction of effective dose (mSv) in protocol B (2.100.1 mSv) and C (1.030.01 mSv - kV settings automatically changed to 80kV) was significant compared to protocol A (4.480.0 mSv), with reductions of 53% and 77% respectively. No significant differences were found in effective dose between different CM concentrations, p-values>0.05. Attenuation values (meanSD) as well as signal-to-noise ratio were comparable between all CM concentrations (300, 350, 370 and 400mg I/ ml), p-values>0.05. Automated tube current modulation allows radiation dose reduction up to 53% and automated tube voltage selection up to 77% respectively, independently from CM concentration and without compromising image quality. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 23 3 programma & abstracts Abstracts Sessie 3 Neuroradiologie Donderdag 11 september, 11:55 – 13:10 uur O03.01 Validation of the NEXUS-criteria for CT R.S. Smit, J.B. Egbers, A.F. Hoogerwaard, J.J. van Netten, D. van der Velde, M. Kraai, J.W. op den Akker Ziekenhuisgroep Twente, Almelo/Hengelo Purpose: The NEXUS-criteria** are validated criteria to identify adult patients who need conventional radiography of the cervical spine after blunt trauma. Despite the fact that CT is internationally seen as the ‘golden standard’ when cervical spine injury is suspected, the NEXUS-criteria have never been validated for CT. We tested the accuracy of the NEXUS-criteria for CT with simultaneously implementation of the Dutch guidelines for blunt trauma (CBO, 2009) of the cervical spine after high-energy trauma. Methods: A retrospective observational study in the period January 1st 2012 to December 31st 2013, including all patients aged 15 years and older with a high-energy- O03.02 The added diagnostic value of CT-perfusion in detection and localization of ischemia in patients suspected of acute posterior circulation stroke E.J.R.J. van der Hoeven1, J.W. Dankbaar2, J.M. Niesten3, I.C. van der Schaaf2, J.A. Vos1, W.J. Schonewille1, L.J. Kappelle2, B.K. Velthuis2 1 St. Antonius Ziekenhuis, Nieuwegein 2 UMC Utrecht, Utrecht 3 OLVG, Amsterdam Background and purpose: Detection of ischemia in patients with suspected posterior circulation stroke is challenging. Accurate diagnosis is important for treatment decision making and secondary prevention. Our aim was to determine the added value of CT-perfusion to non-contrast CT and CT-angiography source images in the detection and localization of ischemia in patients suspected of acute ischemic posterior circulation stroke. 24 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l trauma (HET). We evaluated the NEXUS-criteria against the outcome of a fracture or no fracture of the cervical spine determined by CT. Results: A total of 875 patients were included, from which 599 patients had a positive- and 276 patients had a negative NEXUS-screening. In the group with the positive NEXUScriteria 35 fractures were found. One patient with a negative NEXUS-screening had a fracture. This leads to a sensitivity of 0,972 (95% CI: 0,837-0,998) and a negative predictive value of 0,996 (95% CI: 0,976-0,999) of the NEXUS criteria. Conclusion: The NEXUS-criteria have a good sensitivity as well as a good negative predictive value for CT of the cervical spine when injury of the cervical spine is suspected in patients with a high-energy-trauma aged 15 years and older. **Hoffman et al. NEJM 2000:94-99 Methods: We selected all patients with suspected acute ischemic posterior circulation stroke between May 2009 and December 2012 from a large prospective multi-center stroke trial. All patients underwent NCCT, CTA and CTP on admission and CT or MRI on follow-up. All images were evaluated for presence and location of ischemia. Results: In 42 of 88 patients (47.7%) follow-up imaging showed a posterior circulation infarct. Compared with NCCT and CTA-SI sensitivity of CTP for detection (31.0% and 33.3% vs. 73.8%, p<0.000) and localization (24.2% and 27.4% vs. 66.1%, p<0.000) of ischemia was significantly higher. Highest sensitivities were found for detection of ischemia in cerebellar (85.2%) and occipital (84.6%) regions. Compared with NCCT and CTA-SI sensitivity for detection of thalamic infarcts was higher for CTP (8.3% and 0.0% vs. 50.0%, p=0.063 and p=0.031 respectively). For all techniques sensitivity was lowest for detection of ischemia in pons and midbrain (10%). Specificity did not differ significantly and was excellent for all techniques (= 93.5%). 3 neuroradiologie Conclusion: CTP has significant added value to NCCT and CTA-SI in the detection and localization of ischemia in patients suspected of acute posterior circulation stroke. O03.03 Predictors of reperfusion in acute ischemic stroke patients A.D. Horsch1, J.W. Dankbaar1, Y. van der Graaf2, W.P.T.M. Mali1, B.K. Velthuis1 1 UMC Utrecht, Utrecht 2 Julius Centrum, Utrecht and stroke severity were collected. Their association with complete reperfusion was analyzed using univariate logistic regression. Purpose: Acute ischemic stroke studies emphasize a difference between reperfusion and recanalization but predictors of reperfusion have not been elucidated. The aim of this study was to evaluate the relationship between reperfusion and recanalization and to identify predictors of reperfusion. Materials and methods: From the XXX trial 178 patients were selected with a middle cerebral artery territory perfusion deficit on admission CT perfusion (CTP) and complete day 3 follow-up CTP and CT-angiography (CTA). Reperfusion and recanalization were evaluated on follow-up imaging and their association was calculated using relative risks. Patient admission and treatment characteristics, and admission CT imaging parameters regarding occlusion site O03.04 Visualization of deep brain stimulation targets in patients with Parkinson’s disease at 1.5-, 3- and 7-T MRIM P.J. van Laar, J.M.C. van Dijk, E.K.L. de Graaf, A.L.J. van Hulzen, L.C. Meiners, M.J. Staal UMC Groningen, Groningen Background and Purpose: Deep brain stimulation (DBS) is a well-established treatment for Parkinson’s disease (PD). Accurate placement of the DBS lead is essential for optimal effect and the definition of the DBS target is highly dependent on visual recognition on magnetic resonance imaging (MRI). We prospectively investigate whether 7T MRI enables better visualization of the DBS targets and leads to better placement of DBS leads in comparison to 1.5T and 3T MRI. 1 9 E Results: Relative risk for complete reperfusion with complete recanalization was 2.60 (CI 1.63-4.13), but around 40% showed a discrepancy between recanalization and reperfusion status. Lower clot burden (OR 1.35, CI 1.14-1.58), more distal thrombus location (OR 2.28, CI 1.18-4.39) and good collateral score (OR 2.84, CI 1.34-6.02) increased the odds of complete reperfusion whilst higher NIHSS score (OR 0.95, CI 0.90-1.00), larger infarct core size (OR 0.32, CI 0.15-0.69) and larger total ischemic area (OR 0.31, CI 0.150.67 for 2001-5000 mm2 and OR 0.16, CI 0.07-0.37 for >5000 mm2) decreased the odds of complete reperfusion. Conclusion: Recanalization and reperfusion are strongly related but not always equivalent in acute ischemic stroke. Lower clot burden, distal thrombus location, collateral score, NIHSS score, infarct core size and total ischemic area are predictors of reperfusion. BKV is a regular presenter for Philips. Materials and Methods: Three patients with PD (mean age 55 years) were scanned on 1.5T, 3T and 7T MRI before the DBS procedure. Coordinates of the DBS targets determined on the MR-images were compared with measured coordinates during surgery. Differences were analyzed with post hoc ANOVA. Results: The 7T MR- images of the DBS targets showed an improved contrast-to-noise ratio (60% better than 3T; 160% better than 1.5T; p<0.005) and signal-to-noise ratio (23% greater than 3T; 50% greater than 1.5T; p <0.005). No difference was found between 7T and 3T MRI in the localization of the DBS leads compared to measured coordinates during surgery. Conclusion: Although 7T MRI enables better visualization of the DBS target in patients with PD, there is no clinical benefit for the localization of the DBS leads. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 25 3 programma & abstracts Abstracts O03.05 Carotid intraplaque hemorrhage progression in asymptomatic subjects: A follow-up study using serial magnetic resonance imaging Q.J.A. van den Bouwhuijsen, M. Selwaness, T.A.N.G. Hui, W.J. Niessen, A. Hofman, G.P. Krestin, O.H. Franco, A. van der Lugt, M.W. Vernooij Erasmus MC, Rotterdam Background: Intraplaque hemorrhage(IPH) in carotid atherosclerotic disease is associated with a high risk of events. Serial imaging is important in understanding the natural course of IPH, as factors that influence IPH development have not been fully elucidated. The purpose of this study was to quantify changes in IPH-volume over time and to study cardiovascular determinants of IPH change. Methods: This study is embedded in a population-based cohort-study in asymptomatic participants who underwent carotid magnetic resonance imaging (MRI). To quantify IPH progression, 40 randomly selected participants with IPH (53 carotids with IPH) and 27 matched-controls (54 carotids O03.06 CTA derived from CT perfusion data obviates the need for separate cranial CTA in Acute Stroke E.J. Ewoud1,2, E.J. Vonken1, F.J.A. Meijer2, J.W. Dankbaar1, A.D. Horsch1, B. Ginneken2, B.K. Velthuis1, I. van der Schaaf2, M. Prokop2 1 UMC Utrecht, Utrecht 2 Radboudumc, Nijmegen Objective: Timing-invariant (or delay-insensitive) CTA that is derived from CT perfusion (CTP) data may obviate the need for a separate cranial CTA in acute stroke, thus enhancing patient safety by reducing total exam time, radiation dose and volume of contrast material. We assessed the diagnostic accuracy of timing-invariant CTA for detecting intracranial artery occlusion in acute ischemic stroke. Methods: Patients with suspected ischemic stroke were prospectively enrolled and underwent CTA and CTP imaging at admission. Timing-invariant CTA was derived from the CTP data. Five neuroradiological observers assessed all 26 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l without IPH) underwent serial MRI (interval 174 months). IPH-volume progression in all carotids was evaluated by applying both a Visual Rating Scale and an automated segmentation tool. Risk factors of IPH-volume progression were investigated by generalized estimating equation analyses. Results: IPH remained present in 50(94.3%) carotids with IPH at baseline. New IPH developed in 5(6.7%) carotids. Visual progression of IPH-volume was present in 15(28.3%), no change in 2(45.3%) and regression in 14(26.4%) of the 53 carotids with IPH at baseline. Smoking was associated with increase in IPH-volume over time (increase in IHP for smokers versus non-smokers; 48.6mm3(4.5;92.7);pvalue=0.03). Conclusion: Carotid IPH remains detectible after more than one year follow-up. In almost one-third of the carotids with IPH there was progression of IPH-volume in a relatively short follow-up. This suggests either that IPH stimulates recurrent hemorrhage or does not resolve fast. IPH development is a heterogeneous process with smoking as a risk factor associated with IPH-progression. images for the presence and location of intracranial artery occlusion in a blinded and randomized manner. Sensitivity and specificity of timing-invariant CTA were calculated using standard CTA as the reference standard. Inter-rater agreement was determined using k statistics. Results: We included 108 patients. Sensitivity and specificity were 100% (95% CI 100-100) for large-vessel occlusions. For MCA occlusions in the M2 segment or more distally, sensitivity was 100% (95% CI 100-100) and specificity was 99% (95% CI 97-100). Calculated sensitivity was lower for few anterior (50%) and posterior (25%) cerebral artery occlusions as some occlusions on standard CTA showed delayed contrast filling on timing-invariant CTA. Inter-rater agreement was very good for both techniques (mean k value: 0.93 and 0.94). Conclusions: Timing-invariant CTA derived from CTP data provides similar diagnostic accuracy and reproducibility and may obviate a separate standard CTA for the detection of artery occlusion in acute stroke. Moreover it may differentiate occlusion and delayed filling. 3 neuroradiologie O03.07 White matter degenerates over time, a longitudinal diffusion MRI analysis L.G.M. Cremers, M. de Groot, A. Hofman, G. Krestin, A. van der Lugt, W. Niessen, M. Ikram, M. Vernooij Erasmus MC, Rotterdam Diffusion Tensor Imaging (DTI) is an Magnetic Resonance Imaging (MRI) technique that quantifies subtle changes of microstructure in normal-appearing white matter. Crosssectional studies have shown that DTI parameters are altered in aging and cognitive decline. Yet, longitudinal data are still scarce. We investigated in a prospective, population-based study longitudinal changes of white matter microstructure using DTI. 501 non-demented participants (mean age 69.9 years) were included. We analyzed change in white matter diffusion characteristics (fractional anisotropy (FA) and mean diffusivity (MD)), on a global and voxelwise level. We adjusted for age, sex, scan interval, intracranial 1 9 E volume, white matter atrophy and white matter lesion load. Additionally, influence of cardiovascular risk factors on DTI changes was studied. Over 2 years of follow-up, global FA decreased by 0.0038 (p<10-6), while MD increased by 9.0 x 10-6mm2/s (p<10-6) reflecting loss of white matter microstructure. Voxelwise analyses showed that FA decreased widespread in the brain, except in the sensorimotor pathway, where an increase in FA was found (see Figure). MD values increased throughout the white matter. We found more pronounced white matter diffusion changes in older persons. Cardiovascular risk factors were not associated with changes in tissue microstructure. We found longitudinal changes in FA and MD, reflecting loss of white matter microstructure over time. Our results are suggestive of widespread normal appearing white matter changes in aging, with relative sparing of sensorimotor fibres. Furthermore, we found that white matter degeneration is more pronounced with higher age, but not driven by specific cardiovascular risk factors. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 27 4 programma & abstracts Abstracts Sessie 4 Interventieradiologie Donderdag 11 september, 11:55 – 13:10 uur O04.01 Survival and recurrence rates after radiofrequency ablation and combined radiofrequency and drug-eluting bead transarterial chemoembolization in inoperable hepatocellular carcinoma J.J. Schaapman, M.C. Burgmans, B. Ortega, R. Wolterbeek, C.S.P. van Rijswijk, S. Osanto, A.F.M. Schaapherder, M.J. Coenraad, A.R. Van Erkel LUMC, Leiden Introduction: Local tumor progression (LTP) rates after radiofrequency ablation (RFA) are higher in hepatocellular carcinoma (HCC) >3cm compared to HCCs =3cm. Combined RFA and drug-eluting-bead transarterial chemoembolization (DEBTACE) can achieve larger ablation zones compared to RFA alone. This retrospective cohort study describes three year local tumor progression free survival and overall survival data of patients treated by RFA and combined RFADEBTACE for HCC =3 cm and >3cm respectively. Methods: The study was approved by the local medical ethics committee. Informed consent was waived for the O04.02 Percutane CT-geleide cryoablaties van niertumoren; een veilige en effectieve behandeling G.A.H. Kock, A.D. Montauban van Swijndregt, B.W. Lagerveld OLVG, Amsterdam Doel: Het evalueren van de veiligheid en effectiviteit van percutane CT-geleide cryoablaties van niertumoren. Materiaal & Methoden: In deze retrospectieve studie werden 45 patiënten met in totaal 48 tumoren gencludeerd die tussen 2007 en 2012 een cryoablatie ondergingen. De patiënten-status werd gecontroleerd op behandelinggerelateerde complicaties tijdens en/of na de cryotherapie en op behandelsucces met ten minste 1 jaar follow-up. De patiënten werden onderverdeeld in drie groepen aan de 28 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l study. Between January 2009 and July 2012, 54 patients (42 males; median age 66 years (range: 29-82)) were treated with RFA for de novo unresectable HCC. 39 patients with HCC measuring >3-7cm underwent RFA-DEBTACE. Fifteen patients received RFA only. Local tumor progression freesurvival (LTPFS) and overall survival (OS) were analyzed with a mean follow-up of 23.8 months (quartiles: 15.5-36.9 months). Results: Compared to the RFA group, patients in the RFADEBTACE had larger tumors (mean diameter 45.7mm versus 21.5mm; p=0.026) and more frequent multifocal disease (46.7% versus 20.5%; p=0.04). Mean OS in the RFA and RFA-DEBTACE group was 41.6 months (95% CI: 34.6-48.6 months) and 34.8 months (95% CI: 23.5-46.1 months) respectively. Patients in the RFA group had better mean LTPFS compared to the RFA-DEBTACE group: 36.9 months (95% CI: 29.6-44.3 months) and 11.0 months (95% CI: 2.819.4 months). Conclusion: Prognosis after RFA is poorer in patients with HCC >3-7cm compared to patients with smaller tumors even when DEBTACE is performed as an adjuvant treatment. hand van de tumorgrootte: <3cm (groep I), 3-4cm (groep II), 4-5cm (groep III). Er werd een biopt genomen van de tumor voor PA. (Voorlopige) Resultaten: Vijf-en-vijftig ablaties werden verricht bij 48 tumoren (7 re-cryoablaties vanwege onvoldoende resultaat of recidief). Er waren slechts milde complicaties: hematoom, insteekopening paresthesin. Dertien tumoren (27%) bleken benigne bij PA: deze werden gexcludeerd bij verdere follow-up. Follow-up werd verricht bij 34 PA-bewezen RCC’s: 22 in groep I, 8 in groep II, 4 in groep III. Resultaat na 1 behandeling: groep I 73% (16), groep II 88% (7), groep III 75% (3). Resultaat na 2 behandelingen: groep I 96% (21), groep II 100% (8), groep III 75% (3). Totaal resultaat na 2 behandelingen was 94%. 4 interventieradiologie Conclusie: Cryotherapie is een veilige en effectieve behandelmethode voor niertumoren tot 5cm. Geen ernstige complicaties werden gerapporteerd. Behandelsucces na een maximum van 2 therapien was 94%. Nevenbevinding: biopsie van de tumor voorafgaand aan de cryotherapie wordt aangeraden om het aantal onnodige behandelingen van benigne laesies te reduceren. O04.03 Antegrade ureteral stenting as an alternative for the retrograde approach: indications, succes rate and complications R.W. van der Meer1, J. Verdult2, S. Weltings2, A. van Erkel1, H. Roshani2, H.W. Elzevier1, L. van Dijk2, H. van der Overhagen2 1 LUMC, Leiden 2 HagaZiekenhuis, Den Haag Results: 130 procedures in 100 patients were performed. A percutaneous nephrostomy catheter had already been placed in the majority of patients (109) for initial treatment of hydronephrosis. Most patients suffered from obstructive ureteral pathology due to malignancy (63), scar tissue (32), or stones (12). A JJ was successfully inserted 125 times. In 3 procedures (2 patients) it was impossible to cross the obstruction, once the ureter could not be catheterised due to gross hydronephrosis and once a defect in the ureter (surgical complication) could not be passed. In 21 patients previous retrograde ureteral stenting had not been successful. In all these patients antegrade ureteral stenting was performed successfully. Eight procedure related complications were reported (6 infections, 1 false tract, 1 malposition). Purpose: Double J stents (JJs) can be used as treatment for obstructive ureteral pathology. JJs are mostly inserted through a retrograde route with cystoscopic guidance. Antegrade percutaneous insertion using fluoroscopic guidance can be performed alternatively. The purpose of this study was to evaluate the indications, success rate and complications of antegrade ureteral stenting in our institution. Methods: Data of consecutive patients in which antegrade ureteral stenting was performed between 2005 and 2013 were retrospectively analysed using patient records and radiology reports. O04.04 4D CTA for the evaluation of arteriovenous malformations a pilot study P.B. Veendrick, R. Mann, C.J.M. Van der Vleuten, F.J.A. Meijer, D.J.O. Ulrich, B. Verhoeven, M.H.W.A. Wijnen, W.M.H. Busser, F. de Lange, L.J. Schultze Kool Radboudumc, Nijmegen The objective of the study was to evaluate the applicability of 4D-CTA in patients with arteriovenous malformations (AVMs) for treatment planning considering dose and image quality compared to digital subtraction angiography (DSA). In this cohort study 23 4D-CTA scans were obtained in 18 patients from June 2011 to March 2014. All 4D-CTAs were acquired using a 320 detector row CT-scanner (Toshiba Aquilion ONE). The angiographies were performed on a high-end angiography system (Philips Alura). Alternate reading of the DSA and 4D-CTA images was performed by 1 9 E Conclusion: Antegrade percutaneous insertion of a double J stent is a good alternative for retrograde insertion, especially when access to the pyelum has already been secured by a percutaneous nephrostomy catheter or when retrograde insertion of a double J stent failed. two experienced observers to assess which modality offered the best diagnostic information. A subjective scale was used to compare the DSA and 4D-CTA images. Additionally, 8 of the 23 4D-CTA scans were recalculated to 10 frames per second (fps) and compared to standard 2 fps 4D-CTAs. Diagnostic information and treatment planning using 4D-CTA was superior to DSA in 11 of the 18 patients (61%), equal to DSA in 4 patients (22%) and inferior to DSA in 3 patients (17%). 10 fps 4D-CTAs allowed for better evaluation of the AVM in all patients. Average effective dose of the 4D-CTAs was 10.17 mSv (1.00-57.2, median 5.53). Average effective dose of the DSAs was 18.3 mSv (0.089-40, median 10.5). In our opinion 4D-CTA images allowed for better treatment planning of the AVM in a majority of patients compared to DSA. 10 fps 4D-CTA gave more insight into the angioarchitecture than standard 4D-CTA. Dose comparison revealed a lower average and median effective dose for 4D-CTA than for DSA. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 29 4 programma & abstracts Abstracts O04.05 Fusion imaging in image guided interventions. A systematic review C. Klink, R. te Riele, T. van Walsum, M. Hunink, A. Moelker Erasmus MC, Rotterdam Purpose: To provide the reader with an overview of the use of fusion imaging with ultrasound in an interventional radiology setting. We present a systematic review addressing frequently used outcome measures and study quality. Furthermore we discuss technical aspects of fusion imaging relevant for a clinical interventional radiology setting. Materials and Methods: We systematically searched PubMed, Cochrane, Embase, Web of Knowledge and Scopus for fusion imaging with ultrasound in interventional radiology. All inclusion and data-extraction steps were performed independently by the two first authors. In absence of consensus, studies were discussed until consensus was reached. O04.06 MRI with a weak albumin binding contrast agent has additional value for the detection of endoleaks in patients with enlarging aneurysm after endovascular repair J. Habets1,2, H. Zandvoort1, F.L. Moll1, E.P.A. Vonken1, L.W. Bartels3, J.A. Herwaarden1, T. Leiner1 1 UMC Utrecht, Utrecht 2 Gelre Ziekenhuizen, Apeldoorn 3 Imaging Science Institute, Utrecht 30 Results: 16 studies were included. They heterogeneous with regard to methods and outcome measures. Most frequent outcome measures were accuracy of targeting and procedural success rate. Accuracy showed needle to target distance ranging from 1.9 0.7mm in phantom studies to 14.0 1.4mm in an in-vivo setting. Success rate was mainly measured for radiofrequency ablation procedures and showed successful ablation in 82.6% - 100% of the cases. Because no randomized controlled trials have been performed so far, overall scientific evidence is low. Conclusions: Real-time registration and fusion of preprocedural volume images with intra-procedural US shows good experimental results and seems promising in a clinical interventional radiology setting. However, patient movement (e.g. breathing) has a great influence on fusion imaging accuracy. Therefore more research in a clinical interventional radiology setting is needed in order to develop methods to overcome these limitations. Also, more structured clinical evidence is required before these technological advances can become standard. The presence of endoleaks was assessed by visually comparing pre-contrast and post-contrast T1-weighted fatsaturated images. Post-contrast images were acquired 5 and 15 minutes after contrast administration. Purpose: to examine the additional diagnostic value of Magnetic Resonance Imaging (MRI) after administration of a weak albumin-binding contrast agent in post-EVAR patients with aneurysm growth. Results: Endoleaks were observed in 25/29 patients (86%) on the post-contrast MRI images. Sixteen (55%) patients had a type II endoleak visualized by MRI and occult on delayed CT images (Figure 1) and three (10%) patients had additional type III/IV endoleaks at the level of the aneurysm sac (n=1) and iliac legs (n=2). In 6/22 patients (27%), both MRI and delayed CT imaging revealed a type II endoleak. MRI had also additional value in five of these six cases (83%) by demonstrating additional lumbar feeding arteries (n=3), additional IMA endoleak (n=1) and by better delineation of the extent of the endoleak (n=3). Method an materials: A prospective diagnostic crosssectional MR imaging study was performed in all patients with AAA growth =5 mm after EVAR and no or uncertain endoleak on CTA. MRI scans were performed on a 1.5-T clinical MRI scanner after administration of the weak albumin-binding contrast agent gadobenate dimeglumine. Conclusion: In patients with enlarging aneurysms of unknown origin after EVAR, MRI with a weak albumin binding contrast agent has additional diagnostic value for both the detection and determination of the origin of the endoleak. This can have important (interventional) treatment implications. k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l 5 miscellaneous I Sessie 5 Miscellaneous I Donderdag 11 september, 11:55 – 13:10 uur O05.01 Wat zijn prognostische factoren voor de effectiviteit van barbotage bij tendinits calcarea van de rotator cuff? S.B.A van der Valk1, B.W. Oudelaar2, A.J.H. Vochteloo2, R. Huis in ‘t Veld2, E.M. Ooms2, R. Schepers-Bok1 1 MRON, Ziekenhuisgroep Twente, Almelo en Hengelo 2 OCON, HENGELO, Nederland Inleiding: Barbotage is de eerste keus behandeling bij patiënten met tendinitis calcarea (TC) die niet goed reageren op conservatieve therapie. Ondanks dat bij 25% van de patiënten met tendinitis calcarea partile rotatorcuff rupturen (PRCR) voorkomen, is niet bekend of deze van invloed zijn op het effect van barbotage. Overige factoren geassocieerd met het falen van barbotage zijn niet bekend. Methode: Tussen januari 2010 en juni 2013 werden n=431 patiënten (n=277 vrouw; gemiddelde leeftijd 51 jaar), die een barbotage ondergingen voor TC, gencludeerd. In een retrospectieve cohort studie werden demografische factoren, O05.02 Patients at risk for contrast induced nephropathy and mid-term effects after contrast administration. A prospective cohort study. S.I. Moos, G. Nagan, R.S. de Weijert, D.N.H. van Vemde, J. Stoker, S. Bipat AMC Amsterdam, Amsterdam Objectives: Determine incidence of: patients at risk for contrast induced nephropathy (CIN), CIN and mid-term effects (renal replacement therapy/death Methods: We conducted a prospective study in consecutive patients undergoing CECT from October 2012 to May 2013. Data were obtained through scripted interviews and the electronic patient-record. We questioned patients about the presence of risk factors. Kidney function before and after 1 9 E echografische bevindingen, pre- en 2 weken postinterventie pijnscores op een 11-punts numerieke schaal (NRS), een dichotome symptomenschaal na 6 maanden (pijnvrij of niet-pijnvrij), roken, diabetes en het aantal behandelingen verzameld. Falen van barbotage was gedefinieerd als het persisteren van klachten zes maanden postinterventie. Logistische regressie analyse werd uitgevoerd ter bepaling van factoren geassocieerd met effectiviteit. Resultaten: Postinterventie pijnscores >3 (OR 2,0; p=0,01) en het ondergaan hebben van meerdere behandelingen (OR 1,8; p=0,043) waren geassocieerd met het falen van barbotage. Partile rotator cuff rupturen (n=70, p=0,660), subacromiale bursitiden (p=0,222) en roken (p=0,226) waren niet van invloed op het effect van barbotage. Conclusie: Hoge pijnscores postinterventie en het nodig hebben van meerdere behandelingen geven een verhoogde kans op falen, maar partile rotator cuff rupturen hebben geen invloed op het effect van barbotage. Barbotage kan daarom ook bij partile rotator cuff rupturen als effectieve behandeling worden toegepast. CECT and the follow-up (FU) during one month were verified. Results: We included 998 patients (mean age: 59.94 years). eGFR was =60ml/mg/1.72m2 in 886(88.8%) patients, 30-59ml/mg/1.72m2 in 108(10.8%) patients and <30ml/ min/1.73m2 in 4(0.4%) patients. We found diabetes mellitus in 137(13.7%), anaemia in 70(7.0%), congestive heart failure in 92(9.2%), peripheral arterial disease in 34(3.4%), age >75 years in 126(12.6%) patients and 301(30.2%) used nephrotoxic medication. Fifty-eight (5.8%) patients were at risk for CIN. Thirty-five (60.3%) risk patients received intravenous prophylactic hydration, 23 (39.7%) patients at risk did not. Of the hydrated patients 11 underwent FU within 1 week; of the non-hydrated patients 7 underwent FU within one week. Two (2/ 58: 3.4%) patients developed CIN (increased serum creatinine = 44 mol/l or =25% within one week), CIN incidences between hydrated and non-hydrated patients were 1/35 vs 1/23. Incidence of renal replacement therapy and death within one month was both 0. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 31 5 programma & abstracts Abstracts Conclusion: The number of patients at risk is low. CIN incidence is low, even in patients not receiving prophylactic hydration. No patient received renal replacement therapy or died. O05.03 Contrast Induced Nephropathy Prevention regimens for patients undergoing intravenous Contrast Enhanced Computed Tomography: A meta-analysis S.I. Moos, R.S. de Weijert, J. Stoker, S. Bipat AMC Amsterdam, Amsterdam Data were pooled (intervention versus control) and analysed by a fixed- or random-effects models depending on heterogeneity. Background: Addition of anti-oxidant to contrast induced nephropathy (CIN) prevention regimens has become part of daily clinical practice. However evidence for the addition of these agents in patients undergoing contrast enhanced computed tomography (CECT) is ambiguous. Purpose: To summarize difference in CIN incidence between prevention regimens with addition of anti-oxidants in patients undergoing CECT. Methods: We performed a review according to the preferred reporting in systematic reviews, meta-analysis (PRISMA) guidelines. We searched MEDLINE, EMBASE and Cochrane (2002 till November 2013). Randomised controlled trials (RCTs) studying CIN prevention in CECT were selected. O05.04 Contrast induced nephropathy and adverse events in the long term after intravenous contrast enhanced computed tomography. A meta-analysis S.I. Moos, D.N.H. van Vemde, J. Stoker, S. Bipat AMC Amsterdam, Amsterdam, Nederland Objective: To assess incidence and relation between contrast induced nephropathy (CIN) and long term adverse events in intravenous contrast enhanced computed tomography (CECT) patients. Methods: A systematic review and meta-analysis according to the Preferred Reporting Items in Systematic reviews and MetaAnalysis guidelines was performed. We searched MEDLINE, EMBASE and Cochrane from 2002 till november 2013. Two reviewers selected relevant papers and extracted data. Data were pooled with a fixed or random effect model depending on variation in data (Akaike information criterion, I2). 32 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l Results: We included eight RCTs. The intervention group comprised 655 patients receiving N-acetylcysteine, Vitamin E or alprostadil combined with saline. The control group comprised 667 patients receiving saline. The risk-difference in CIN incidence between intervention and the control groups was -0.08(95%CI:-0.11--0.04), p<0.0001). Subgroup analysis for N-acetylcysteine only as intervention compared to the control group showed a difference in CIN incidence; risk difference: -0.09(95%CI:0.16- -0.01), p=0.03). Patients with kidney disease showed a risk-difference in CIN of -0.10(95%CI:-0.16--0.04), p=0.001), for N-acetylcysteine only this was: -0.10(95%CI:-0.16- -0.04), I2=24%, p=0.001 as well. The risk difference in patients undergoing emergency CECT was -0.04(95%CI:-0.16-0.08), p=0.49). Conclusion: Hydration with prevention agents seems to decrease CIN incidence when compared to hydration only. RCTs with controls not receiving any prevention are lacking. Results: We included 15 studies, containing 4,455 patients. We found a mean incidence of: 51.52% chronic kidney disease, 22.60% diabetes mellitus, 25.55% cardiovascular disease and 9.12% use of nephrotoxic medication. Mean CIN incidence was: 8.20%(95%CI:4.98-13.21). Incidence of adverse events permanent renal failure, renal replacement therapy and death was: 13.28%(95%CI:5.57-28.45), 0.50%(95%CI:0.13-1.98), and 13.46%(95%CI:6.55-25.65). The risk difference for permanent renal failure between CIN patients and patients without CIN was: 0.07(95%CI:0.05-020), I2=53%, p=0.25, for renal replacement therapy: 0.05(95%CI:-0.07-0.16), I2=81%, p=0.41 and for death: 0.15(95%CI:0.02-0.29), I2=0%, p=0.03. Conclusion: CIN is not related with increased risk for permanent renal failure and renal replacement therapy after intravenous CECT. Despite the statistical association it is questionable if death is a manifestation of CIN or co-morbidity. 5 miscellaneous I O05.05 Imaging of the whole spine: differentiating (early) spondyloarthritis and degenerative changes F. de Bruin, D. van der Heijde, J.L. Bloem, M. Reijnierse LUMC, Leiden Teaching points The purpose of this exhibit is: - To review the underlying pathologic mechanisms of spondyloarthritis (SpA) and degenerative changes of the spine - To learn key concepts in imaging appearances of early and established spondyloarthritis and stages of degenerative changes - To learn the protocols and value of different imaging modalities, including whole spine MRI, whole spine CT and conventional radiographs Outline/Table of content: - Pathologic mechanisms of spondyloarthritis and degenerative changes O05.06 Degenerative Changes of the Spine on MRI in Patients with Inflammatory Back Pain from the DESIR Cohort F. de Bruin1, M.O. Treyvaud2, J.L. Bloem1, M. Dougados2, L. Gossec2, A. Feydy2, D. van der Heijde1, M. Reijnierse1 1 LUMC, Leiden 2 Hopital Chocin, Parijs, France The role of spinal MRI in screening for spondyloarthritis needs to be determined. Purpose was to describe the prevalence of degenerative changes(DCs) on MRI in axSpA and no-axSpA patients (based on ASAS criteria) in a cohort of patients aged 18-50 with inflammatory backpain (IBP) =3 months, =3 years. Baseline 1.5T MRI (sagittal T1TSE and STIR) of the spine were scored independently by 2 blinded readers for: see figure 1. If needed, a third reader adjudicated. Patient groups were compared using chi2 test, 1 9 E - Imaging protocols for whole spine MR and whole spine CT - Key concepts of SpA on MR imaging Inflammatory lesions (bone marrow changes) enthesitis Spondylitis Spondylodiscitis (Anderssons lesions) Facet joint arthritis Structural lesions Erosions Syndesmophytes ankylosis Fatty changes - Key concepts of degenerative changes Degenerative disc disease Modic changes Schmorls nodes and osteochondrosis osteophytes - Examples of different stages of both entities on : Whole spine MR Whole spine CT Conventional radiographs regression analysis was used to associate age and DCs. 648 pts (303 male, 47%) with mean age 34 (9) were evaluated. 454 pts (70%) had axSpA. 456 pts (70%) showed one or more DCs (median 4, range 1-39). Pts with no DCs were evenly distributed between patient groups (56/194, 29% and 136/456, 30%) (P=.854). In 366 (57%) pts, DCs were observed in the lumbar spine and in 292 (45%) pts in L4-L5 and L5-S1. No significant difference between patient groups was found for any DC using cut-off points 1 to 7 (P =.072 to .954). With increasing age, the number of canal stenosis, extrusion, HIZ, FJOA, Modic I and Pfirrmann increased (b=.002 to .058, P=.047 to <.001). Prevalence of DCs is high in pts with IBP and in accordance with literature. Most DCs are found in the (lower) lumbar spine. Prevalence of DCs increased with age. No difference was found between patient groups. Current ASAS criteria are accurate for including a homogenous patient population with respect to DCs. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 33 5 programma & abstracts Abstracts O05.07 Association of tracheal index on chest computed tomography with COPD, lung function, emphysema and airway wall thickness. E. Pompe, L. Gallardo Estrella, B. van Ginniken, H.J. de Koning, M. Oudkerk, E.M. van Rikxoort, F.A.A. Mohamed Hoesein, J.W.J. Lammers UMC Utrecht, Utrecht Purpose: Chronic obstructive pulmonary disease (COPD) has been associated with tracheal shape changes. Knowledge on the association of tracheal shape with CT-quantified emphysema and airway wall thickness is lacking. The association of tracheal index (TI) on inspiratory CT scans with emphysema in subjects with and without COPD was assessed. Method and materials: 1109 men from the NELSON trial with inspiratory CT and pulmonary function tests were 34 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l included. TI was defined by the ratio of coronal and sagittal length. CT-quantified emphysema was assessed by the 15th percentile method (Hounsfield unit number below which 15% of all voxels are distributed) and airway wall thickening with Pi10. Results: Based on lung function 437 participants were classified as COPD. TI was not significantly different between participants without and with COPD, with mean SD TI values of 0.65 0.10 and 0.65 0.10, respectively. TI correlated with FEV1, r = 0.06 (p = 0.04), but not with FEV1/ FVC, r = 0.02 (p = 0.443). TI was not correlated with perc15 (r= 0.004, p = 0.89) or Pi10 (r=0.04, p = 0.23). Conclusion: TI is not significantly different between participants with and without COPD and is not correlated with other quantitative CT measurements used for COPD, although results may be different in moderate to severe COPD. 6 miscellaneous II Sessie 6 Miscellaneous II Donderdag 11 september, 11:55 – 13:10 uur O06.01 Hepatocellular adenoma: to treat or not to treat? A comprehensive analysis of the current literature D.C. Bijdevaate, M. Thomeer Erasmus MC, Rotterdam Hepatocellular adenoma (HCA) is an uncommon solid benign tumor of the liver with an estimated incidence of 3-4 per 100.000 women. HCA are found more often in women using contraceptives. Typically, these tumors are treated conservatively with a negative advice on the use of oral contraceptives and prevention of pregnancy. However, HCA can bleed with hemodynamic instability and a small subgroup may potentially degenerate in carcinoma, making more active treatments recommended. By reviewing the recent literature, bleeding and malignant degeneration seems to occur primarly in lesions with a diameter of 5 cm or larger. Taking the new phenotypic subclassification of HCAs in account, bleeding can appear in every subtype but malignant degeneration in most cases, only in B-catenin HCAs. Due to possible serious complications of liver surgery in these generally young females with obesitas several less invasive alternatives have been proposed as primary treatment strategy. These techniques are mainly radiofrequency ablation and image guided transcatheter embolization. In our paper we review the indications of minimally invasive treatment of HCA and we will compare the different treatment options based on an update of the current literature. O06.02 Histology of hypodense parafissural pseudolesions in the liver L.J.P. Sonnemans, N. Köster, J.A. van der Laak, P.J. Slootweg, M. Prokop, W.M. Klein Radboudumc, Nijmegen accentuation) for the Periodic acid-Schiff (PAS) staining and the percentage of the sections accentuated by the staining. Paired samples t-tests tested for differences between left side and right side biopsies. The correlation with radiodensity was assessed by Spearman rank correlation coefficients (rs). Aim: Hypodense attenuating areas (pseudolesions) are regularly seen on CT at the right side of the falciform ligament of the liver. This study investigates histological the origin of the pseudolesion. Results: Biopsies from 17 corpses showed a strong tendency (p=0.083) that the site of the pseudolesion contains about 40% more collagen. The amount of fat (p=0.698), glycogen (p=0.286), number of portal triads (p=0.661) and central veins (p=1.000) showed no difference. A positive correlation (rs=0.521, p=0.013) was observed between the intensity of the PAS-staining and venous radiodensity. All other correlations between histology and radiodensity were not significant. Methods: Biopsies, at the right and left side of the falciform ligament at the level of the left portal vein, were collected from adult deaths during autopsy. At the same locations, radiodensity was measured at pre- and postmortem CT. Digital image analysis determined the amount of collagen and fat in the sections. Two observers counted the mean number of portal triads and central veins per field of view. Glycogen content was assessed by an intensityscore (0=no accentuation; 1=subtle accentuation; 2=strong 1 9 E Conclusion: Histological examination showed 40% more collagen to be present at the site of the pseudolesion. The amount of fat, glycogen, number of portal triads and central veins showed no differences. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 35 6 programma & abstracts Abstracts O06.03 Whole liver CT texture analysis: effect of the presence of metastatic disease on the remaining ‘nondiseased’ liver parenchyma D.M.J. Lambregts1, S.-X. Rao2, R. Schnerr1, W. van Ommen1,3, L.A. Heijnen1, M.H. Martens1, R.F.A. Vliegen4, G.L. Beets1, R.G.H. Beets-Tan1 1 MUMC, Maastricht 2 Fudan University, ShanghaI, China 3 Catharina Ziekenhuis Eindhoven 4 Atrium Medisch Centrum, Heerlen Purpose: To evaluate the potential of whole-liver CT texture analysis of apparently disease-free liver parenchyma for discriminating between colorectal cancer (CRC) patients with and without hepatic metastases. Material and methods: The primary staging CT-examinations of 29 CRC-patients were analysed. Three subgroups were assessed: patients without metastases (n=15), with synchronous metastases (n=10) and patients who developed metachronous metastases within 2 years (n=4). Whole-liver CT texture analysis was performed by manual delineation of the non-diseased liver (excluding O06.04 Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: A meta-analysis C.A.J. Puylaert, J.A.W. Tielbeek, S. Bipat, J. Stoker AMC Amsterdam, Amsterdam Purpose: To assess the role of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and scintigraphy in grading Crohn’s disease (CD) activity. Materials and Methods: MEDLINE, EMBASE and Cochrane databases were searched for studies evaluating CT, MRI, US and scintigraphy in grading CD activity as compared to (ileo)-colonoscopy, biopsies or intraoperative findings as the reference test. Two independent reviewers assessed the data. Three by three tables (none, mild, frank disease) were constructed for all studies and overall grading accuracy, overgrading and undergrading were calculated/ summarized by fixed or random effects models. 36 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l metastases/benign liver lesions) on routinely acquired portal-phase images. The texture parameters mean greylevel intensity (M), entropy (E) and uniformity (U) were derived with no filtration and different filter values (fine=0.5, medium=1.5 and coarse=2.5). Results: Mean E1.5 and E2.5 in patients with synchronous metastases were significantly higher compared with the non-metastatic patients (p=0.02 and p=0.01). Conversely, mean U1.5 and U2.5 were significantly lower in the synchronous metastases group (p=0.04 and p=0.02). Texture parameters for the metachronous metastases group were not significantly different from the non-metastatic group (p>0.05), although - similar to the synchronous metastases group - there was a trend towards increased E1.5, E2.5 and decreased U1.5, U2.5 values. Areas under the ROC curve for the diagnosis of synchronous metastatic disease based on E1.5,2.5 and U1.5,2.5 ranged between 0.74-0.78. Conclusion: Texture analysis of the apparently nondiseased liver holds promise to differentiate between patients with and without metastatic liver disease from CRC. Further research is required to determine its potential role for the early detection of metachronous/occult liver disease. Results: Our search yielded 9356 articles, from which 19 articles were determined eligible for inclusion. A total of 549 patients were included. Per-patient data showed overall grading accuracy values for CT, MRI, US and scintigraphy of 86% (95%CI: 75-93%), 84% (95%CI: 67-93%), 44% (95%CI: 28-61%) and 40% (95%CI: 16-70%), respectively. CT and MRI data were pooled and showed similar overall grading accuracy estimates (P=0.8). Per-segment data showed overall grading accuracy values for CT, MRI, US and scintigraphy of 87% (95%CI: 77-93%), 78% (95%CI: 72-82%), 66% (95%CI: 52-78%) and 86% (95%CI: 80-91%), respectively. CT showed similar grading accuracy to MRI (P=0.08) and scintigraphy (P=0.8). Both CT and scintigraphy showed higher grading accuracy than US (P=0.001 and P=0.003, respectively). Conclusion: CT and MRI showed comparable high accuracy values both in the per-patient and per-segment analyses. Results for US and scintigraphy were inconsistent and limited data was available. 6 miscellaneous II O06.05 Klinische waarde van verbeterde detectie door digitale borst tomosynthese en het gesynthetiseerde 2D mammogram bij borstkanker E.J.B. van Dijk, M.C.J.M. Kock Albert Schweitzer Ziekenhuis, Dordrecht Doelstelling: - Toelichting techniek en gebruik van digitale borst tomosynthese (DBT) en het gesynthetiseerde 2D mammogram (C-view) binnen de mammaradiologie. - Uitleg over verbeterde detectie en effect op de stralingsdosis. - Bespreken cases welke de verbeterde detectie van DBT illustreren. - Omvattend literatuur overzicht. - Presentatie eerste resultaten prospectief onderzoek naar de diagnostische waarde van C-view in een Nederlandse mammapoli. Achtergrond: Sinds 2013 hebben we de beschikking over Hologic-Selenia-Dimensions systemen. Hierdoor kunnen we in n compressie zowel een conventioneel FFDM vervaardigen als een digitale tomosynthese, binnen de dosislimieten. Ook kan dmv een algoritme een 2D mammogram gesynthetiseerd worden (C-view). O06.06 Screening outcome at subsequent digital screening mammography in the south of the Netherlands R.J.P. Weber1, J. Nederend1, L.E.M. Duijm2 1 Catharina Ziekenhuis, Eindhoven 2 Canisius Wilhelmina Ziekenhuis, Nijmegen Purpose: To determine screening outcome at subsequent rounds of full-field digital screening mammography (FFDM). Methods and Materials: We included a consecutive series of 77,664 FFDM screens with a prior screen-film mammography screen obtained between July 2009 and July 2011 and 90,295 FFDM screens with a prior FFDM screen, obtained between July 2011 and July 2013. During 1-year follow-up, breast imaging reports, surgical reports and pathology results were collected of all referred women. Screening outcome for both periods was compared. 1 9 E Onze ervaringen met 20.000 casus worden gedeeld aan de hand van casus presentaties. Eerste resultaten van origineel onderzoek naar de diagnostische waarde van gesynthetiseerde 2D mammogram (C-view) binnen de populatie van de mammapoli worden gedeeld. Beschrijving beelden en details van de techniek: Bij tomosynthese wordt door angulatie van de buis en detector ten opzichte van de mamma een 3D dataset verkregen. Detectie, karakterisering alsmede lokalisatie kan zo nauwkeuriger worden bepaald. Aanvullend kan door een algoritme een 2D mammogram (C-view) gesynthetiseerd worden. Conclusie/Discussie: - Tomosynthese als aanvulling op het FFDM geeft een verbeterde detectie, zowel in een klinische als in een screeningspopulatie. - Tomosynthese geeft een verbeterde diagnostische accuratesse voor niet-gecalcificeerde laesies. - Tomosynthese als aanvulling op FFDM geeft een relatieve verdubbeling van de dosis, (DBT + FFDM): 2.5mGy. - De readingtime verdubbelt bij tomosynthese als aanvullend onderzoek. - 2D mammogram (C-view) is veelbelovend, maar de klinische waarde moet nog worden bevestigd. Results: Referral rate and cancer detection rate in the first period were respectively 2.6% and 6.9 per 1,000 screens, compared to 2.7% (P=0.3) and 6.6 (P=0.6) in the second period. In the first period, 22.1% (118/534) of cancers comprised ductal carcinoma in-situ (DCIS) versus 21.4% (128/599) in the second period (P=0.8). Overall positive predictive value of referral (PPV) was comparable, 25.6% and 25.4% respectively (P=0.9). In the second period the PPV for microcalcifications was 33.1%, compared to 24.1% (p=0.001). No difference was found in tumor histology (P=0.4), tumor size (P=0.4), lymph node stage (P=0.99), and tumor grade (p=0.1). In the second period DCIS was significantly more often of higher grade, 50.8% versus 35.6% in the first period (p=0.02). Mastectomy rate was 1.2 per 1,000 screened women in the first period versus 0.8 in the second period (p=0.01). Conclusion: Cancer detection rate, overall PPV and referral rate are similar for subsequent FFDM screens in both periods. Mastectomy rate was lower and DCIS was more often of high grade in the second period. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 37 6 programma & abstracts Abstracts O06.07 Detection of bone marrow edema after irradiation with Dual-Energy CT (DE-CT) and virtual non-calcium images A.A. Postma1, A.A.R. Stadler1, R.A. Bockmann1, F. Hoebers2, P. Kessler1, L.J. Poort1 1 MUMC, Maastricht 2 Maastro, Maastricht, Purpose: To investigate the accuracy of Dual Energy CT(DE-CT) non-calcium images for detection of edema of the mandible after irradiation and surgery. Method and materials: 15 adult 18 month-old Gttingen mini-pigs received irradiation with an equivalent dose of 0, 25, 50 or 70 Gy. At 13 weeks tooth extraction and placement of 4 implants was performed in the left mandible. Six months post radiation therapy all animals underwent DE-CT and MRI of the mandible. MRI STIR was used for grading of bone marrow edema(0-3). DE-CT with simultaneous imaging at 80 kV and 140 kV was performed. Virtual non-calcium images were reconstructed 38 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l with a 3-material decomposition algorithm. HU was measured at 4 ROI’s in the non-calcium images by two observers in 15 pigs. These were compared to MRI. Results: HU measurements between both observers had good comparability. Mean HU value of the non-calcium images of the leftsided(L) was higher than right-sided(R) (marrow: L -66,6; R -73,6; p> 0,05) (cortex : L 63,6; R 57,8; p>0,05). MRI STIR demonstrated increased signal intensity in higher radiation groups. An increase of signal intensity at STIR imaging was accompanied by an increase in HU at non-calcium images in the bone marrow(R=0,59, p<0,05), but not at the cortex(R=0,27, p>0,05). Conclusion: Virtual non-calcium images derived from DE-CT are able to demonstrate bone marrow edema in radiation induced bone changes in the bone marrow, but not in the cortex. DE-CT non-calcium images can provide additional information on bone marrow edema. Disclosure: Partially funded by BioComp Industries BV. 7 musculoskeletale radiologie Sessie 7 Musculoskeletale Radiologie Vrijdag 12 september, 11:15 – 12:30 uur O07.01 Traumatic Hip Dislocation P.H. Ousema, R.E. Westerbeek Deventer Ziekenhuis, Deventer Purpose: To recognize the different types (posterior, anterior and obturator) of traumatic hip dislocations (THD) and their respective trauma mechanisms. The role of different radiological modalities will be discussed. The associated injuries that are common with THD will be reviewed. We will present all types of THD with our own material. Background: 90 % of THD’s are in the posterior direction, 10 % are in the anterior direction. An uncommon form of hip dislocation is obturator luxation, or dislocation in the inferior direction. In case of a posterior hip dislocation, the mechanism of injury is usually a high energy trauma where an axial load is applied to the femur with the hip in flexion. O07.02 Opposed-phase gradient echo MR imaging improves image quality and visualization of erosions in arthritis W. Stomp, J.L. Bloem, T.W.J. Huizinga, A.H.M. van der Helm-van Mil, M. Reijnierse LUMC, Leiden In rheumatoid arthritis, identifying the exact demarcation of erosions on MR images can be difficult because the cortical defect might be obliterated by either synovium or bone marrow edema. Opposed-phase MR imaging might enhance the visibility of this transition. Our purpose was to determine whether opposed phase gradient-echo imaging improves visualization of erosions when compared to regular T1w TSE sequences. Unilateral wrist and MCP joints of 14 early arthritis patients were imaged on a 1.5T extremity MRI. Coronal T1w TSE and opposed phase T1w gradient-echo sequences were obtained both before and after gadolinium contrast administration. 1 9 E Anterior dislocation occurs with forced abduction with the hip in external rotation. Obturator uxation can occur when the subject falls with both the hip and the knee in flexion. Associated injuries with hip dislocation are femur and acetabular fractures, sciatic nerve injury and damage to the blood supply of the femoral head. Imaging Findings: Four patients with a traumatic hip dislocation from our database are presented. Two patients had a posterior dislocation, one had an anterior dislocation and one had an obturator luxation. The imaging findings on conventional x-ray as well as CT will be presented. Conclusion / Discussion: THD usually occurs in the posterior direction as a result from a high energy trauma. An uncommon form of THD is obturator luxation, in which the femoral head is dislocated in the inferior direction. T2w TSE images were also obtained and were available to support scoring for both image sets. Images were assessed for image quality on a 0-5 scale and scored according to the OMERACT RAMRIS score for erosions in consensus by two observers blinded to clinical data. A reference score was established using all available images together. Scanning time was shorter for the opposed phase sequence (0:43 vs 3:30). Overall image quality, absence of movement artifacts and sharpness were better using opposed phase images than T1w TSE images. Homogeneity, Signal-tonoise ratio, erosion scores and rater confidence did not differ between sequences. There was a trend towards higher sensitivity of opposed phase images for detection of erosions (85.6%, 95%CI 76.6-91.6% vs 68.0%, 95%CI 57.7-76.9%). Our results demonstrate the feasibility of using a fast outof-phase T1w spoiled-gradient echo sequence to assess erosions. It decreases imaging time while providing better image quality and might increase sensitivity for small erosions. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 39 7 programma & abstracts Abstracts O07.03 Quantitative CT arthrography of the human knee to measure cartilage biochemical composition: results of an in-vivo validation study against ex-vivo reference standards J. van Tiel, M. Siebelt, M. Reijman, P.K. Bos, E. Waarsing, J.A.N. Verhaar, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus MC, Rotterdam Purpose: Recently, the ability of CT arthrography (CTa) to quantitatively measure knee cartilage composition in terms of its sulphated glycosaminoglycan (sGAG) content has been demonstrated in an ex-vivo study using human cadaveric knee joints. Since a validation study comparing in-vivo acquired CTa outcomes against ex-vivo reference standards for cartilage composition has not yet been performed, the aim of the present study was to perform such a validation in humans with knee OA. Methods: We included 12 knee OA patients (Kellgren and Lawrence grade 2-4) who underwent CTa one month before O07.04 T2 relaxation times of knee articular cartilage in osteoarthritis patients are not influenced by gadolinium contrast agent J. Verschueren, J. van Tiel, M. Reijman, E.E. Bron, S. Klein, J.A.N. Verhaar, S.M.A. Bierma-Zeinstra, G.P. Krestin, G. Kotek, E.H.G. Oei Erasmus MC, Rotterdam Purpose: Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) and T2-mapping are often used as quantitative imaging biomarkers in osteoarthritis (OA) research to measure different cartilage components. As acquisition of dGEMRIC and T2-mapping within one post-contrast imaging session improves efficiency and reduces scan time and costs, our purpose was to assess the influence of contrast agent on T2 relaxation times acquired in-vivo at 3T in OA patients. Material and Methods: Ten knee OA patients (KellgrenLawrence grade 2-3) underwent dGEMRIC and T2 mapping at 3T. A 3D fast spin-echo sequence with 5 echo times for 40 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l total knee replacement (TKR). Mean X-ray attenuation values were calculated in 6 regions of interest (ROI) of the femoral and tibial cartilage. All cartilage ROIs were harvested during TKR and rescanned with contrast-enhanced microCT (CE-CT) which served as surrogate reference standard for cartilage sGAG content since it has been shown to accurately measure sGAG. We analyzed the correlation between mean CTa X-ray attenuation and mean CE-CT X-ray attenuation with linear regression. Results: Mean X-ray attenuation values of the different ROIs were 115-455 Hounsfield Units. Outcomes of CTa had a strong correlation with CE-CT X-ray attenuation, representing sGAG content of articular cartilage, in the femoral (r= 0.76), tibial (r= 0.77) and tibiofemoral cartilage (r= 0.76 (figure 1). Conclusion: Our results suggest that CTa can accurately measure sGAG content of articular cartilage in human knee joints in-vivo. The coefficient of determination, however, is only moderate and therefore CTa outcomes are likely to be also influenced by other composites of cartilage, e.g. collagen. T2 mapping was performed before and 75 minutes after intravenous administration of gadolinium dimeglumine for dGEMRIC. Mean T2 relaxation times were calculated in 6 cartilage regions in medial and lateral femur condyles and tibia plateaus using in-house developed post-processing software. Pre- and post-contrast T2 relaxation times were compared with correlation analysis, intraclass correlation coefficient (ICC) and Wilcoxon signed-rank test. Results: Pre- (mean 41.5; range 28.8-64.7 ms) and postcontrast (mean 41.1; range 28.5-73.0 ms) T2 relaxation times were strongly correlated (Fig. 1) (r=0.87, r2=0.75, p<0.001) with a high ICC (0.92, 95CI: 0.86-0.95), and their mean values were not statistically significantly different (p=0.08). Conclusion: The results indicate that pre- and post-contrast T2 relaxation times of in-vivo OA knee cartilage acquired at 3T are strongly correlated and that there is no evidence to suggest a difference in T2 relaxation times. Therefore, T2-mapping can be performed reliably within a single postcontrast imaging session in combination with dGEMRIC acquisition. 7 musculoskeletale radiologie O07.05 Osteoporosis Screening with Computed Tomography: Contrast Media Significantly Affects Bone Signal E. Pompe1, M.J. Willemink1, G. Dijkhuis2, H.J.J. Verhaar1, F.A.A. Mohamed Hoesein1, P.A. de Jong1 1 UMC Utrecht, Utrecht 2 St. Antonius ziekenhuis, Nieuwegein Purpose: Osteoporosis could be detected by determining the bone density (BD) in a region of interest (ROI) within a lumbar vertebra on CT. The effect of intravenous contrast media on BD measurements on computed tomography (CT) examinations performed for other indications was evaluated. Materials and Methods: 152 subjects (99 without and 53 with malignant renal neoplasm) who underwent both un-enhanced and two contrast-enhanced (arterial and portal venous phase) abdominal CT exams in a single session between June 2011 and July 2013 were included. BD was evaluated on the three exams as CT-attenuation values in O07.06 Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is superior to T1rho-mapping in measuring cartilage glycosaminoglycan content: results of an in-vivo validation study against ex-vivo reference standards for cartilage composition J. van Tiel, G.P. Kotek, M. Reijman, P.K. Bos, E.E. Bron, S. Klein, J.A.N. Verhaar, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus MC, Rotterdam Purpose: T1rho-mapping has been proposed as noncontrast-enhanced alternative to delayed gadoliniumenhanced MRI of cartilage (dGEMRIC). However, no thorough validation studies comparing both techniques acquired in-vivo in one patient against a reference standard for GAG have been performed. The aim of this study was to assess the correlation of in-vivo dGEMRIC and T1rhomapping outcomes in osteoarthritis patients with cartilage GAG content determined using an ex-vivo reference standard. 1 9 E Hounsfield Units (HU) in the first lumbar vertebra (L1). Results: Subjects were stratified based on the presence of malignancies, because BD measurements were significantly higher in the group without malignancies (p<0.01). CT-attenuation values were significantly higher in contrast-enhanced phases, compared to the un-enhanced phase (p<0.01). In patients without malignancies, HU-values increased from 128.848.6 HU for the unenhanced phase to 142.347.2 HU for the arterial phase and 147.047.4 HU for the portal phase (p<0.01). In patients with malignancies, HU-values increased from 112.138.1 HU to 126.238.4 HU and 130.137.3 HU (p<0.02), respectively. With thresholds of =110 HU, =135 HU, =160 HU to define osteoporosis, measurements in the arterial phase and portal phase resulted in 7-25% false negatives. Conclusion: Our study showed that intravenous contrast injection substantially affects BD-assessment on CT and taking this into account it may improve opportunistic screening for osteoporosis. Methods: We included 12 knee OA patients (Kellgren and Lawrence grade 2-4) who underwent dGEMRIC and T1rho-mapping at 3T before total knee replacement (TKR). T1- and T1rho-values of both scans were calculated in 6 regions of interest (ROI) of the femoral and tibial cartilage. All cartilage ROIs were harvested during TKR and rescanned with contrast-enhanced microCT (CE-CT) which served as surrogate reference standard for cartilage sGAG content since it has been shown to accurately measure sGAG. We analyzed the correlation between T1- and T1rho-values and CE-CT outcomes with linear regression. Results: T1- and T1rho-values were 280-834 ms and 31-53 ms for dGEMRIC and T1rho-mapping respectively throughout the tibiofemoral knee joint. dGEMRIC outcomes had a strong negative correlation with CE-CT X-ray attenuation (r=-0.71) (figure 1). T1rho outcomes did not correlate with cartilage GAG content of articular cartilage (r=-0.01) (figure 1). Conclusion: Our results suggest that dGEMRIC can accurately measure articular cartilage GAG content, whereas T1rho-mapping is not suitable for this purpose. Therefore, despite the need to use a contrast agent, we consider dGEMRIC to be superior to T1rho-mapping for quantitatively measuring cartilage GAG content. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 41 7 programma & abstracts Abstracts O07.07 Evaluating MRI-detected tenosynovitis of the hand and wrist in early arthritis W.P. Nieuwenhuis, A. Krabben, W. Stomp, T.W.J. Huizinga, J.L. Bloem, A.H.M. van der Helm-van Mil, M. Reijnierse LUMC, Leiden Objectives: MRI is a sensitive method to detect local inflammation in Rheumatoid Arthritis (RA). In addition to synovitis and bone marrow edema (osteitis) it visualizes tenosynovitis. The prevalence of MRI-detected tenosynovitis and the diagnostic value in early arthritis are unclear. This study aimed to identify the frequency of MRI-detected tenosynovitis at the metacarpophalangeal (MCP) and wrist joints in early arthritis, the association with RA and severity features within RA. Methods: 178 early arthritis patients underwent unilateral 1.5T extremity-MRI at baseline. The MCP and wrist-joints were scored using the RAMRIS-method extended with Haavardsholms tenosynovitis score. 69 patients fulfilled the 2010 RA classification criteria during the first year and were 42 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l compared with the other patients. Within RA-patients comparisons were made for anti-citrullinated-peptide-antibody (ACPA)-positivity and for radiographic progression during year-1. Results: 65% of all early arthritis patients had any MRIdetected tenosynovitis. RA patients were more often affected than non-RA patients (75% versus 59% p0.023). The flexor tendons at MCP-5, the extensor tendons at MCP-2 and MCP-4 and extensor compartment-I of the wrist were more frequently affected in RA than in other diagnoses (odds ratios 2.8 (95%CI 1.2-7.0), 9.1(95%CI 1.9-42.8), 14.2 (95%CI 1.7-115.9), 4.0 (95%CI 1.4-11.1) respectively). These associations were independent of local MRI-detected synovitis. Within RA-patients tenosynovitis-scores were not associated with ACPA-positivity or radiographic progression. Conclusions: Tenosynovitis is common in early arthritis. The flexor tendons at MCP-5, the extensor tendons at MCP-2 and MCP-4 and the first extensor compartment of the wrist are more often affected in RA patients, independent of local synovitis. 8 mammoradiologie Sessie 8 Mammoradiologie Vrijdag 12 september, 11:15 – 12:30 uur O08.01 Association Between Rim Enhancement of Breast Tumors in Dynamic Contrast-Enhanced MRI and Outcome of Patients With Invasive Breast Cancer A.M.T.h. Schmitz1, C.E. Loo2, K.G.A. Gilhuijs1 1 UMC Utrecht, Utrecht 2 Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam Purpose: Rim enhancement (RE) on dynamic contrastenhanced (DCE)-MRI of breast cancer (BC) has been associated with high tumor-grade, increased VEGFexpression, negative hormone-receptor-expression, and axillary lymph-node metastases. However, association with patient outcome is largely unknown, and potential benefit as predictive marker for therapy selection not yet established. Aim was to determine association of RE with invasive BC recurrence (IBCR) and death-attributable-to-BC (DBC) on follow-up. clinical examination were retrospectively included. Median follow-up was 87 months (range: 3-150). Patients received additional preoperative DCE-MRI. Presence of RE was assessed according to BI-RADS. Tumor characteristics were assessed from resection specimens. Patients were stratified upon immunohistochemical BC subtype. Associations were analyzed using Kaplan-Meier and log-rank tests. Multivariate Cox regression was employed. Results: Overall, for IBCR (N=53), association was seen with tumor-grade (p=0,032), resection margin status (RMS; p=0,042), ER-status (p=0,050) and RE (p=0,056). RE and tumor-grade retained independent significance in multivariate analysis discriminating between good and poor (95,7%-79,6%) survival. For DBC (N=39), no association with RE was observed (p=0,189). No associations were found in the ER+/Her2- (N=419) and the Her2+ subgroup (N=75). However, in the triple-negative subgroup (N=65), IBCR (N=10) was strongly associated with RE (p=0,001) and RMS (p=0,002). Moreover, RE was the only characteristic associated with DBC (N=9; p=0,003). Material & Methods: Five-hundred-and-sixty-one consecutive women (age 26-86 years) in the MARGINS-trial (2000-2008) who had pathology-proven invasive BC eligible for breast-conserving-therapy on conventional imaging and Conclusion: Presence of RE on DCE-MRI may be a promising biomarker for tumor recurrence in patients with triple-negative BC. O08.02 7T Breast MR Imaging for Preoperative Characterization of Breast Cancer using One-stop-shop Dynamic Contrast Enhancement, Diffusion-weighted Imaging, and Phosphorus MR Spectroscopy A.M.T.h. Schmitz1, W.B. Veldhuis1, M.B.E. Menke-Pluijmers2, W.J.M. van der Kemp1, T.A. van der Velden1, M.C.J.M. Kock2, P.J. Westenend2, D.W.J. Klomp1, K.G.A. Gilhuijs1 1 UMC Utrecht, Utrecht, Nederland 2 Albert Schweitzer Hospital, Dordrecht treatment failure still occurs in other. Continuing need exists for patient tailored prognostic models at time of diagnosis. Preoperative core-biopsy results in discordant tumor-grade in up to 40% compared to postoperative assessment. Imaging features may potentially close this gap, providing full overview of tumors. Study aim is to assess the potential of functional 7T-Breast-MRI biomarkers characterizing tumor proliferation in-vivo. Purpose: Breast cancer detection at earlier stages has raised concern of overtreatment in patient subgroups, while 1 9 E Material and Methods: A one-stop-shop 7T-MRI (Philips) protocol was developed including high-temporal (HT/5seconds/2,8mm-isotropic) and high-spatial (HS/90seconds/0,7mm-1,0mm-isotropic) dynamic contrastenhanced (DCE)-MRI, diffusion-weighted imaging, and phosphorus spectroscopy (31P-MRS) to analyze tumor R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 43 8 programma & abstracts Abstracts metabolism. Sixteen women (53-70 years) with biopsyproven invasive breast cancer received a preoperative 7T-MRI. DCE-MRI characteristics were assessed according to BI-RADS. ADC-values were calculated and hypointense tumor areas scored. Localized 31P-MR spectra were scored (1-5) on tumor proliferation using a newly developed lexicon. Pathology characteristics were assessed from resection specimens and correlated to MRI-features. Explorative analyses were performed using box-plots, Pearson ChiSquare and Krusal-Wallis tests. Results: In 16 patients, 18 malignant lesions were detected O08.03 Association between parenchymal enhancement of the contralateral breast in DCE-MRI and outcome of patients with unilateral breast cancer B.H.M. van der Velden1, I. Dmitriev1, C.E. Loo2, K.G.A. Gilhuijs1 1 UMC Utrecht, Utrecht 2 Antoni van Leeuwenhoek, Amsterdam Background: Non-tumor stromal breast parenchyma is known to affect outcome of patients with breast cancer. DCE-MRI visualizes parenchymal perfusion. Given typical symmetry between breasts, we hypothesize that healthy contralateral parenchyma is comparable to ipsilateral parenchyma before tumorgenesis. Hence, DCE-MRI of the contralateral breast may give insight in ipsilateral parenchyma prior to tumorgenesis. The aim of this study was to determine if contralateral parenchymal enhancement is associated with outcome of patients with unilateral breast cancer. Material and methods: Five-hundred-and-twenty-four patients with pathology-proven unilateral invasive breast cancer were retrospectively analyzed. These patients were 44 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l on HS-DCE-MRI. Mean largest tumor diameter was 22mm (range 8-58). Time-to-enhancement on HT-DCE-MRI ranged from 12s-29s. Shortest interval was observed in a rimenhancing triple-negative tumor. First observations showed correlations between P-MRS score and mitotic cell index (N=11; p=0,02), and a trend between ADC and modified Bloom-Richardson tumor-grade (N=11; p=0,097). Conclusion: A one-stop-shop 7T-Breast-MRI protocol was developed to explore prognostic and predictive tumor biomarkers in-vivo. First explorations indicate feasibility to visualize tumor-grade in-vivo. eligible for breast-conserving therapy on basis of conventional imaging and physical examination, and received a preoperative DCE-MRI in study context (2000-2008). To quantify contralateral parenchymal enhancement, the breast, pectoral muscle, skin, and parenchyma were automatically segmented from the MRI. In the segmented parenchyma, enhancement was calculated as the relative signal increase between the last and first post-contrast scan. The mean signal increase in the 10% most enhancing voxels was computed, and its association with recurrence-free survival (RFS) was established using Kaplan-Meier and log-rank testing. Results: Average age at diagnosis was 56 years (27-84); median follow-up was 86 months (3-150); and the largest tumor diameter on MRI was 19 mm on average (5-70). Fourhundred-and-fifty patients (86%) were in the RFS group. The mean top 10% contralateral enhancement (p=0.025), receptor subtype (p=0.020), and tumor diameter (p=0.045) were significantly associated with RFS. Conclusions: Patients with less prominent contralateral parenchymal enhancement at MRI may have lower RFS than patients with more prominent enhancement. 8 mammoradiologie O08.04 Ultrasound guided breastconserving surgery for palpable and non-palpable early stage invasive breast cancer: Results from a general hospital W.A. Slijkhuis, K.E. Droogh-de Greve, J.L.M. de Win, J.W.C. Gratama Gelre Ziekenhuizen Apeldoorn, Apeldoorn Aim: Breast conserving surgery (BCS) for patients with breast cancer is associated with tumor-involved resection margins in up to 20% of cases. A previous study reported a lower rate of tumor-involved resection margins in 3% of patients and a reduction of unnecessary healthy breast tissue resection when intraoperative ultrasound guidance is used. Therefore, the aim of this prospective observational study is to evaluate the outcome after implementation of ultrasound guided BCS at our institution. Methods: From June 2013 till present, 43 patients with palpable and non-palpable T1-2N0-1 invasive breast cancer were enrolled and compared with a historical reference O08.05 Stralingdosis van contrastenhanced spectral mammography vergeleken met full field digital mammografie U.C. Lalji1, C. Jeukens1, E. Meijer2, B. Bakija1, R. Theunissen1, J.E. Wildberger1, M. Lobbes1 1 MUMC, Maastricht 2 Maxima medisch centrum, Veldhoven Achtergrond: Contrast-enhanced spectral mammography (CESM) toont veelbelovende eerste resultaten, maar leidt tot een verhoogde stralingsdosis in vergelijking met Full Field Digital Mammografie (FFDM). Ons doel was om de stralingdosis geassocieerd met CESM te vergelijken met FFDM. Methoden: Stralingsgerelateerde data (zoals buisspanning), gecomprimeerde borstdikte, glandulariteit, Entrance Skin Air Kerma (ESAK) en Average Glandular Dose (AGD) werden 1 9 E group of 43 patients treated with palpation guided or wire guided conventional BCS. Primary outcomes were surgical margin involvement, and excess healthy tissue resection defined by a calculated resection ratio (CRR). Results: Study population and reference group comprised invasive ductal carcinoma in 39 and 41 patients respectively, other patients had invasive lobular carcinoma. In both groups, three patients (7%) had tumor-involved margins with a need for additional re-excision or mastectomy. These cases were explained by invasive lobular carcinoma or surrounding ductal carcinoma in situ (DCIS). Ultrasound guided BCS resulted in reduced excision volumes (median 34 vs. 52 cc) and improved CRR (median 0,9 vs. 0,5) compared with conventional BCS. Conclusion: In our series, ultrasound guided BCS results in a comparable rate of tumor-involved resection margins compared with conventional BCS. However, it reduces unnecessary healthy tissue resection. With increased learning and experience we soon expect to demonstrate the benefits of ultrasound guided BCS. verzameld voor 47 CESM en 715 FFDM patiënten. Alle onderzoeken werden uitgevoerd op dezelfde mammograaf. Dosiswaarden gerapporteerd door het systeem werden gevalideerd middels fantoomexperimenten. Resultaten: De dosiswaarden gerapporteerd door het systeem kwamen kwalitatief goed overeen met de waarden verkregen bij de fantoomexperimenten. Gemiddelde ESAK bedroeg 10.5 mGy voor CESM en 7.46 mGy voor FFDM. AGD bedroeg 2.80 mGy voor CESM en 1.55 mGy voor FFDM. Conclusie: Vergeleken met onze reguliere FFDM nam de AGD bij CESM toe met 1.25 mGy (+81%), terwijl ESAK toenam met 3.07 mGy (+41%). Ondanks deze toename zijn deze waarden nog steeds binnen algemeen geaccepteerde limieten voor mammografie. Desalniettemin zal de diagnostische meerwaarde van CESM ten opzichte van FFDM afgewogen moeten worden tegen deze dosisverhoging, met name in jonge vrouwen. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 45 8 programma & abstracts Abstracts O08.06 De diagnostische waarde van T2- en diffusie-gewogen axillaire MRI voor okselklierstadiëring bij borstkanker M. Paiman1, R.J. Schipper1, R.G.H. Beets-Tan1, P.J. Nelemans1, B. de Vries1, E.M. Heuts1, K.K.B.T. van de Vijver2, K.B.M.I. Keymeulen1, B. Brans1, M.L. Smidt1, M.B.I. Lobbes1 1 MUMC, Maastricht, Nederland 2 Nederlands Kanker Instituut - Antoni van Leeuwenhoek, Amsterdam Doel: Vaststellen van de diagnostische waarde van nietcontrast-versterkte axillaire T2-gewogen (T2W) en diffusiegewogen (DW) MRI en apparent diffusion coefficient (ADC) voor okselklierstadiring bij mammacarcinoompatiënten. Methoden: Van 52 mammacarcinoompatiënten werden een 3.0T axillaire T2W MRI zonder vetsuppressie en DW MRI (b-waardes 0, 500, 800 sec/mm2) gemaakt, gevolgd door de schildwachtklierprocedure en/of okselklierdissectie. Twee radiologen beoordeelden elke lymfeklier op een schaal van 0 (benigne) tot 4 (maligne), eerst op T2W MRI, daarna op toevoegde DW MRI. Twee onderzoekers berekenden de gemiddelde ADC voor elke lymfeklier. Parameters voor diag- O08.07 Diffusion weighted imaging of breast lesions: a systematic review and meta-analysis M.D. Dorrius, H. Dijkstra, M. Oudkerk, P.E. Sijens UMC Groningen, Groningen Purpose: To evaluate the effect of the choice of b-values and prior use of contrast medium on ADCs of breast lesions derived from DWI, and on the discrimination between benign and malignant lesions. Materials and Methods: A literature search was performed of relevant DWI studies. Meta-analysis focussed on ADC-values rather than true diffusion, not available in the fast majority of studies acquired with just a few b-values. The accuracy of DWI to characterize lesions by using b-value =600s/mm2 and b-value >600s/ mm2 was presented as pooled sensitivity and specificity. The ADC was calculated for both groups. This choice of cut-off was motivated by earlier findings in a breast DWI study of healthy volunteers, demonstrating that 46 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l nostische waarde voor T2W MRI, T2W+DW MRI en ADC meting werden berekend op basis van een klier-per-klier en patint-per-patint matching. Resultaten: Bij 50 patiënten was DW beeldkwaliteit voldoende. Er werden 171 lymfeklieren verwijderd waarvan 135 zichtbaar op MRI. Bij histopathologische analyse werd metastasering gevonden in 23 lymfeklieren (13 patiënten). T2W MRI had hoge diagnostische waarde (specificiteit 94-97% en 89-95%; negatief voorspellende waarde (NVW) 87-91% en 83-89%, respectievelijk op klier- en patintniveau), met goede interwaarnemer overeenkomst (? 0.70). Toevoeging van DW MRI resulteerde in lagere specificiteit (60-88% en 51-84%) en vergelijkbare NVW (88-89% en 89-90%). ADC meting gaf een specificiteit van 63% en 59-62% en NVW van 83-84% en 81-82%, met uitstekende interwaarnemer overeenkomst (ICC 0.83). Conclusie: Hoewel axillaire T2W MRI hoge diagnostische waarde heeft, heeft het onvoldoende negatief voorspellende waarde om een alternatief te vormen voor de schildwachtklierprocedure voor het uitsluiten van okselkliermetastasering. DW MRI en ADC meting zijn niet van toegevoegde waarde. Een contrastmiddel zou overwogen kunnen worden ter verbetering van de diagnostische waarde. at b-values smaller than 600s/mm2 the DW signal is monoexponential. Also, lesions were pooled as pre- or post-contrast DWI. Results: Of 317 articles, 26 met the inclusion criteria. Mean ADC was significantly higher (p<0.001) for the group of b-values =600s/mm2 compared to >600s/ mm2. The sensitivity (91% and 89%, respectively) and specificity (75% and 84%) were similar (p>0.05) in both groups. Contrast media had no significant effects on the ADCs (p>0.08). The contrast between benign and malignant lesions was optimal (58.4%) for the combination of b=0 and 1000s/mm2. Conclusions: The wide variety of b-value combinations applied in different studies significantly affects the ADC of breast lesions and therefore confounds quantitative DWI. If only a couple of b-values are used, those of b=0 and 1000s/mm2 are recommended for the best improvement of contrast between benign and malignant lesions. 9 Forensische Radiologie Sessie 9 Forensische Radiologie Vrijdag 12 september, 11:15 – 12:30 uur O09.01 Forensic safety of MRI in gunshot victims P.A.M. Hofman1, M. Luijtne2, W. van Lohuizen2, J. Kroll1, R.S. Schnerr1, I.I.H. Haest1 1 MUMC, Maastricht 2 Nationale Politie, Heerlen projectile types in a 1.5 and 3 Tesla MRI system, projectiles were placed in seven gelatine phantoms with mechanical characteristic of human muscle tissue. Projectiles were placed with and without a simulated trajectory. Before and after exposure to the magnetic field the gels were scanned on CT assess of the projectiles. Purpose: Multi-detector computed tomography (MDCT) has proven to be of value for the reconstruction of trajectories of projectiles and the assessment of the injuries. However for the depiction of soft tissue injury MRI is superior to MDCT and MRI may be of value to assess trajectories through soft tissue. In a clinical setting there are guidelines for the application of MRI in patients with projectiles or fragments and with certain precautions MRI is safe for these patients. However this has not been studied from a forensic point of view. Subjects and Method: To assess the behaviour of three O09.02 Comparison between radiologist and pathologist in determining trajectories in gunshot victims R.A.T. van Kan1, B. Kubat2, I.I.H. Haest3, W. van Lohuizen1, J. Kroll3, M.J. Lahaye3, A.A. Postma3, P.A.M. Hofman3 1 Nationale Politie, Heerlen 2 Netherlands Forensic Institute, Den Haag 3 MUMC, Maastricht Purpose: Traditionally the pathologist describes gunshot trajectories as part of the post-mortem examination in gunshot victims. Forensic radiology has shown to be accurate in determining the trajectories using computed tomography (CT). The goal of this study is to investigate if there are discrepancies between the trajectories describe by the pathologist and radiologist and if these discrepancies can be attributed to characteristics of the trajectory. Subjects and Method: The data of all shooting incidents between 2010 and 2013 were collected, in which both a 1 9 E Results: The ferromagnetic projectiles tend to rotate parallel to the z-axis of the magnetic field and 5 out of the 7 projectiles moved through the phantom, either through the simulated trajectory or a new trajectory. This was observed in both the 1,5 and 3 Tesla system. Due to extensive susceptibility artefacts the anatomy around the projectile was not visible. Conclusion: Ferro-magnetic projectiles rotate and migrate in a gelatine phantom. It is very likely these projectiles will also migrate in a human body in a MRI system. Therefore we conclude that MRI is not forensic safe in these instances. forensic radiological and pathological examination were performed by means of a total body CT-scan and a full post mortem respectively. From the final independent report of these examinations we determine the number of trajectories, the tract of the trajectories, if these trajectories crossed the lung, abdomen, skull, spine, bone and whether the trajectory was linear. Results: The data of 13 incidents were collected with a total of 48 trajectories. Nine trajectories went through the lung, seven through the abdomen, thirty through bone, six through the spine and 10 through the head. In 19 out of the 48 trajectories there was a discrepancy between the radiologist and the pathologist. There was no association between the course of the trajectory and the discrepancies. Conclusion: In almost 40% of the trajectories there is discrepancy between the radiologist and pathologist. The literature shows that radiology has a higher diagnostic value for determining a trajectory. A more detailed analysis of each trajectory is needed to determine the cause of the discrepancies. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 47 9 programma & abstracts Abstracts O09.03 Postmortem interval estimation: value of postmortem cerebral CT A.R. Bayat, K. Kamphuis, D. Koopmanschap, W.M. Klein Radboudumc, Nijmegen Objective: After death a series of changes naturally occurs in the human body. Understanding these changes and the contributing factors will lead to a better understanding of the normal process of hypostasis and decomposition, a better estimation of the postmortem interval (PMI) and thus to a better diagnosis of cause and time of death. The aim of this study was to investigate the correlation between the PMI and postmortal intracranial density measurements. Materials and method: We retrospectively investigated 63 postmortal cerebral CT scans. We measured the density in Hounsfield units (HU) of the dorsal part of the superior O09.04 Leeftijdsbepaling van subdurale hematomen met CT en MRI: een systematische review F.A.M. Postema, T. Sieswerda-Hoogendoorn, D. Verbaan, C.B. Majoie, R.R. Van Rijn AMC, Amsterdam Introductie: Het dateren van subdurale hematomen kan helpen bij het stellen van de diagnose kindermishandeling. In deze studie hebben we onderzocht of er voldoende bewijs is in de literatuur dat dit betrouwbaar gedaan kan worden met behulp van variatie van de densiteit/ intensiteit van SDHs op CT en MRI scans in de tijd. Methoden: We hebben een systematisch review gedaan in MEDLINE, EMBASE en Cochrane om naar artikelen te zoeken die de densiteit/ intensiteit van SDHs op CT en MRI beschrijven in relatie tot tijd tussen trauma en scannen. Twee onafhankelijke onderzoekers selecteerden de artikelen, beoordeelden de methodologische kwaliteit en verzamelden 48 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l sagittal sinus, both vitreous humors, both anterior and posterior horn of lateral ventricles, left frontal lobe, left caudate nucleus, right parafalcine, left dentate nucleus and right cerebellar hemisphere. Correlation between density and PMI was determined using linear regression and is reported using the Pearson’s correlation coefficient. Results: The PMI range was 2.95-69.2 hours. All densities showed significant increase over time. The density of liquor and the density of the right cerebellar hemisphere showed the highest correlation with the PMI of all intracranial regions of interest (resp. r=0.69 and r=0.68, both p<0.0001). Conclusion: The normal postmortal changes are detectable in density of the intracranial structures. This goes especially for the HU increase of liquor during the postmortem interval. This could be of great value for forensic methods to estimate the PMI and needs further prospectively investigation, which we are currently performing. gegevens. We berekenden medianen met interquartile ranges. Verschillen tussen groepen werden getoetst met een MWU of Kruskal Wallis H test. Resultaten: We includeerden 23 studies (1070 SDHs) betreffende CT en 5 studies (126 SDHs) betreffende MRI. Data van 17 studies (413 SDHs) konden gepoold worden. Er waren significante verschillen in tijdsintervallen for de verschillende densiteiten op CT (P<0.001). Het mediane tijdsinterval verschilde significant tussen kinderen en volwassenen voor iso- en hypodensiteit (p=0.000) en hyperdensiteit (p=0.046). Tijdsintervallen tussen mishandelde en niet-mishandelde kinderen was niet significant verschillend. Voor MRI verschilden de tijdsintervallen voor de verschillende intensiteiten op T1 en T2 niet van elkaar (respectievelijk p=0.108 en p=0.194). Conclusie: De meeste tijdsintervallen voor de verschillende densiteiten/ intensiteiten van SDHs op CT en MRI zijn breed en overlappen. Daarom kunnen CT en MRI bevindingen niet gebruikt worden om SDHs accuraat te dateren. 9 Forensische Radiologie O09.05 Leeftijdsbepaling van subdurale hematomen; enquete onder radiologen F.A.M. Postema, T. Sieswerda-Hoogendoorn, C.B. Majoie, R.R. Van Rijn AMC, Amsterdam Introductie: Subdurale hematomen (SDHs) zijn een veel voorkomende bevinding bij toegebracht schedel-hersenletsel. Het dateren van SDHs kan helpen de anamnese te relateren aan radiologische gegevens. In de rechtszaal kan het bijdragen aan het identificeren van een verdachte. Doel van deze studie is het beschrijven van de ervaring van Nederlandse radiologen met het dateren van SDHs. Methoden: We stuurden een online enquete naar Nederlandse kinder- en neuroradiologen. De enquete bestond uit sociodemografische gegevens, theoritische O09.06 Post-mortem CT imaging with biopsies as an alternative to autopsy in the diagnosis of cause of death in the intensive care unit: initial observations F.C.H. Bakers, P.A.M. Hofman, J. Kroll, R. Prevos, B. de Vries, B. Latten, I.I.H. Haest, M.J. Lahaye MUMC, Maastricht Purpose: Public objection to autopsy has led to a decrease in autopsy rates and consequently to a search for minimally invasive diagnostic alternatives. This study aimed to evaluate the accuracy of post-mortem CT (including standardized image-guided organ biopsies) in establishing cause of death and death related diagnosis compared to standard autopsy in adult deaths in the intensive care unit (ICU). Methods: In this ongoing study (January 2014-present), so far 15 adult ICU-deaths have been included. Information regarding clinical history and circumstances of death were 1 9 E vragen en 8 casussen waarin de deelnemers gevraagd werd SDHs bij kinderen te dateren obv beelden uit CT en MRI scans. Resultaten: Eenenvijftig van de 172 aangeschreven radiologen (30%) vulde de enquete in. Het percentage deelnemers dat rapporteerde dat het mogelijk was een SDH te dateren varieerde tussen 58 en 90% voor de 8 verschillende casussen. In 4 van de 8 casussen (50%) viel de leeftijd van het SDH zoals bekend uit de anamnese in de range zoals gerapporteerd door de deelnemers. Geen van de deelnemers van ‘erg zeker’ van zijn/ haar leeftijdsbepaling. Conclusie: De resultaten laten zien dat er een grote praktijkvariatie bestaat tussen Nederlandse radiologen betreffende het dateren van SDHs. Dit implicert dat het dateten van SDHs niet gebruikt kan worden in de rechtszaal, aangezien er geen uniformiteit onder experts bestaat. available for all patients. All patients received whole-body CT with standardized biopsies (of right lung,liver and kidney) followed by full autopsy. CT-scans and autopsy findings were reported independently. So far the data of 9 autopsies were available for correlation with imaging. Results: Primary cause of death was established in 8/9 (89%) of cases with postmortem CT. In 1/9 (11%) of cases sepsis due to peritonitis was missed with post-mortem CT. In 2/9 (22%) CT found a clinical relevant diagnosis, missed with standard autopsy (massive lung embolism/large bleeding in obturator space), which was later confirmed by second-look pathologic examination. In 3/9 (33%) of the cases minor relevant diagnosis (which did not contribute to the cause of death) not detected with post-mortem CT (unknown small malignancies (n=2)/vasculitis (n=1)) were found at autopsy. Conclusion: These preliminary results show that postmortem CT supported by biopsies can accurately establish the cause of death in adult ICU deaths and may thus become an alternative to the classical clinical autopsy. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 49 10 programma & abstracts Abstracts Sessie 10 Educatief & Onderwijs Vrijdag 12 september, 11:15 – 12:30 uur O10.01 Radiologisch onderwijs/ kennisniveau blijkt onder de maat A. van der Plas Medisch Centrum Alkmaar, Alkmaar Radiologie krijgt een steeds centralere rol in het klinisch diagnostische proces. Helaas zijn er signalen dat het radiologisch onderwijs niet voldoende meegroeit met deze ontwikkelingen. Voor een verdere inventarisatie van de huidige situatie wat betreft radiologische kennis/ onderwijs is een enquête gehouden onder de Nederlandse coassistenten. De enquête is verricht in de periode van september 2012 - maart 2013 en bestaat uit 19 vragen. De coassistent kan aan de hand van een score 1 t/m 5 (1 = oneens, 5 = eens) aangeven of hij/zij het eens is met de stelling. De vragen informeren m.n. naar het O10.02 Authentic radiology progress tests (voortgangstoetsen) in postgraduate medical education with volume datasets A. van der Gijp, C.J. Ravesloot, C.A. Tipker, K. de Crom, D.R. Rutgers, M. van der Schaaf, K.L. Vincken, M. Maas, J.P.J. van Schaik UMC Utrecht, Utrecht Purpose: In current radiology practice radiologists interpret digital images, with a substantial amount of volume datasets. Testing of radiology residents is mainly based on 2D images. Adding volume datasets could improve test quality. We aimed to assess reliability and quality of tests with volume datasets compared to former paper-based tests. Methods: A digital testing program (VQuest) allowing volume dataset viewing and manipulation was developed in a Dutch university medical center. Participants can navigate through datasets in different planes and contrast settings. 50 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l huidige radiologische kennisniveau, het nut/wens van meer radiologisch onderwijs en de ondersteuning van supervisoren op de werkvloer. In totaal hebben 884 Nederlandse coassistenten (is 30% van alle coassistenten) de enqute ingevuld. Uit de cijfers blijkt o.a. dat meer dan de helft van de coassistenten zijn of haar radiologische kennis op z’n best gezien matig vind. De overgrote meerderheid (78%) van de coassistenten is (zeer) ontevreden met het radiologisch onderwijs dat zij hebben gekregen. Ook blijkt dat meer dan 10% van de ondervraagde coassistenten zowel een slecht kennisniveau heeft als onvoldoende begeleiding krijgt op de werkvloer. Kortom, het is ondermaats gesteld met het radiologisch onderwijs/ kennisniveau van de Nederlandse coassistenten. Een manier om het radiologisch kennisniveau te verbeteren is simpelweg meer aandacht voor het vakgebied tijdens de opleiding of initiatieven buiten de officiële opleiding om. In 2013, VQuest was used for two progress tests (A and B), with 383 and 356 radiology residents. Both tests contained 200 questions. In total 68 questions were image-based, including 31 volume datasets. Participants received a questionnaire concerning test quality. Results: The tests were completed by all participants. Overall reliability of both tests was high, Cronbach’s a = .92 and .87 respectively. Spearman brown corrected reliabilities of volume dataset questions were slightly higher (.77 for k=40, for both tests) compared to 2D questions (.74 and .75). Questionnaire response rate was 58% and 52%. Authenticity of digital image questions was graded higher compared to former paper-based image questions, t(205) = 6.03 (p = .001) and t(174) = 4.70 (p<0.000). Perceived image quality was higher in test A (t(202) = 9.98; p = .001, r = .57), though not significantly higher in test B. Conclusion: Digital testing of radiology residents allows volume dataset viewing, has a high reliability and a better test quality compared to paper-based tests. 10 educatief & onderwijs O10.03 Wat is een goed radiologisch verslag? Overzicht van de richtlijnen S. Jacobs, J. Bakker Albert Schweitzer Ziekenhuis, Dordrecht Het radiologische verslag is de belangrijkste methode voor radiologen om de interpretatie van beelden te communiceren. Het speelt een grote rol in de besluitvorming over diagnose, management en aanvullend onderzoek. Er bestaan grote verschillen in verslaglegging tussen landen, ziekenhuizen en zelfs tussen directe collega’s. Wat is een goed radiologisch verslag? We geven een overzicht van de internationale richtlijnen. Er bestaan in de literatuur zes richtlijnen, opgesteld door de ACR (VS), RCR (Groot-Brittanie), CAR (Canada), SIR (VS, interventie), ECR (Europa) en RANZCR (Australi en NieuwZeeland). De overeenkomsten zijn de beschrijving van inhoudelijke punten; patint karakteristieken, vraagstelling, kwaliteit van het onderzoek, vergelijking met vorige O10.04 TraIT: Een duurzame IT infrastructuur in Nederland voor translationeel onderzoek A.L.A.J. Dekker, J. Van Soest, S. Klein, W. Niessen, A. Van der Lugt MAASTRO Clinic, Maastricht Doelstelling: Introduceren van de diverse diensten die TraIT aanbiedt voor translationeel medisch onderzoek met een focus op klinische beeldvorming. Achtergrond: Het CTMM Translational Research IT (TraIT) project, gestart in 2011, beoogt een duurzame IT-infrastructuur voor Nederland op te leveren die de verzameling, opslag, analyse, archivering en beveiliging van de gegevens gegenereerd in translationeel medisch onderzoek ondersteunt. TraIT bestaat uit vijf datageorienteerde werkpakketten te weten: ‘Clinical Research Data’, ‘Biomedical Imaging’, ‘Biobanking’, ‘Experimental Data Management and Analysis’ en ‘Digital Pathology’. Daarnaast zijn er overstijgende werkpakketten voor ‘Data Integration’ en ‘Deployment’. Ondersteund door meer dan 25 partners waaronder alle UMCs, KWF, de Hartstichting en diverse commercile partners zoals Philips, stelt TraIT haar diensten gratis ter beschikking. 1 9 E onderzoeken, diagnose en eventueel advies. Er bestaat een groot verschil in aanbeveling hoe bevindingen het best beschreven worden; de ECR en de RANZCR beschrijven gedetailleerd de manier waarop bevindingen gerapporteerd dienen te worden; zoals het vermelden van afmetingen, echogeniciteit/densiteit/intensiteit en specifieke positieve of negatieve kenmerken die een diagnose ondersteunen of juist minder waarschijnlijk maken. De ECR adviseert als enige in de volgorde: beginnen met de bevindingen die relevant zijn voor de klinische vraag of verdachte pathologie. De overige richtlijnen geven slechts aan dat bevindingen ‘gepast’ of ‘precies’ beschreven moeten worden. Alleen de RANZCR zegt een evidence-based richtlijn te hebben opgesteld. Een andere ontwikkeling is gestandaardiseerde templates waarbij bevindingen in een vaste volgorde worden afgevinkt. Conclusie: binnen de 6 bestaande internationale richtlijnen voor radiologische verslaglegging adviseert alleen de ECR en de RANZCR gedetailleerd hoe bevindingen gerapporteerd dienen te worden. Dit kan als leidraad in de dagelijkse praktijk dienen. Details: Binnen het werkpakket ‘Biomedical Imaging’ zijn er op dit moment een viertal diensten in productie samen onder BioMedical Imaging Archive. NBIA (National Biomedical Imaging Archive ): Open source beeldarchief speciaal ontworpen voor klinische beeldvormingsstudies. XNAT (Extensible Neuroimaging Archive Toolkit): Open source IT platform dat, naast een archieffunctie, ook geschikt is voor rekenintensieve beeldanalyses. CTP (Clinical Trial Processor): Open source applicatie voor het de-identificeren, filteren en uploaden van beelden vanuit een ziekenhuis naar BMIA of XNAT. Keosys: Commercile viewer waarmee beelden uit BMIA cloud-based kunnen worden beoordeeld door een radioloog of nucleair geneeskundige. Op dit moment worden er meer dan 20 beeldvormingsstudies met meer dan 1500 patiënten en 1TB aan beelddata door TraIT ondersteund. Conclusie/ discussie: TraIT heeft bewezen kwalitatief hoogwaardige en kosteloze diensten te kunnen leveren voor klinische studies met een beeldvormingscomponent. Referenties www.ctmm-trait.nl R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 51 10 programma & abstracts Abstracts O10.05 Radiologische bevindingen bij patienten met sikkelcelanemie; wat te zien en waarom? L.E.M. Smagge1, R.E. Westerbeek1, J.L.E. Tai2 1 Deventer Ziekenhuis, Deventer 2 St. Elisabeth Ziekenhuis, Willemstad, Curaçao Sikkelcelanemie (SCA) is een recessief overerfbare ziekte, die gekenmerkt wordt door de productie van een abnormaal hemoglobine molecuul waardoor een sikkelvormige deformiteit kan ontstaan van de rode bloedcel (RBC). Dit heeft tot gevolg dat passage van deze abnormaal gevormde RBC’s binnen kleinere bloedvaten wordt bemoeilijkt, niet O10.06 NON-DIAGNOSTIC RESULTS OF FINE NEEDLE ASPIRATION CYTOLOGY OF THYROID NODULES S. Jacobs Albert Schweitzer Ziekenhuis, Dordrecht Background and purpose: Fine Needle Aspiration (FNA) Cytology has a central place in the diagnosis of thyroid gland nodules. We evaluated the proportion of non-diagnostic cytology results after first and after repeat FNA. Also the effect of operator experience was evaluated. Material and methods: 293 cytology results of FNA performed in our institution in 2010 and 2011 were available for retrospective analysis. 53 were excluded from further analysis (47 previous FNA before 2010, 2 second repeat FNA, 4 interval > 6 months). 240 remaining cytology results in 203 patients were dichotomized using the Bethesdasystem with 1 as non-diagnostic and 2 to 6 as diagnostic. Operator experience was categorized as 52 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l alleen vanwege de vorm maar ook door de grotere neiging tot adhesie aan het bloedvat endotheel, met ischaemie en infarcering tot gevolg.An de hand van een patient casus zullen de diverse radiologische afwijkingen van sikkelziekte worden besproken en uitgelegd. Het doel zal zijn dat men de kenmerken van deze in Nederland relatief weinig voorkomende aandoening beter zal herkennen en begrijpen. Leerdoelen:-Inzicht geven in de pathofysiologie en daaropvolgende radiologische bevindingen van sikkelcelanemie-Wanneer bij bepaalde radiologische bevindingen te denken aan sikkelcelanemie. Waar moet de radioloog op beducht zijn bij een patient met een bekende sikkelcelanemie. experienced (staff radiologist) or inexperienced (radiology resident). Differences were analyzed using the Chi-Square test. Results: The cohort consisted of predominantly females (N=175, 86%). Mean patient age was 53 (median 54, 14-87). Non-diagnostic cytology occurred in 55 of 214 initial FNA (26%). Non-diagnostic cytology occurred in 13 of 26 repeat FNA (50%). Total non-diagnostic cytology after second FNA was 20%. Approximately 50% of the FNA was performed by a staff radiologist. There was no significant difference between experienced and inexperienced operators (24% and 32%; p=0.21). Conclusions: Although FNA cytology is a valuable tool in the evaluation of thyroid gland nodules there is a high proportion of non-diagnostic test results (26%). It is important to repeat FNA cytology because diagnostic results are obtained in 50% of the previously non-diagnostic FNA. In this study non-diagnostic FNA cytology is not influenced by operator experience. 10 educatief & onderwijs O10.07 Computed tomography observer agreement in malignant lymphoma A.H. de Jong UMC Utrecht, Utrecht Purpose: To determine pretreatment computed tomography (CT) observer agreement in patients suffering from malignant lymphoma. Materials and methods: Pretreatment CT scans of 43 patients with newly diagnosed lymphoma (Hodgkin lymphoma: n=3, non-Hodgkin lymphoma: n=40) were reviewed by three experienced radiologists (with >5 years, >10 years and >20 years of CT experience). CT scans were assessed for the presence of lymphomatous involvement in predefined nodal regions (cervical, infraclavicular, axillary, mediastinal, hilar, para-aortic, mesenteric, para-iliac, and inguinal) and extranodal regions (liver, lung, spleen, bowel, and bone marrow), in a blinded manner. Corresponding Ann Arbor stages were assigned. The first observer assessed each CT scan twice, with a time interval > 1 month between 1 9 E both readings. K-statistics were used to analyze interand intraobserver agreement, Cohen’s kappa = 0.70 was considered as clinically acceptable. Results: Interobserver agreement for nodal region involvement varied from very poor for infraclavicular lymph nodes (?=0.07) to almost perfect for para-iliac lymph nodes (?=0.95). Intraobserver agreement for nodal region involvement was clinically acceptable for all regions, except for infraclavicular and inguinal lymph nodes. Interobserver agreement for extranodal sites varied from poor (?=-0.02 for intestinal involvement) to almost perfect (?=0.88 for lung involvement), intraobserver agreement was clinically acceptable.Ann Arbor stage interobserver agreement was clinically unacceptable (?= 0.58 to 0.69), intraobserver agreement appeared to be clinically acceptable. Conclusion: CT observer agreement in malignant lymphoma varies considerably among different nodal and extranodal regions, and appears to be suboptimal for Ann Arbor staging. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 53 11 programma & abstracts Abstracts Sessie 11 Miscellaneous III Vrijdag 12 september, 11:15 – 12:30 uur O11.01 De voorspellende waarde van CT-hersenen bij een licht traumatisch schedel/hersenletsel in een nietacademisch ziekenhuis J.J.G. Slangen, N. Pernot, D. Rijpsma, C. Meeuwis Rijnstate, Arnhem Vraagstelling: Zijn de CT in minor Head Injury Patients (CHIP)criteria (1) ook toepasbaar in een niet-academisch centrum? Methoden: In onze retrospectieve analyse hebben we vanaf augustus 2010 tot februari 2014 data verzameld van opeenvolgende volwassen patiënten met een licht traumatisch schedel/hersenletsel (LTSH). 3154 patiënten werden gescand volgens de CHIP-criteria (1) waarbij een patint tenminste aan 1 major of 2 minor criteria moest voldoen. CT-hersenen vanwege een LTSH leverden een neurocraniale traumatische afwijking.20 van deze positieve scans betreffen echter patiënten met maximaal 2 minor criteria en geen major criteria. De helft van deze patiënten was gentoxiceerd. Conclusie: Sinds de invoering van de CHIP-predictieregel in 2010 is het aantal CT-hersenen in onze kliniek aanzienlijk toegenomen. De indruk was dat door de implementatie van deze richtlijn er een groot aantal patiënten gescand werd zonder traumatische hersenafwijkingen. Echter uit onze evaluatie blijkt dat ook in een niet-academisch centrum evenveel neurocraniale traumatische bevindingen worden gevonden als in een academische setting zoals waar de CHIP-studie heeft plaats gevonden.De CHIP-criteria lijken daarmee dus ook toepasbaar in een niet-academisch centrum. 1. Minor head injury: CT-based strategies for management--a cost-effectiveness analysis. Smits M, et al. Radiology. 2010 Resultaten: 252 (8%) van de 3154 patiënten met een Feb;254(2):532-40. O11.02 Is reperfusion mandatory for hemorrhagic transformation occurrence after rtPA treatment in patients with acute ischemic stroke? A.D. Horsch1, J.W. Dankbaar1, Y. Van der Graaf2, W.P.T.M. Mali1, B.K. Velthuis1 1 UMC Utrecht, Amsterdam 2 Julius Centrum, Utrecht selected with (1) an ischemic deficit in the middle cerebral artery territory and (2) admission and follow up non-contrast CT (NCCT) and CT perfusion (CTP). Reperfusion status was divided in a no-reperfusion group and a complete- or partialreperfusion group. Occurrence of any HT was assessed on follow up NCCT. HT rates between groups were compared with Fischer’s exact test. Purpose: Recombinant tissue Plasminogen Activator (rtPA) is given in acute ischemic stroke patients to achieve recanalization and reperfusion. Hemorrhagic transformation (HT) is a serious complication of treatment with rtPA. HT is related to increased permeability after blood-brain barrier (BBB) injury. It is not clear whether this occurs (1) secondary to reperfusion in combination with ischemic BBB injury or (2) as a direct consequence of the disruptive effect of rtPA on the BBB. The aim of this study was to establish whether reperfusion is mandatory for the occurrence of HT. Materials and Methods: From the XXX patients were 54 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l Results: Inclusion criteria were met in 191 patients of which 130 (68%) were treated with rtPA. Absolute risks of HT for patients treated with rtPA were not significantly different between no-reperfusion and complete- or partialreperfusion groups (18% versus 15%, P=0.726). In the group without rtPA treatment there was a non-significant trend of higher HT rates in the no-reperfusion group (15% versus 4%, P=0.196). Conclusion:Our results suggest that the increased risk of HT in acute ischemic stroke treatment is related to the direct effects of rtPA on the BBB and not to reperfusion status. BKV is a regular presenter for Philips. 11 miscellaneous III O11.03 Bone marrow FDG-PET/CT cannot replace bone marrow biopsy in diffuse large B-cell lymphoma H.J.A. Adams1, T.C. Kwee2, R. Fijnheer2, S.V. Dubois2, R.A.J. Nievelstein2, J.M.H. de Klerk2 UMC Utrecht, Utrecht This study aimed to investigate whether visual and quantitative 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/ CT)-based bone marrow assessment can replace blind bone marrow biopsy (BMB) in newly diagnosed diffuse large B-cell lymphoma (DLBCL). This retrospective study included 78 patients with newly diagnosed DLBCL who had undergone both FDG-PET/CT and BMB. FDG-PET/ CT images were visually evaluated for bone marrow involvement. Patient-based sensitivity of visual FDG-PET/ CT assessment was calculated using BMB as reference standard. Metabolically active volume (MAV), maximum standardized uptake value (SUVmax), 3D partial volume O11.04 Diffusely increased bone marrow FDG uptake in treatment-naive lymphoma: incidence and relevance H.J.A. Adams, T.C. Kwee, R. Fijnheer, S.V. Dubois, R.A.J. Nievelstein, J.M.H. de Klerk UMC Utrecht, Utrecht Purpose: To determine the incidence of diffusely increased bone marrow 18F-fluoro-2-deoxy-D-glucose (FDG) uptake at positron emission tomography (PET) in treatment-naive lymphoma, and to assess the frequency of lymphomapositive bone marrow biopsies (BMBs) in these patients. Materials and Methods: All FDG-PET scans of patients with newly diagnosed or relapsed lymphoma presenting between July 2004 and February 2014 were reviewed. Patients with non-focal, diffusely increased bone marrow FDG uptake, without any anticancer or hematopoietic growth factor therapy within three months before FDGPET, were identified. The incidences of diffusely increased bone marrow FDG uptake, and the frequencies of positive 1 9 E corrected mean standardized uptake value (cSUVmean), and 3D partial volume corrected mean metabolic volume product (cMVPmean) of FDG-avid bone marrow lesions were measured. Cox regression analysis was used to determine the influence of (potential) prognostic factors (BMB status, visual [dichotomous] FDG-PET/CT bone marrow status, MAV, SUVmax, cSUVmean, cMVPmean, and International Prognostic Index score) on progression-free survival (PFS) and overall survival (OS). FDG-PET/CT detected bone marrow involvement in 34 (43.6%) cases and BMB in 16 of 78 cases (20.5), of whom 11 were also detected by FDG-PET/ CT, resulting in a patient-based sensitivity of 68.8% (95% confidence interval [CI] = 44.2-86.1%) for FDG-PET/CT. In the multivariate Cox proportional hazards model, only BMB status was an independent predictive factor of PFS (P=0.016) and OS (P=P=0.004). In conclusion, FDG-PET/CT misses bone marrow involvement that has been detected by BMB in a non-negligible proportion of patients. Furthermore, both visual and quantitative FDG-PET/CT based bone marrow assessment are prognostically inferior to BMB. Therefore, FDG-PET/CT cannot replace BMB in newly diagnosed DLBCL. posterior iliac crest BMBs among those cases with diffusely increased bone marrow FDG uptake were calculated, in all lymphomas, and in Hodgkin lymphoma, aggressive, indolent, and intermediate-grade non-Hodgkin lymphoma (NHL) separately. Results: A total of 542 FDG-PET scans were reviewed. The incidences of diffusely increased bone marrow FDG uptake in all lymphomas, and in Hodgkin lymphoma, aggressive NHL, indolent NHL, and intermediate-grade NHL separately, were 4.2%, 9.3%, 3.4%, 3.3%, and 7.1%, respectively. The frequencies of positive BMBs among all cases with diffusely increased bone marrow FDG uptake in all lymphomas, and in Hodgkin lymphoma, aggressive NHL, indolent NHL, and intermediate-grade NHL separately, were 55.0%, 0.0%, 83.3%, 83.3%, and 100%, respectively. Conclusion: The incidence of diffusely increased bone marrow FDG uptake in treatment-naive lymphoma is low, albeit higher in Hodgkin lymphoma than in NHL. BMB in such patients is very likely to be negative in Hodgkin lymphoma, but positive in the majority of NHL cases. R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 55 11 programma & abstracts Abstracts O11.05 Appearance of the synovium on contrast-enhanced MRI of the knee in asymptomatic controls compared to juvenile idiopathic arthritis patients C.M. Nusman1, R. Hemke1, M.A. Benninga2, A. Kindermann2, M.A.J. Van Rossum1, T.W. Kuijpers2, M. Maas1 1 AMC Amsterdam, Amsterdam 2 Emma Kinderziekenhuis AMC, Amsterdam Purpose: Inflamed synovium as primary disease target in juvenile idiopathic arthritis (JIA) can be objectified with magnetic resonance imaging (MRI) after intravenous contrast administration. The purpose of this study was to assess the enhancing synovium on MRI of the knee in asymptomatic children compared to JIA patients. Methods: Controls were 25 children who underwent MR enterography with intravenous contrast and had no (history of) joint complaints or signs of joint inflammation. Twentyfive JIA patients were age/sex-matched and divided in three clinical subgroups: new-active, relapse and inactive. Two O11.06 Cerebral perfusion from infant till adolescence assessed with MR pseudo continuous ASL M. Lequin, T. Compagnoni EMCR, Nederland Background and aim: Arterial spin labeling (ASL) is a MR technique to assess brain perfusion without necessity of intravascular administered MR contrast [1]. Our aim was to obtain age dependent normal values of brain perfusion from infant till adolescence. Methods: In this retrospective study we included children aged 1-14 years recruited from our MRI database. In each age group 6 individuals where included who had a normal MRI scan which included ASL. All children were scanned on a 1,5 T MRI scanner (General Electrics). A pseudo continuous ASL technique was used. Exclusion criteria were: congenital abnormalities, brain lesions, meningitis, scan artifacts. Measurement sites were cerebellar hemispheres, 56 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l readers, blinded for JIA/controls, independently measured enhancing synovium and scored synovial thickening (ST) (scale 0-2) at six locations on an axial fat-saturated T1-weighted MRI of the knee. Agreement on incongruent cases was obtained. Differences in ST score and thickness of enhancing synovium between the controls and (subgroups) of JIA patients were assessed. Results: Mean age of all subjects (42% female) was 13.5 years (SD 2.5). Enhanced thickened synovium was present in 9 (36%) controls and 20 (80%) patients. ST score differed significantly (p=0.000) between controls and patients. ST score could differentiate controls from all JIA subgroups (p=0.003-0.028) (Figure 1). Synovial thickness differed between controls (mean 1.4-1.9mm) and clinically active patients (mean 1.8-2.6mm) on 4/6 locations (p=0.020-0.049). Discussion: This study is the first to objectively quantify enhanced synovial thickening in an asymptomatic population compared to JIA patients. ST score on MRI can adequately differentiate asymptomatic controls from (subgroups of) JIA patients. These findings further establish MRI as diagnostic and disease activity monitoring tool in JIA. vermis, basal ganglia, thalamus and temporal, parietal, occipital and frontal lobes. Results: Perfusion values of thalami and basal ganglia appeared fairly constant at different ages. An increase of perfusion was noted in the cerebellar hemispheres from 3 years of age. The cerebellar vermis showed a relative high perfusion in all ages. A slight progressive increase of perfusion was seen at the level of the temporal and occipital lobes without a specific peak. A progressive increase of perfusion was noted at the level of the frontal lobes and parietal lobes. In general, we found a considerable interindividual variability, without significant variations between genders. Conclusions: ASL shows an age dependence of cerebral perfusion. This normative data can help to identify abnormal cerebral perfusion, focal or global, which may lead to diagnoses or a better understanding of the neurological presentation of a child. 11 miscellaneous III O11.07 High resolution non-pressure MRI for preoperative work-up in anorectal malformation during the neonatal period: a prospective study comparing with X-ray fluoroscopic imaging using surgical findings as reference standard N. de Graaf, M.G. Thomeer, A. Devos, M.L. Lequin, C.J.H.M. Meeussen, I. de Blaauw, C.E.J. Sloots Erasmus MC, Rotterdam modalities and surgical findings concerning anatomy and level of rectal pouch were compared using McNemar’s test. Purpose: Aim of this prospective study is to compare X-ray fluoroscopic studies, MRI and surgical findings in newborns with anorectal malformation. Results: There were nine patients with a bulbar fistula, six with a prostatic fistula, five with a vestibular fistula, five with a cloaca, four with no fistula, one with a H-type fistula, one with anal stenosis , one with a perineal fistula and one with a bladder neck fistula. Compared to surgery, MRI or X-ray fluoroscopic studies predicted anatomy correct in 88% (29/33) and 61 % (20/33) respectively (p=0,012). The distal end of the rectal pouch was correctly predicted in 88%(29/33) and 67% (22/33) respectively (p=0,065). The length of the common channel in cloacal malformation was correctly predicted in all with MRI (100 %,5/5) and in 80 % (4/5) with X-ray fluoroscopic studies. Materials and Methods: From 2008 until 2013 33 neonates with anorectal malformations were included. Approval from the local review board was obtained and all parents gave informed consent. All patients underwent high resolution MRI without instillation of contrast (non-pressure), X-ray fluoroscopic studies, and surgical reconstruction. Results of the different Conclusion: High resolution non-pressure MRI is more reliable than X-ray fluoroscopic studies to determine the type of anorectal malformation, level of the rectal pouch, and evaluation of the length of the common channel. MRI can replace X-ray fluoroscopic studies in the preoperative work-up of patients for anorectal malformation reconstruction. 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 57 programma & abstracts auteursindex Auteursindex Graaf, Y. van der O11.02 Busser, W.M.H. O04.04 O03.03 Chamuleau, S. O02.03 Adams, H.J.A. O11.03 Gratama, J.W.C. O08.04 Coenraad, M.J. O04.01 O11.04 Groot, M. de O03.07 Compagnoni, T. O11.06 Akker, J.W. op den O03.01 Haberland, U. O02.07 Cremers, L.G.M. O03.07 Alberda, W.J. O01.03 Habets, J. O02.03 Crom, K. de O10.02 Altintas, S. O02.04 O04.06 Dankbaar, J.W. O03.02 Bakers, F.C. O01.05 Haest, I.I.H. O09.01 O03.03 O09.02 Bakers, F.C.H. O09.06 O03.06 O09.06 Bakija, B. O08.05 O11.02 Heijde, D. van der O05.05 Bakker, J. O10.03 Das, M. O02.04 O05.06 Baltussen, E.J.M. O02.01 O02.05 Heijnen, L.A. O01.01 Bartels, L.W. O04.06 O02.06 O01.02 Bayat, A.R. O09.03 O02.07 O01.05 Beets, G.L. O01.01 De Vries, B. O08.06 O06.03 O01.02 Dekker, A.L.A.J. O10.04 Helm- van Mil, A.H.M. van derO07.02 O01.05 Devos, A. O11.07 O07.07 O06.03 Dijk, E.J.B. van O06.05 Hemke, R. O11.05 Beets-Tan, R.G.H. O01.01 Dijk, J.M.C. van O03.04 Herwaarden, J.A. O04.06 O01.02 Dijk, L. van O04.03 Herwerden, L.A. van O02.03 O01.05 Dijkhuis, G. O07.05 Heuts, E.M. O08.06 O06.03 Dijkstra, H. O08.07 Hoebers, F. O06.07 O08.06 Dmitriev, I. O08.03 Hoeven, E.J.R.J. van der O03.02 Benninga, M.A. O11.05 Doekas, M. O01.03 Hofman, A. O03.05 Beuers, U.H. O01.06 Dorrius, M.D. O08.07 O03.07 Bezooijen, R. O01.04 Dougados, M. O05.06 Hofman, P.A.M. O09.01 Bierma-Zeinstra, S.M.A. O07.04 Droogh-de Greve, K.E. O08.04 O09.02 Bijdevaate, D.C. O06.01 Dubois, S.V. O11.03 O09.06 Bipat, S. O05.01 O11.04 Hoogerwaard, A.F. O03.01 O05.02 Duijm, L.E.M. O06.06 Horsch, A.D. O03.03 O05.03 Dwarkasing, R.S. O01.03 O03.06 O06.04 Egbers, J.B. O03.01 O11.02 Blaauw, I. de O11.07 Elzevier, H.W. O04.03 Hui, T. O03.05 Bloem, J.L. O05.05 Erkel, A. van O04.03 Huis in ‘t Veld, R. O05.04 O05.06 Erkel, A.R. van O04.01 Huizinga, T.W.J. O07.02 O07.02 Ewoud, E.J. O03.06 O07.07 O07.07 Feydy, A. O05.06 Hulzen, A.L.J. van O03.04 Blomberg, B.A. O02.02 Fijnheer, R. O11.03 Hunink, M. O04.05 Bockmann, R.A. O06.07 O11.04 Ikram, M. O03.07 Bos, P.K. O07.03 Franco, O.H. O03.05 Jacobs, S. O10.06 O07.06 Gallardo Estrella, L. O05.07 O10.03 Bouman, D. O01.04 Gijp, A. van der O10.02 Jager, G.J. O02.01 Bouwhuijsen, Q.J.A. van den O03.05 Gilhuijs, K.G.A. O08.01 Jeukens, C. O08.05 Brans, B. O08.06 O08.02 Jong, P.A. de O02.02 Bron, E.E. O07.04 O08.03 O07.05 O07.06 Ginneken, B. O03.06 Jong, A.H. de O10.07 Bruin, F. de O05.06 Ginniken, B. van O05.07 Jost, G. O02.07 O05.05 Gossec, L. O05.06 Kamphuis, K. O09.03 Budde, R.P.J. O02.03 Graaf, E.K.L. de O03.04 Kan, R.A.T. van O09.02 Burgmans, M.C. O04.01 Graaf, N. de O11.07 AUTEUR 58 k i j k o o k abstract o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l auteursindex Kant, I.M.J. O02.01 Lalji, U.C. O08.05 Montauban van Swijndregt, A.D. O04.02 Kappelle, L.J. O03.02 Lambregts, D.M.J. O01.01 Moos, S.I. O05.01 O05.02 Kemp, W.J.M. van der O08.02 O01.02 O05.03 Kessler, P. O06.07 O01.05 Nagan, G. O05.01 Keymeulen, K.B.M.I. O08.06 O06.03 Nederend, J. O06.06 Kietselaer, B.L.J.H. O02.04 Lammers, J.W.J. O05.07 Nederveen, A.J. O01.06 Kietselear, B. O02.05 Lange, F. de O04.04 Nelemans, P.J. O08.06 Kindermann, A. O11.05 Latten, B. O09.06 Netten, J.J. van O03.01 Klazen, C. O01.04 Laufer, E.M. O02.03 Niessen, W. O03.07 Klein, S. O07.04 Leiner, T. O02.02 O10.04 O07.06 O04.06 Niessen, W.J. O03.05 O10.04 Lequin, M. O11.06 Niesten, J.M. O03.02 Klein, W.M. O06.02 Lequin, M.L. O11.07 Nieuwenhuis, W.P. O07.07 O09.03 Lobbes, M. O08.05 Nievelstein, R.A.J. O11.03 Klerk, J.M.H. de O11.03 Lobbes, M.B.I O08.06 O11.04 O11.04 Lohuizen, W. van O09.01 Nijhof, W.H. O02.01 Klink, C. O04.05 O09.02 Nijnatten, T. van O01.02 Klomp, D.W.J. O08.02 Loo, C.E. O08.01 Nusman, C.M. O11.05 Kock, G.A.H. O04.02 O08.03 Nuyttens, J.J.M.E. O01.03 Kock, M.C.J.M. O06.05 Lugt, A. van der O03.05 Oei, E.H.G. O07.03 O08.02 O03.07 O07.04 Kok, M. O02.04 O10.04 O07.06 O02.05 Luijtne, M. O09.01 Ommen, W. van O06.03 O02.06 Maas, M. O10.02 Ooms, E.M. O05.04 O02.07 O11.05 Ortega, B. O04.01 Koning, H.J. de O05.07 Majoie, C.B. O09.04 Osanto, S. O04.01 Koopmanschap, D. O09.03 O09.05 Oudelaar, B.W. O05.04 Köster, N. O06.02 Mali, W.P.T.M. O11.02 Oudkerk, M. O05.07 Kotek, G. O07.04 O03.03 O08.07 Kotek, G.P. O07.06 Mann, R. O04.04 Ousema, P.H. O07.01 Kraai, M. O03.01 Martens, M.H. O01.01 Overhagen, H. van der O04.03 Krabben, A. O07.07 O01.02 Paiman, M. O08.06 Krestin, G. O03.07 O01.05 Pernot, N. O11.01 Krestin, G.P. O03.05 O06.03 Plas, A. van der O10.01 O07.03 Meer, R.W. van der O04.03 Pompe, E. O07.05 O07.04 Meeussen, C.J.H.M. O11.07 O05.07 O07.06 Meeuwis, C. O11.01 Poort, L.J. O06.07 Kroll, J. O09.01 Meijer, E. O08.05 Postema, F.A.M. O09.04 O09.02 Meijer, F.J.A. O03.06 O09.05 O09.06 O04.04 Postma, A.A. O06.07 Kubat, B. O09.02 Meiners, L.C. O03.04 O09.02 Kuijpers, T.W. O11.05 Menke-Pluijmers, M.B.E. O08.02 Prevos, R. O09.06 Kwee, T.C. O11.03 Mihl, C. O02.04 Prokop, M. O03.06 O11.04 O02.05 O06.02 Laak, J.A. van der O06.02 O02.06 Puylaert, C.A.J. O06.04 Laar, P.J. van O03.04 O02.07 Rao, S.-X. O01.01 Lagerveld, B.W. O04.02 Moelker, A. O04.05 O01.02 Lahaye, M.J. O01.02 Mohamed Hoesein, F.A.A. O07.05 O06.03 O01.05 O05.07 Ravesloot, C.J. O10.02 O09.02, O09.06 Moll, F.L. O04.06 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 59 programma & abstracts auteursindex Reijman, M. O07.03 Sosef, M. O01.01 Verhoeven, B. O04.04 O07.04 Staal, M.J. O03.04 Vernooij, M. O03.07 O07.06 Stadler, A.A.R. O06.07 Vernooij, M.W. O03.05 Reijnierse, M. O05.05 Stoker, J. O01.06 Verschueren, J. O07.04 O05.06 O05.01 Vincken, K.L. O10.02 O07.02 O05.02 Vleuten, C.J.M. van der O04.04 O07.07 O05.03 Vliegen, R.F.A. O06.03 Ridder, M.A.J. de O01.03 O06.04 O01.01 Riele, R. te O04.05 Stomp, W. O07.02 Vochteloo, A.J.H. O05.04 Rijn, R.R. van O09.04 O07.07 Vonken, E.P.A. O04.06 O09.05 Suchá, D. O02.03 Vonken, E.J. O03.06 Rijpsma, D. O11.01 Symersky, P. O02.03 Vos, J.A. O03.02 Rijswijk, C.S.P. van O04.01 Tai, J.L.E. O10.05 Vries, B. de O09.06 Rikxoort, E.M. van O05.07 Takx, R.A.P. O02.02 Waardhuizen, R.M. van O01.03 Roshani, H. O04.03 Tanis, W. O02.03 Waarsing, E. O07.03 Rossum, M.A.J. van O11.05 Theunissen, R. O08.05 Wagenberg, J.M.F. van O01.04 Runge, J.H. O01.06 Thomeer, M. O06.01 Walsum, T. van O04.05 Rutgers, D.R. O10.02 Thomeer, M.G. O11.07 Weber, R.J.P O06.06 Rutten, M.J. O02.01 Tiel, J. van O07.03 Weijert, R.S. de O05.01 Sassen, S. O01.01 O07.04 O05.02 Schaaf, I.C. van der O03.02 O07.06 Weinans, H. O07.03 Schaaf, M. van der O10.02 Tielbeek, J.A.W. O06.04 O07.06 Schaaf, I. van der O03.06 Tipker, C.A. O10.02 Weltings, S. O04.03 Schaapherder, A.F.M. O04.01 Treyvaud, M.O. O05.06 Westenend, P.J. O08.02 Schaapman, J.J. O04.01 Turek, J. O02.04 Westerbeek, R.E. O07.01 Schaik, J.P.J. van O10.02 O02.05 O10.05 Schepers-Bok, R. O05.04 O02.06 Wijnen, M.H.W.A. O04.04 Schipper, R.J. O08.06 O02.07 Wildberger, J.E. O02.04 O02.05 Schmitz, A.M.Th. O08.02 Ulrich, D.J.O. O04.04 O02.06 O08.01 Valk, S.B.A. van der O05.04 O02.07 Schnerr, R. O06.03 Van de Vijver, K.K.B.T. O08.06 O08.05 Schnerr, R.S. O09.01 Veendrick, P.B. O04.04 Willemink, M.J. O07.05 Schonewille, W.J. O03.02 Velde, D. van der O03.01 Willemssen, F.E.J.A. O01.03 Schultze Kool, L.J. O04.04 Velden, B.H.M. van der O08.03 Win, J.L.M. de O08.04 Seehofnerova, A. O02.04 Velden, T.A. van der O08.02 Wolterbeek, R. O04.01 O02.07 Veldhuis, W.B. O08.02 Zandvoort, J.A. O04.06 Selwaness, M. O03.05 Velthuis, B.K. O03.02 Siebelt, M. O07.03 O03.03 Sieswerda-Hoogendoorn, T. O09.04 O03.06 O09.05 O11.02 Sijens, P.E. O08.07 Vemde, D.N.H. van O05.01 Slangen, J.J.G. O11.01 O05.03 Slijkhuis, W.A. O08.04 Verbaan, D. O09.04 Sloots, C.E.J. O11.07 Verdult, J. O04.03 Slootweg, P.J. O06.02 Verhaar, H.J.J. O07.05 Smagge, L.E.M. O10.05 Verhaar, J. O07.03 Smidt, M.L. O08.06 O07.04 Smit, R.S. O03.01 O07.06 Soest, J. van O10.04 Verheij, J. O01.06 Sonnemans, L.J.P. O06.02 Verhoef, C. O01.03 60 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l AAntekeningen 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 61 programma & abstracts aantekeningen 62 k i j k o o k o p o f w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l aantekeningen 1 9 E R A D I O L O G E N D A G E N - 1 1 e n 1 2 S E P T E M B E R 2 0 1 4 63 programma & abstracts PLATTEGROND En programma LIMOUSIN 1 LIMOUSIN 2 LIMOUSIN 3 DEXTER 18-17 DEXTER 28-27 FOYER DEXTER 16-15 DEXTER 11-14 DEXTER 26-25 DEXTER 21-24 REGISTRATIE GARDEROBE GALLOWAY RODE GEUS 64 k i j k o o k o p o f ENTREE w w w . c o n g r e s s c o m p a n y . c o m w w w . r a d i o l o g e n . n l RADIOLOGENDAGEN 2014 Sexy secties Geachte collega’s, Wij wensen u heel veel plezier op de radiologendagen 2014. De continue wisselwerking (en bijscholing) tussen de radioloog met een deelspecialisatie en de op dat onderdeel algemene radioloog is de grote pijler van de radiologendagen. De secties zijn daarbij het kloppende hart van de radiologendagen. Elke sectie heeft een lid in het wetenschappelijke comité welke de bijdrages vanuit het deelgebied coördineert zoals refresher courses etc. Dit jaar besteden we nog explicieter aandacht aan de secties zoals het thema Sexy Secties al aangeeft. Meerdere secties houden dit jaar op de donderdagmiddag een sectie vergadering. Verschillende secties hebben zich al aangemeld voor 2015 dus dit gaat een nieuwe traditie worden! Graag wil ik ook uw aandacht vestigen op de misser/complicatie sessie op de vrijdag welke de radiologendagen 2014 met een knal zal afsluiten! Iedereen (sprekers, sponsors etc.) die een bijdrage levert aan de radiologendagen 2014 willen we hierbij bedanken. Het Organisatie Comité van de Radiologendagen 2014, Jeroen Hendrikse, Sebastiaan Jensch, Ingrid Bruijnzeel-Koster, Otto Elgersma, Marieke Sprengers Het uitgebreide programma en de omschrijving en de leerdoelen van de Refresher courses vindt u op pagina 2 t/m 16. Foyer Limousin 1 Limousin 2 Limousin 3 Dexter 15-16 Dexter 11-14 Dexter 21-24 Dexter 25-26 08:00 – 08:30 Ontvangst & registratie 08:30 – 09:30 Refresher course: Refresher course: Maligne lymfomen De (schedel)basis in acute/ levensbedreigende setting 09:30 – 10:00 Missers & veiligheidscultuur 10:00 – 10:30 Cognitieve errors in radiology 10:30 – 10:45 Complicatie registratie 10:45 – 11:15 Koffie/theepauze 11:15 – 12:30 Parallelsessie 7: Parallelsessie 8: Parallelsessie 9: Parallelsessie 10: Parallelsessie 11: MSK Mammoradiologie Forensische Radiologie Educatief & Onderwijs Miscellaneous III 12:35 – 13:00 Prijzensessie Philipsprijs Best Abstract Prijs Travel Grant 13:00 – 14:00 Lunch 14:00 – 14:30 Missers: Acute Radiologie 14:30 – 15:00 Missers: Kinderradiologie 15:00 – 15:30 Missers: Thoraxradiologie 15:30 – 16:00 Complicaties: Interventie Rad. 16:00 Sluiting door de voorzitter 16:05 Afsluitende borrel Vrijdag 12 september 2014 Foyer Limousin 1 Limousin 2 Limousin 3 Dexter 15-16 Dexter 11-14 Dexter 21-24 Dexter 25-26 08:00 – 09:00 Ontvangst & registratie 09:00 – 09:05 Opening door voorzitter Openingssessies 09:05 – 10:15 10:15 – 10:45 Koffie/theepauze 10:45 – 11:45 Refresher course: Refresher course: De postoperatieve knie Diagnose en behandeling levermetastasen 11:55 – 13:10 Parallelsessie 2: Parallelsessie 1: Parallelsessie 3: Parallelsessie 4: Parallelsessie 5: Parallelsessie 6: Cardiovasculair Abdomen Neuroradiologie Interventieradiologie Miscellaneous I Miscellaneous II 13:10 – 14:10 Lunch 14:10 – 14:40 NVvR en de federatie 14:40 – 14:55 Laudatie Prof.dr. J.S. Lameris 15:00 – 16:00 Parallel sectiemiddag: Refresher course: Refresher course: Parallel sectiemiddag: Parallel sectievergadering: Mamma diagnostiek Coronair CT voor elke KNO MSK Abdomen radioloog afwijkende eindtijd: 16:30 uur alleen toegankelijk voor leden afwijkende eindtijd: 17:30 uur anno 2014 16:00 – 16:30 Koffie/theepauze 16:30 – 17:30 Speciale sessie AIOS: Refresher course: Refresher course: Werken in buitenland The Great Mimickers De geschiedenis in Chest Radiology van de Radiologie 17:30 – 18:15 Quiz 18:15 Sluiting door de voorzitter 18:15 Borrel met aansluitend diner & feest Orangerie Donderdag 11 september 2014 programma & abstracts voorwoord 19 sponsoren en exposanten Bayer Healthcare Biomedic Bracco Imaging Europe C.R. Bard Netherlands Sales ChipSoft GE Healthcare Guerbet Nederland Interact Medical Klinipath Mermaid Medical Oldelft Benelux ScoVas Medical Siemens Nederland Toshiba Medical Systems Nederland Tromp Medical programma & abstracts - 19E nederlandse radiologendagen - 11 en 12 september 2014 Hoofdsponsoren radiologendagen 2014 19 programma & abstracts RADIOLOGENDAGEN Sexy secties ‘Eye Candy?’ 11 - 12 SEPTEMBER 2014 1931 Congrescentrum Brabanthallen ’s-Hertogenbosch Travel Grant RSNA abstracts www.radiologen.nl www.congresscompany.com
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