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
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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
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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
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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
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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
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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
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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
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programma
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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
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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
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1 1
e n
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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
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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
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1 1
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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
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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
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programma
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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
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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.
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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.
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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’.
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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
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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.
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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.
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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
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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
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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
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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.
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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
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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.
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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
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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.
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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.
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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
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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.
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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
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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.
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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.
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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
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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
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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.
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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
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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
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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.
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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.
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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
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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.
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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).
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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.
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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
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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.
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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.
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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.
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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
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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.
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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
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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.
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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
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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
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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
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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
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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
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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.
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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
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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
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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.
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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
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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
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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.
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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.
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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.
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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.
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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
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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
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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
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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.
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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
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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
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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.
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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,
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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.
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programma
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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
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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
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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
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AAntekeningen
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aantekeningen
62
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programma
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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
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ENTREE
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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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