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Scientific Exhibitions 409

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SE 01 AB-01Essential items for structured reporting of rectal cancer MRI: 2016 consensus from the Korean Society of Abdominal Radiology (KSAR) study group for rectal cancerYoung Seo Cho1, Seong Ho Park2

1Hanyang University Guri Hospital, 2Asan Medical Center, Korea. parksh/[email protected]

TEACHING POINTS: 1.To present an evidence-based expert consensus on

how to report rectal MRI performed to stage a rectal cancer.

2.TolistessentialimagingfindingsonrectalMRIandtoexplain how they should be described in a structured format.

3. To explain the rationale and clinical relevance regarding each reporting items and its format.

TABLE OF CONTENTS/OUTLINE: 1.How KSAR expert consensus was made Explana-tionsonthemodifiedDelphiprocess.

2. Table to show the structured report ing form recommended by KSAR.

3. Explanations on each essential reporting item (1 through 12) with example figures, each in a unified format that includes a) suggested reporting form with %agreementamongtheexperts,b)examplefigureswith appropriate surgical/pathological correlation, and c) rationale and clinical relevance. 01)Distanceofthelowesttumormarginfromtheanal

verge02)Distanceof the lowest tumormargin from the

anorectal junction03) Tumor relationship to the anterior peritoneal

reflection04) Circumferential tumor location05) Longitudinal tumor size06) T stage (AJCC)07) Maximum extramural depth of tumor invasion08) Shortest tumor distance from the mesorectal

fascia or the levator09) Anal sphincter involvement10) Mesorectal lymph node spread11) Extramesorectal lymph node spread12) Extramural venous invasion (EMVI)

4. Interactive quiz cases for selftest.

SE 01 AB-02“CYSTIC model” in common and uncommon cystic lesions of pancreasBinit Sureka, Archana Rastogi, Asit Arora, Tushar Kanti Chattopadhyay, Shiv Kumar Sarin InstituteofLiverandBiliarySciences(ILBS),NewDelhi,India. [email protected]

This poster will acquaint the readers and the viewers with the list and imaging characteristics of various common and uncommon cystic lesions encountered in pancreas.We propose a new“CYSTIC model” approach which will ease in narrowing down the list of differential diagnosis. Using these new model we classify the characteristics of different types of cystic lesions in pancreas.Since the use of cross-sectional body imaging has increased three fold in the last two decades, the radiologists should be aware of the various types of common and uncommon pancreatic cystic lesions.CYSTIC model C - Characterist ic location and loculation Y - Years - age group S - Sex size shape T - Tumor enhancement pattern I - Incidence Imaging prognosticator for malignancy C - Communication with ductcalcificationcentralscar

SE 01 AB-03Autoimmune pancreatitis: parenchymal and ductal imaging featuresBinit Sureka, Archana Rastogi, Shiv Kumar SarinInstituteofLiverandBiliarySciences(ILBS),NewDelhi,India. [email protected]

Autoimmune pancreatitis (AIP) is a rare under diagnosed fibroinflammatory variant of chronic pancreatitis. Its true incidence and prevalence in general population is still not confirmed despite advances in medicine.

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Differentiatingitfrompancreaticcancerisofparamountimportance.Wehighlighttheimagingfindingsintype1and type 2 AIP.We will discuss the pancreatic parenchymal changes and pancreatic ductal changes encountered in AIP.We will also discuss the various extrapancreatic organ involvement and imaging features. We will see the differential diagnoses to be considered in AIP.

SE 01 AB-04Percutaneous transhepatic interventions in the treatment of liver abscessesKarimov Shavkat Ibragimovich, Hakimov Murod Shavkatovich, Hasanov Vali Rakhmatullayevich, Rakhmanov Sobir Urinbayevich, DjafarovSaidamirMuradovich,Viktoriya TsayTashkent Medical Academy, Uzbekistan. [email protected]

PURPOSE: Tostudy the effectiveness of percutane-ously-drainage methods in treatment of patients with liver abscesses.MATERIALS AND METHODS: A retrospective study of patients with liver abscesses treated in Tashkent Medical Academy for the period 2008-2013.52 patients aged 21 to 68 years, with solitary and multiple liver abscesses.Multiple abscesses were accompanied with cholangitis. Cholangiogenic abscesses were in 5 (9.6%) patients, cryptogenic - in 10 (19.2%), post-traumatic - in 3 (5.8%), postoperative - in 3 (5.8%), the residual cavity after echinococcectomy - in 31 (59.6%) patients. Tactics of surgical treatment of abscesses included percutaneous transhepatic puncture under fluoroscopic guidance, contrasting with subsequent drainage of the cavity;passive drainage with fractional washingwithSol.Dioxydini.Ultrasound, fistulography was made on 5-7 days to determine the adequacy of the drainage position correction or replacement of drainage on a larger diameter. After readjustment of foci, in an outpatient setting within 3-4 weeks was performed dynamicultrasound,controlfistulography, ifnecessary,correction and removal of drainage.Cholangiogenic liver abscesses were occurred in malignant bile duct obstruction, after retrograde cholangiography without subsequent decompression. In such cases, appropriate treatment was imposition of percutaneous transhepatic antegrade cholangiostomy and decompression.RESULTS: For adequate drainage is necessary to create a drainage loop across the inner surface of the abscess cavity.Severe complications in patients treated by this method are not met. One patient had catheter breakage,removedunderfluoroscopyandrestorationofdrainage.Theaveragetimeofthefirsthospitalstaywas

4.4 ± 2.9 days, the general terms of treatment -52.1 ± 14.7 days.Mortality with puncture-drainage treatment of liver abscesses was 1 (1.9%).At patient with sepsis developed multiple organ failure.CONCLUSION: The operation of choice in liver abscesses is puncture-drainage intervention.Minimally invasive surgical treatment of cholangiogenic liver abscess involves treatment of causative agent of ascending infection - decompression of the biliary tract. At multiple small liver abscess is indicated a rational antibiotic therapy.

SE 01 AB-05Prediction of late postoperative hemorrhage after the Whipple procedure using CT performed during the early postoperative periodYou jin Lee, Ga Jin Han, Jin joo Kim, Suk Kim, Namkyung Lee Pusan National University Hospital, Korea. [email protected]

PURPOSE: Delayedpostpancreatectomyhemorrhage(PPH) is the serious complication of Whipple surgery. There are many reports about computed tomography (CT) findings at the time of bleeding and clinical risk factors associated with late PPH. The purpose of this study is to evaluate the radiologic features associated with late PPH at the first postoperative follow up CT before bleeding.MATERIALS AND METHODS: This retrospective study included 151 patients had undergone Whipple surgery. Two radiologists reviewed the initial postoperative follow-up CT images, including presence of suggestive feature of pancreatic fistula and abscess, fluid along hepaticojejunostomy and pancreaticojejunostomy (PJ),thedensityofascitesandthesizeofvisibleGDAstump.Postoperativeperitonealfluidanalysiswasalsoevaluated. Simple and multivariate logistic regression analyses were performed to identify independent clinical and imaging variables associated with late PPH.RESULTS: 20 patients (13.2%) showed late hemorrhage duetoabnormalityofGDAstumporothervesselsandactive ulcer at anastomosis site. Univariate analysis showed that infected fluid revealed on peritoneal fluid analysis and CT findings including pancreatic fistula, abscess,andlargersizeofGDAstumpwereassociatedwith bleeding. On multivariate analysis, The presence of radiological featuressuggestiveofapancreaticfistula,abscessandaGDAstump>4.45mmwereassociatedwith delayed hemorrhage (p = 0.004, p = 0.031, and p = 0.009, respectively).CONCLUSION: Early postoperative CT findings includingGDA stump size larger than 4.45mm,abscess,andpancreaticfistulacouldplayimportantrole


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in predicting late PPH.

SE 01 AB-06Comprehensive illustrations of focally increased echogenic conditions in hepatic sonography Hyun Cheol Kim,SangWonKim,DalMoYangKyung Hee University Hospital at Gangdong, Korea. [email protected]

PURPOSE: 1. To demonstrate various conditions of focally increased

hyperechogenicity of the liver.2. To discuss the clues for differential diagnosis of these

hyperechoic conditions.MATERIALS AND METHODS: 1. Introduction2. Common hepatic conditions showing focally increased

echogenicity of the liver1) Hemangioma2) Hepatocellular carcinoma3) Intrahepatic cholangiocarcinoma4) Abscess5) Metastasis6) Focal fat deposition7) Normal structures

3. Uncommon hepatic conditions showing focally increased echogenicity of the liver1) Focal nodular hyperplasia2) Hepatic adenoma3) Lipomatous tumor4) Angiosarcoma5) Hematoma with laceration

4. Some clues for differential diagnosis of focal hyperechoic condition of the liver

CONCLUSION: Familiarity with the sonographic features of a variety of focally increased echogenic condition of the liver can be helpful for the correct diagnosis and an appropriate management.

SE 01 AB-07Clinical applications of CT perfusion imaging in gastric cancerGen Yan1, Yinghua Xuan2

1AffiliatedHospital,JiangnanUniversity,2Jiangnan University, China. [email protected]

PURPOSE: To explore the characteristics of variously differentiated gastric cancers on computed tomography (CT) perfusion imaging, specific perfusion parameter values, and potential clinical applications in the diagnosis of gastric cancer.

MATERIALS AND METHODS: Fifty patients with pathologically confirmed gastric cancer were recruited and all subjects underwent abdominal examinations on a 64-slice spiral CT perfusion imaging scanner. The acquired volume data were used for calculations, mapping, and analysis by using an abdominal tumor perfusion protocol in the CT perfusion software package tomeasure4parameters:bloodflow(BF),bloodvolume(BV), mean transit time (MTT), and the permeability surface (PS) . The patients were divided into 3 groups: group 1, well differentiated gastric adenocarcinoma (n = 1); group 2, moderately differentiated gastric adenocarcinoma (n = 24); group 3, poorly differentiated gastric adenocarcinoma (n = 16).RESULTS: Comparing the 3 groups, differences between the well-differentiated group and the moderate differentiation group were all statistically significant for BF, BV, and PS (p < 0.05), as well, differences between the well-differentiated group and the poor differentiation groupwereallstatisticallysignificantforBF,BV,andPS(p < 0.05); moreover, BV and PS values demonstrated highstatisticalsignificance(p<0.01).CONCLUSION: Abdominal CT perfusion imaging is a functional imaging technology with potential applications in the clinical diagnosis and treatment of gastric cancer from the perspective of hemodynamics. BV and PS values could serve as indicators of the degree of malignancy and aid in prognostic assessments of gastric cancer.

SE 01 AB-08Mysterious splenic diseases: comprehensive review with cross-sectional imagingMin-Jeong Kim, Jinyoung Chang, Hong Il Ha, Kwanseop Lee Hallym University Sacred Heart Hospital, Korea. [email protected]

TEACHING POINTS: 1. To describe the key imaging findings of the normal

spleen with its congenital anomalies using ultrasound, computed tomography, and magnetic resonance imaging.

2.Torecognizeandillustrateessentialimagingfindingsof various splenic disease.

3. To solve quiz cases and to remind the important radiologic features of splenic diseases.

TABLE OF CONTENTS/OUTLINE: 1. The key cross-sectional imaging findings of the

normal spleen.2. Table to show various splenic disease according to

categories.3. Illustrations of various splenic disease focusing essentialradiologicfindings

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- Congenital diseases (accessory spleen, polysplenia, and asplenia)

- Trauma-Inflammation(abscess,tuberculosis,andsarcoidosis)- Vascular disorders (infarction, torsion, and arteri-

ovenous malformation)- Hematologic disorders (sickle cell disease and

extramedullary hematopoiesis)- Benign tumors (cyst, hemangioma, lymphangioma,

hamartoma, and sclerosing angiomatoid nodular transformation)

- Malignant tumors (lymphoma, angiosarcoma, and metastases)

- Miscellaneous (portal hypertension, Gamna-Gandy nodules)

4. Quiz cases for selftest

SE 01 AB-09A review of risk stratification and response evaluation system for gastrointestinal stromal cell tumors (GISTs)Kok Soon Chow, Gurmit Kaur Sardara Singh, BashironJamaludin,YuanYingTan,DingXinHeh,Murrali Silvarajoo Penang General Hospital, Malaysia. [email protected]

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are the commonest mesenchymal tumors of the gastrointestinal tract first described by Mazur and Clark in 1983.They arise from interstitial cells of Cajal of myenteric plexus. They immunophenotypically express CD117,a tyrosine-kinasegrowth factor receptor fromKIT-gene mutation which distinguishes GIST from other mesenchymal and sarcomatous counterparts. GISTs have a distinct clinical behavior and way of metastases that deserves dil igent assessment. This article provides insights and comparisons among various risk stratificationandresponseevaluationsystemforGISTs.DISCUSSION:AlthoughFletcher’s (NIH) criteria,Miettinen’s (AFIP) criteria,TGMsystemandTNMsystemhadbeenproposedasriskstratificationsystemsfor GISTs, questions remain on which criteria best reflectsthetruenatureofGIST.Whilethemostwidelyaccepted prognostic factors remains to be anatomical and histolopathological (i.e., mitotic rate, tumor size and tumor site), problems arise in low grade tumors with aggressive behaviors, overt symptoms and peritoneal disseminations. Biochemical markers are yet to be incorporated in the risk stratifications systems. Therefore their roles need to be further explored. GISTs demonstrate unique response to Imatinib that differs from other solid tumors, hence making the conventional RECIST inappropriate. The roles of a newly proposed

Choi’s criteria andPETas baseline investigationand treatment response monitoring would be further discussed.CONCLUSION: Although the time where GIST as an elusive tumor has long gone, controversies remain when it comes to the assessment of GIST before and after treatment. In summary, a clinicopathological approach would be holistic.

SE 01 AB-10Parametric response mapping of dynamic CT: enhanced prediction of survival in hepatocellular carcinoma patients treated with transarterial chemoembolizationCho Rong Seo, Seung Joon Choi Gachon University Gil Medical Center, Korea. [email protected]

PURPOSE: The aim of this study was to evaluate the prognosticsignificanceofparametricresponsemapping(PRM) analysis for hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).MATERIALS AND METHODS: We recruited 52 HCC patients who underwent TACE. These patients underwent longitudinal multiphasic CT before and after TACE. We applied PRM analysis to the baseline CT beforeTACEandfirst/secondfollow-upCTs.Theresultsof PRM analyses were used to stratify patients into responders and non-responders. Overall survival was compared between the two groups. An independent survival analysis using conventional radiological assessments was performed, and the results were compared with PRM results. Univariate and multivariate analyses were performed to identify clinical factors affecting survival.RESULTS: The PRM analyses demonstrated the responding group had median survival of 492 days, while the non-responding group had median survival of 286 days (p = 0.005 for differences in survival). The manual analyses indicated median survivals of 530 and 365 days for the responding and non-responding groups, respectively (p = 0.034). Tumor size and alpha-fetoprotein level were found to be significantly related to overall survival after univariate and multivariate analyses.CONCLUSION: The results of PRM analysis could be a better performance predictor of overall survival for patients with HCC undergoing TACE.


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SE 01 AB-11Amalgam filling appendix vermiformisAli Kemal Sivrioglu1, Süleyman Tutar2

1KasımpasaMilitaryHospital,2GATA Haydarpasa Teaching Hospital, Turkey. [email protected]

CASE REPORT: A25-year-oldmanwithaleftflankpainadmitted to the urology service.Costovertebral angle tenderness was present in the physical examination. Sub centimeter metallic foreign body was seen in the right hemi pelvis determined in the direct urinary system radiography. Ultrasonography was not detected in urinary tract stones. Metallic foreign body was seen in the tip of the appendix vermiformis on noncontrast CT. And there was no other computed tomography evidence. Urinary tract infection diagnosis by the full urinalysis. When the medical history of the patient is re-examined wecanseethathehasdroppedhistoothfillingsbefore2 months. Therefore we concluded that the foreign body foundmaybeapartofthedentalamalgamfilling.Thepatient has not received any stomach ache in 2 month time. He was seen follow up on his request. CONCLUSION: Usually foreign bodies taken in by oral ways are excreted by the digestive system. However if the objects are sharp, solid, thin and long, increases the possibilityofcomplications.Duringeating thepatientcan swallow the dental amalgam without noticing. However their small volume and nodular shape make them often get excreted from the body asymptomatically. Although limited for diagnose of dental foreign bodies caused appendicitis rare in the literature. Some authors think that the presence of the foreign body in appendix vermiformis that can be trigger inflammation and perforation, so that to prevent some complications they suggest elective surgery.

SE 01 AB-12Cross-sectional imaging of intrahepatic cholangiocarcinoma: development, growth, spread, and prognosisNieun Seo, Jin-Young Choi, Mi-Suk Park, Yong Eun Chung, Myeong-Jin Kim Severance Hospital, Korea. [email protected]

TEACHING POINTS: 1. To introduce recent updates in epidemiology and

pathologic concepts of intrahepatic cholangio-carcinoma (ICC)

2. To present an imaging atlas of ICC with radiologic-pathologic correlation and differential diagnosis

3. To describe imaging features of ICC using advanced

MR technology4. To discuss the prognostic imaging features of ICCCONTENTS/OUTLINE:1. Epidemiology2. Pathologic considerations and cholangiocarcino-

genesis1) Gross morphology2)Newpathologicsubclassification(1) Perihilar large duct type(2) Peripheral small duct type3) Premalignant lesions of ICC4) Relationship with pancreatic counterparts

3. Updated imaging features and differential diagnosis1) Technical considerations of CT and MRI2) Typical imaging features and its differential

diagnosis(1) Mass-forming ICC(2)PeriductalinfiltratingICC(3) Intraductal growing ICC

4. Prognostic implications of imaging features1) Prominent arterial enhancement2)Delayedenhancement

SE 01 AB-13Double-contrast upper gastrointestinal barium examination findings of chronic gastritis with Helicobacter pylori infectionFumio Kotake, Naoki Naitoh, Chuichi Sekine Saiseikai Kawaguchi General Hospital, Japan. [email protected]

PURPOSE: To evaluate the usefulness of radiological findings for the diagnosis of chronic gastritis with Helicobacter pylori (H. pylori) infection.MATERIALS AND METHODS: The study included 164 participants (66 women and 98 men; mean age 55.2 years; age range 34-80 years) who underwent serum H. pylori antibody titers and double-contrast upper gastrointestinal barium examinations on the same day in the health examination center of our hospital. The participants were divided into H. pylori-negative group (H. pylori antibody titer < 3.0 U/ml), H. pylori-highly negativegroup(3U/ml≤H.pyloriantibodytiter<10.0U/ml) and H. pylori-positive group (H. pylori antibody titer≥10.0U/ml)accordingtotheH.pyloriantibodytiterfindings. Radiography was performed in accordance with the imaging guidelines of the Japanese Society of Gastrointestinal Cancer Screening. Gastric fold thickness was measured on a frontal or right anterior oblique view using double-contrast radiography in the supine position, and the surface gastric mucosa was classifiedassmooth,granular,andreticulardependingon its characteristics.RESULTS: A total of 79 participants were assigned to

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the H. pylori-negative group, 14 to the H. pylori-highly negative group, and 71 to the H. pylori-positive group. Gastric fold thickness was observed; the disappearance of gastric folds was demonstrated in 16 participants, whereas fold thickness values of 2.0-3.9 mm (n = 76), 4.0-5.9 mm (n = 43), and more than 6 mm (n = 29) were detected in the remaining participants. Gastric fold thickness in the H. pylori-positive group (5.7 ± 1.4 mm) and H. pylori-highly negative group (3.6 ± 1.7 mm) wassignificantlyincreasedcomparedwiththatintheH.pylori-negative group (2.9 ± 0.6 mm) (p < 0.05). Surface gastric mucosa was demonstrated to be smooth (n = 71), granular (n = 82), or reticular (n = 11). When gastric fold thicknesswas>4.0mmordisappearancewasnoted, and granular or reticular surface gastric mucosa was used for predicting chronic gastritis with H. pylori infection, the diagnostic sensitivity, specificity, PPV, NPV, and accuracy were 94.9% and 84.9%, 84.7% and 100%, 85.2% and 100%, 94.7% and 83.5%, and 89.6% and 91.5%, respectively.CONCLUSION: Double-contrastuppergastrointestinalbarium examination is a useful tool for the diagnosis of chronic gastritis with H. pylori infection.

SE 01 AB-14Calcification contained peritoneal diseasesYongsoo Kim, Sang Joon Lee, Young Seo Cho, Sanghyeok Lim Hanyang University Guri Hospital, Korea. [email protected]

PURPOSE: 1. To illustrate calcification containing peritoneal

diseases2. To differentiated the imaging characteristics of

peritoneal diseases by using the morphology and distributionofcalcifications

CONTENTS:WeretrospectivelyreviewedCTfindingsinpathologicallyconfirmed calcification contained peritoneal diseases. Weclassifiedperitonealdiseaseasfollows:1. Central calcification; carcinoid tumor, sclerosing

mesenteritis, spillage of gallstones, Gossypiboma2. Peripheral rim calcification; Sclerosing peritonitis, peritonealcarcinomatosiswithcalcification,rupturedovarian teratoma, ruptured hydatid cysts

3. Clustered calcification; Tbc lymphadenitis, parasite infestation

SUMMARY: A review of the pathology and imaging characteristics of calcification containing peritoneal diseasesarepresented.AlthoughtheseCTfindingsareoverlapping,classifiedthembymorphologyishelpfulinnarrowing the range of the differential diagnosis.

SE 01 AB-15Usual versusunusual,differentiation of epithelial tumor from non-epithelial tumor in the stomach: case based analysisJunghee Yoon, Juhee Ahn, Junghee Son, Seungho Kim, Yedaun Lee Inje University Haeundae Paik Hospital, Korea. [email protected]

LEARNING OBJECTIVES: 1. To differentiate epithelial tumor from non-epithelial tumor and inflammatory diseases in the stomach. 2. To introduce differential diagnostic radiologic finding of various diseases in stomach with endoscopic and pathologic correlation.BACKGROUND: Multidetector computed tomography (CT) offers new opportunities to get information about both the gastric wall and the extragastric extent of disease. In practice, we often meet various solid lesions in the stomach. As they are resemble each other, radiologists misdiagnosed each disease entities, occasionally. But as the therapeutic strategy and clinical courses are different, it is important to differentiate from each diseases. In this exhibit, each diseases is introduced with radiologic findings and correlated with endoscopicandpathologicfindings.IMAGING FINDINGS: The contents of stomach lesions are epithelial tumors (advanced gastric carcinoma), inflammatorydisease(gastriculcer,gastritis)andnon-epithelial tumor (GIST, lymphoma, schwannoma, leiomyoma, leiomyosarcoma and sarcoma), and these cases are presented as case based studies (imaging features of contrast-enhanced CT and endoscopic or pathologicfindings).CONCLUSION: This exhibition gives a review of imaging characteristics of epithelial and non-epithelial tumors. Familiarity with imaging appearances of epithelial and non-epithelial tumor and with the diagnostic pitfalls to these diseases is useful in making the correct diagnosis.

SE 01 AB-16Combined hepatocellular-cholangiocarcinoma (cHCC-CC) of the liver with stem cell featuresDaeJungKim CHA University, CHA Bundang Medical Center, Korea. [email protected]

1.cHCC-CCbyWHOclassification1) cHCC-CC with classic type2) cHCC-CC with stem cell features (1) cHCC-CC with stem cell features, typical

subtype (2) cHCC-CC with stem cell features, inter-

mediate-cell subtype


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(3) cHCC-CC with stem cell features, cholangio- cellular subtype

2. Recent pathologic features of cHCC-CC with stem cell features

3. Recent clinical features of cHCC-CC with stem cell features1) Western studies versus Asian studies2) Clinical differentiation of subtypes

4. Imaging features1) CT and MRI2) How to approach for diagnosis

5. Treatment and prognosis1) Surgery and liver transplantation2) Transarterial chemoembolization3) Adjuvant chemotherapy

SE 01 AB-18Multidetector CT of obturator foramen: anatomy and pathological conditionsHui-Ming Wang, Chia-Ying Lin, Ming-Tsung Chuang National Cheng-Kung University Hospital, Taiwan. [email protected]

PURPOSE: 1. To review the embryology of obturator foramen 2. To show the normal anatomic variants of obturator

foramen 3. To demonstrate the various pathological conditions

within or around the obturator foramenCONTENT ORGANIZATION: 1. Embryology of obturator foramen2. Anatomical variants of obturator foramen3. Pathological conditions of obturator foramen

1) obturator hernia (including incarcerated small bowel and urinary bladder)

2) trauma with fractures and various viscus injuries (including bladder rupture, urethra injury, laceration of obturator artery)

3) infection/abscess

4)inflammation5) metastatic tumors

SUMMARY: 1. Understanding normal anatomy and various anatomic

variants is important in interpretation. 2.MDCTwithmultiplanar reformation provides a

comprehensive information in demonstration of various pathological conditions.

3. Early awareness of pathological conditions enables us to a prompt management for the patients.

SE 01 AB-19Prediction of therapeutic response to transcatheter arterial chemoembolization in patients with hepatocellular carcinoma based on liver dynamic CT findings and computerized CT texture analysisHyun Jeong Park1, Jung Hoon Kim2, Seo-youn Choi3, Eun Sun Lee1, Sang Joon Park4, Jae Young Byun5, Byung Ihn Choi1 1Chung-Ang University Hospital, 2Seoul National University Hospital, 3Soonchunhyang University Bucheon Hospital, 4Seoul National University College of Medicine, 5The Catholic University of Korea, Seoul St. Mary's Hospital, Korea. [email protected]

PURPOSE: To assess the potential utility of CT texture analysis for prediction of therapeutic response to transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC).MATERIALS AND METHODS: Ninety-six patients with 132 HCCs underwent liver CT prior to TACE. Using post-TACECT,HCCswereclassifiedintoeithergoodorpoor responders (GRs or PRs). We evaluated the visual attenuation and arterial enhancement ratio (AER) of tumorsonthearterialphase.CTtexturewasquantifiedwith2Dand3Danalysis.Weanalyzed independentpredictors of response using multivariate analysis.RESULTS: Of the 132 HCCs, 85 (64.4%) were GRs and 47 (35.6%) were PRs. Arterial enhancement on visual assessment (p = 0.004) and AER (p < 0.001) weresignificantlyassociatedwithGRs. In2Dand3Danalysis,GRsshowedsignificantly lowerhomogeneity,higher mean attenuation, gray-level co-occurrence matrix (GLCM) moments, and higher percentile CT numbers (p < 0.05). In multivariable analysis, higher GLCM moments (OR = 7134.03), higher AER (OR = 13.55), and smaller tumor size (OR = 13.55) were significant independentpredictorsforgoodresponse(p< 0.05).CONCLUSION: CT is useful for prediction of therapeutic responseofHCCsafterTACE,notonlywithCTfindingsincluding higher AER and smaller tumor size, but also with texture analysis including higher GLCM moments

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SE 01 AB-20Fetus-in-fetu: a teenage boy with abdominal mass and stomach acheZaidah Mohd Ismail, Noriza Zainol Abidin, NurAhidaMDAhir,MahendranRajagopal,Ruwaida Yaakub Hospital Sultan Abdul Halim Sungai Petani, Malaysia. [email protected]

Fetus-in-fetu is a rare benign condition in which a nonviable fetus is found in the body of its twin. Approximately 100 cases were reported before. It was first described by Meckel in the late 18th century. We present a 15-year-old boy with an abdominal mass since birth associated with sudden onset of severe abdominal pain. A large soft tissue mass with human vertebral column and axial skeleton noted within was detected on an abdominal radiograph. The diagnosis of fetus-in-fetu was made with a differential diagnosis of a teratoma given. A computed tomography scan was performed recently and a large fetoid-like mass was noted in this teenage peritoneum. Excision of this mass has been planned for this patient within this week. Fetus-in-fetu is a very interesting case and extremely rare. Most of the presentation was reported during infancy or early childhood. With the current imaging modalities, the diagnosis of fetus in fetu facilitates the surgeon for preoperative diagnosis and further plan of management. Curative treatment is a complete excision of this mass whichallowsconfirmationofthediagnosis.

SE 01 AB-21Spontaneous rupture of huge renal angiomyolipoma during pregnancy: a case reportZayaDuisyenbi, Khulan Khurelsukh, Ononchimeg Buriad United Family Intermed Hospital, Ulaanbaatar, Mongolia. [email protected]

SUMMARY: The patient 37 years old woman, in 34 week of gestation with no significant medical history presented to the emergency department with sudden onset of moderate right abdominal pain and vomiting. The pregnancy proceeded without complications until 34 weeks of gestation. On prior abdominal ultrasound, during first trimester of pregnancy was not detected any abnormality. CBC test showed 11.7 × 103/μLofleukocyte, and CRP 70 nmol/l, RBC 3.84 106/μL,HGB10.9 g/dl and HCT of 32%.IMAGING FINDINGS: An ultrasound examination revealed a new huge (10-8 cm) hyperechoic lesion withcentralhypoechoiccontentsandsurroundingfluidcollection noted in the lower pole of the right kidney,

which suggesting hemorrhagic angiomyolipoma. Contrast enhanced MRI scan showed the fat containing huge mass with intrarenal and perirenal hematoma in right kidney, suggestive of hemorrhagic renal angiomyolipoma. DIAGNOSIS: Ruptured angiomyolipoma with evidence of retroperitoneal hemorrhage. The differential diagnosis includes hemorrhage from an angiomyolipoma, renal cell carcinoma or a metastatic lesion. Right nephrectomy was performed without complication, following urgent caesarean delivery. The histological study of the resected mass revealed the presence of angiomyolipoma.DISCUSSION: Angiomyolipoma (AML) is benign tumor composed of vessels, smooth muscle and adipose tissue. The association of this complication with pregnancy has been reported sporadically in the literature. The risk factors associated with the spontaneous rupture and perirenal or intratumoral bleeding, include: associat ion with pregnancy, gestational growth rate, tuberous sclerosis, signs and symptoms,andabiggersize(>4cm).CONCLUSION: DevelopmentofAMLassociationwithpregnancy is rare. AML shows a greater growth index in pregnant women. Rupture of renal angiomyolipoma and massive retroperitoneal hemorrhage, during pregnancy is rare and occasionally fatal. The priority is timely diagnosis in urgent cases for appropriate treatment management.

SE 01 AB-22Comprehensive review of congenital anomalies, anatomic variants and diagnostic pitfalls in pancreatic imaging Jong Eun Lee1, Sang Soo Shin2, Jin Woong Kim1, Sook Hee Heo1, Yong Yeon Jeong1, Heoung Keun Kang1 1Chonnam National University Hwasun Hospital, 2Chonnam National University Hospital, Korea. [email protected]

TEACHING POINTS: 1. To list common and uncommon congenital anomalies

of pancreas.2. To describe typical imaging findings of various

congenital anomalies of pancreas.3. To understand anatomic variants and diagnostic

pitfalls in pancreatic imaging.TABLE OF CONTENTS:1. Introduction2. Embryologic development of pancreas.3. Normal anatomy of pancreas4. Pearls and pitfalls of various modalities in pancreatic

imaging1) US and EUS


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2) CT3) MR imaging

5. Congenital anomalies1) Fusion anomaly2) Migration anomaly3)Duplicationanomaly4)Anatomicanomaliesrelatedtospecificpancreatic

or peripancreatic disease6. Anatomic variants and diagnostic pitfalls1)Fattyinfiltration2) Pseudomass (1) Normal alteration of pancreatic contour (2) Lymph node enlargement adjacent to pancreas (3) Accessory splenic tissue in pancreas paren-

chyma

SE 01 AB-23Focal nodular hyperplasia: a case reportJavzandolgor Nyamsambuu1, Rolomjav Sukhbat1, Munkhzaya Chogsom2, Uranbaigal Enkhbayar3, Tugsjargal Purevsukh3 1Luxmed Hospital, 2National Cancer Center of Mongolia, 3Mongolian National University of Medical Science, Mongolia. [email protected]

INTRODUCTION: FNH is benign tumor, most frequently found in young to middle aged adults, with a strong female predilection with no association with cirrhosis, alcoholism and viral hepatitis.CASE REPORT: We report a case of a 16 years old, female who presented with abdominal discomfort for 15 days. There was no body weight loss, fever, nausea, vomiting or jaundice. Laboratory investigations revealed the following: white blood cells 7.15 (10*3/uL), platelet 283 (10*3/uL), hemoglobin 131 g/L, INR 1.08, AST 24 U/L, ALT 30 U/L, albumin 4.3 g/dL, total protein 7.2 g/dL, bilirubin 20 umol/L. The serum level of AFP was 0.7 ng/mL, CA 125 was 18.3 U/mL, CEA 0.5 ng/mL, CA 19-9 was 18.0 U/mL normal. Tests for hepatitis B surface antigen and anti-HCV antibodies were negative.IMAGING STUDIES: The ultrasound examination revealed well defined heterogeneously mass with mixed, hyperechoic echogenicity in the right lobe of liver, measuring 7.0 x 6.5 cm in diameter. On nonenhanced CTscan,thetumorappearedwelldefined,hypodensepatternwith no calcification. During the arterialphase of dynamic enhanced CT the tumor depicted heterogeneousenhancementwithwell-definedlobulatedmargins, nodular mass with central scar in right liver lobe.Duringtheportalphasethecentralscarremainedhypodense, in portal and delayed phase tumor showed homogeneity and isodense pattern with central scar 7.6 × 6.7 × 7.5 cm in diameter (images 1-5).

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There were bi l iary duct di latat ion, lymph node involvement, portal and hepatic vein thrombosis, no splenomegaly and hepatomegaly. We determined the liver volume and segmentation analysis on CT image (images 6-8)

PATHOLOGY: Pathological analysis of liver mass led to a diagnosis of FNH.DISCUSSION: Focal nodular hyperplasia is a localized, welldefinedfocallesionwithinanotherwisenormalliver.Liver function tests are within normal range. Malignant transformation of FNH has not been reported. The US features of FNH are variable. The mass may appear hypoechoic, isoechoic or hyperechoic. In non-enhanced CT scan, FNH may be isodense or hypodense and appears hyperdense in contrast enhanced arterial phase, becomes less dense in venous phase and appears isodense to the liver in delayed phase. Same werethefindingsinreportedpatient. Inthiscase, liverenzymes, other laboratory tests, consisting of AFP and CEA, were normal. We reported an interesting case of focal nodular hyperplasia in Mongolia.

SE 01 AB-24Pyogenic hepatic abscess: case reportBatsaikhan Narankhuu, Undrakh Erdene Erdenebold, EnkhAmgalan Tseyenregzen United Family Intermed Hospital, Ulaanbaatar, Mongolia. [email protected]

BACKGROUND: Annual incidence rate of approximately 3.6 per 100,000 in the United States. An 8 to 20 cases of every 100,000 hospital admissions. Patient is 77 years old female had abdominal pain, fatigue and fever so came for further diagnosis. Vital signs showed blood pressure 90/50 pulse 72, breathing 16. Palpation showed right upper side and epigastric regions were painful. Laboratory data showed elevated CRP -2669.1 nmol/L; Neut % -84.80%; WBC -9.79 103/mlMDCTof the abdomen CECT report: on precontrast images cystic lesions size 4.6 cm, give capsular enhancement, most likely dilated intrahepatic biliary ducts or septated abscesses. On arterial and portal phases there is large attenuation differences more in S4/5/6/7 and on delay phase liver parenchyma became almost homogenous, most likely edema due to portal vein thrombosis. Impression was a large cystic changes in S3, S5 and S7 of the liver, most likely dilated segmental biliary ducts or multiple liver abscesses, less likely CCC.TREATMENT: We managed pyogenic hepatic abscess-es with antibiotic administration and US drainage.CONCLUSION: Hepatic abscess is fortunately a rela-tively uncommon disease. The presenting complaints, physical findings and laboratory markers can be entirely variable as illustrated by our patient. Our case underlines the importance in keeping hepatic abscesses on the differential diagnosis, especially in those patients with the risk factors described. In the past all of liver abscess were cured by surgery. However now it can be cured by drainage without surgery. All of these are thanks to improving technology of CT.

SE 01 AB-25MR imaging of perianal fistulas: tracing the tracts Sonali Sethi, Puneet Jain, Pankaj Kumar, Vineeta Mehta, Vineet Sethia FortisHospital,ShalimarBagh,NewDelhi,[email protected]

PURPOSE: Perianal fistulas are an important cause of morbidity in the young and a common cause for repeated surgical explorations. With the advent of MRI and its excellent multi-planar capabilities it is now possible to provide surgically relevant information.MATERIALS AND METHODS: MRI pelvis of patients withperianalfistulasreferredtoradiologydepartmentin


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FortisHospitalShalimarBaghbetweenDecember2015andApril2016werestudied.ThefistulaswereclassifiedaccordingtoSTJamesUniversityHospitalClassificationandthefindingswerepresentedintheformofapictorialessay. The relevant anatomy of the sphincter complex, howtodescribeafistulaandreportingchecklist isalsodescribed.RESULTS AND CONCLUSION: MR imaging has significantly helped the clinical management of peri-anal fistulas. It enables us to define the anatomical relationships of the tract with respect to the sphincter complex, identify sites of secondary infection and secondary tracts/ramif icat ions which can alter the surgical course and have implications on the postoperative outcome.

SE 01 AB-26Spectrum of pancreatitis associated complications using MDCT as diagnostic modalityRuchi Gupta1, Sonali Sethi2, Amit Verma3, Richa Tiwari4, Neha Nischal4, Surabhi Gupta4

1AIIMS, Patna, India, 2Fortis Hospital Shalimar Bagh, Delhi,India,3Ottawa University, Canada, 4GB Pant Hospital, India. [email protected]

LEARNING OBJECTIVES: To elucidate the role of MDCTinevaluationofpancreatitisassociatedcomplica-tions. To describe the spectrum of complications in the settingofpancreatitisinrelationtoimagingfindings.Todiscuss the incidences of various complications of acute and chronic pancreatitis. BACKGROUND: Amongst abdominal pathologies pancreatitis is one of the most important cause contributing to major morbidity. The presentation varies from mild to severe and also can be fatal leading to major morbidity and mortality. As per revised Atlanta classification, CECT is the primary imaging tool for assessing the complications. This study describes the spectrumofpancreaticandextrapancreaticfindingsinthe setting of pancreatitis.MATERIALS AND METHODS: This is a retrospective study carried out on 45 patients diagnosed as pancreatitis on ultrasonography and biochemical markers. All of them were imaged on 256 slice Siemens, Somatom CT scanner, using nonionic IV contrast with or without oral water, keeping radiation dose to lowest possible. The raw and post processed images were evaluatedusing ‘Singovia’ toevaluate theprimarydisease and related complications.RESULTS: Outof45patients,chronicfluidcollections,acute pseudocyst, pancreatic and peripancreatic walled off necrosis accounted for the majority of cases 38 (84.4%) followed by pleural effusion 15 (33.3%), venous

thrombosis 8 (17.7%), pseudoaneurysm 5 (11%), cholecystitis 4 (8.8%), cholangitis 4 (8.8%), obstructive jaundice 4 (8.8%), duct disruption 3 (6.6%), infected necrosis 2 (4%), GI hemorrhages 1 (2%), ischemic enteritis 1 (2%), left-sided portal hypertension 1 (2%).CONCLUSION: MDCT is themainstayofdiagnosisof acute and chronic pancreatitis, used to stage the severityofinflammation,detectpancreaticnecrosisandidentify local complications.

SE 01 AB-27Castleman’s disease in the abdomen and pelvis: imaging manifestations and its mimicsNam Kyung Lee, Seung Baek Hong, Seung Hyun Lee, Ga Jin Han, Suk Kim Pusan National University Hospital, Korea. [email protected]

PURPOSE: Castleman’sdisease in theabdomenorpelvis in the radiology literature is generally limited. Thus, we describe typical and atypical imaging features intheCastleman’sdiseaseintheabdomenandpelvis.Additionally, we identify the characteristic imaging features todifferentiateCastleman’sdisease from itsmimics.CONTENT ORGANIZATION:1.OverviewofCastleman’sdisease.

1) Clinical features2) Pathologic features3) Radiologic features

2.Castleman’sdiseaseintheabdomenandpelvis.1) Typical imaging features2) Atypical imaging features

3. The entities that Castleman disease may mimic in the abdomen and pelvis.

SUMMARY: Knowledge of characteristic imaging features ofCastleman’s disease in the abdomenand pelvis can help in the diagnosis and differential diagnosis.

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SE 01 AB-28Radiology-pathology correlation of rectal cancer with MR imaging and whole-mount pathologic specimen: general review of rectal MR imaging and clinical implicationsSung Kyoung Moon1, Sung Eun Ahn2, Seong Jin Park2, Joo Won Lim2,DongHoLee2 1Kyung Hee University Hospital, 2Kyung Hee University Medical Center, Korea. [email protected]

TEACHING POINTS:1. To present the adequate image acquisition of the

rectal MR Imaging for rectal cancer.2. To display the anatomical landmarks and discuss its

clinical implications.3. To educate the interpretation method of rectal MR

imaging according to TNM staging.4. To demonstrate the educational cases with rectal MR

imaging and whole-mount specimen for radiology-pathology correlation.

5. To discuss on-going issues of guidelines of rectal cancer treatment.

TABLE OF CONTENTS: 1. MR imaging techniques for rectal cancer - High Resolution MR Imaging techniques -Diffusion-WeightedImaging2. Anatomical landmarks of the rectum and anus. -Rectum,mesorectalfascia,andperitonealreflection - Sphincter anatomy - Surgical outlines for TME, ultralow anterior resec-

tion, and intersphincteric resection - Beyond TME3. Interpretation of rectal MRI with TNM staging and

substaging - AJCC Staging system and various substaging with T

staging - N staging and distant metastasis evaluation4. Representative cases with rectal MR imaging and

whole-mount specimen - T staging issue - Extramural vascular invasion (EMVI) in rectal cancer5. Ongoing issues in diagnosis and treatment guidelines - Review of various treatment guidelines; NCCN,

ESMO, UK NICE, and Japanese guidelines - Clinical issues and recent researches

SE 01 AB-29Missed abdominal malignancy interpreted as an acute inflammation in the emergency department: looking beyond the acute inflammationJi Hye Min1, Seo-youn Choi2, Hye Na Jung1, Hong Eo1, Jung Whan Yoon1 1Samsung Medical Center, 2Soonchunhyang University Bucheon Hospital, Korea. [email protected]

TEACHING POINTS: To learn and be familiar with variable abdominal malignancies as a cause or mimicker ofacuteinflammationintheemergencydepartment.TABLE OF CONTENTS: We will present missed abdominal malignancies, which were initially regarded asacuteinflammation.1. Acute appendicitis - Associated appendiceal tumor or cecal cancer2. Acute gastritis -Associatedorconfirmedasstomachcancer3. Hepatic abscess -Confirmedascholangiocarcinoma - Associated colon cancer4. Acute cholecystitis - Associated GB/cystic duct cancer - Associated metastatic lymphadenopathy from

stomach cancer5. Acute cholangitis -ConfirmedasCBDcancer6. Acute pancreatitis - Associated hidden pancreatic cancer

SE 01 AB-30Extrahepatic biliary obstruction evaluationAnanda Murthy Health City Cayman Islands, Cayman Islands. [email protected]

PURPOSE: To determine the various caused in levels of extrahepatic biliary obstruction by using various Imaging techniques (US, ERCP, PTC, CT scan and MRCP) along with outlining the merits and demerits of these techniques, and also to draw a standard imaging protocol.MATERIALS AND METHODS: 100 patients with clinical and laboratory features suggestive of Biliary obstruction were studied by using at least two imaging modalities for each with Ultrasound being the initial procedure over a period of 1 year and results were tabulated.RESULTS: Out of 100 patients males were 58 and females were 42 with average age of presentation being 56.71 years. 78% of cases showed intraductal obstruction while 22% extraductal. Level of obstruction


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being 13% at portal hilum, 16% in suprapancreatic, 65% intrapancreatic and both supra- and infrapancreatic 5%. In one case level of obstruction was both at portal hilum and suprapancreatic region. The commonest causes of obstruction include choledocholithiasis (44), carcinoma pancreas (14 cases), periampullary a. (13) and cholangiocarcinoma (11) and other minor causes which are not common. The overall diagnostic accuracy of detection of level of obstruction was maximum for ERCP/PTC (95.83%) followed by MRCP (95.45%), CT (85.71%) and US (83.5%). For assessing the cause, MRCP had the highest accuracy (87.5%) followed by CT (85.71%), US (77%) and ERCP/PTC (75%).CONCLUSION: Ultrasound is the 1st choice in initial screening of patients to rule out the obstruction of biliary tree. ERCP is the modality of choice for both diagnosis and treatment. MRCP is highly accurate noninvasive procedure for diagnosing the level of obstruction. CT is fast and rapid with few motion artifacts and helpful in ascertaining the cause of obstruction. Endosonography is invasiveandnotthefirstchoiceof investigation.Outstudy yielded results similar to other studies.

SE 01 AB-31Focal nodular hyperplasia: imaging patterns on gadoxetic acid-enhanced MR imagesJung-Hee Yoon1, Seung-Ho Kim1, Yedaun Lee1, Hyun Seok Jung2 1Inje University Haeundae Paik Hospital, 2Inje University Busan Paik Hospital, Korea. [email protected]

PURPOSE: To compare intraindividual differences in enhancement pattern of pathologic confirmed hepatic focal nodular hyperplasia between gadoxetic acid (Gd-EOB-DTPA)-enhancedmagneticresonanceimages.MATERIALS AND METHODS: This is a HIPAA-compliant, IRB-approved retrospective study with waiver for informed consent, from January 2011 to January 2015, 12 patients (M:F = 6:6; mean age, 40.5 years) with 13 focal nodular hyperplasias (mean diameter, 2 cm)underwent gadoxetic acid (Gd-EOB-DTPA)-enhancedmagnetic resonance images.Diagnosisoffocal nodular hyperplasia was based on histopathologic criteria. MR imaging was obtained during four arterial, portal venous, and up to four transitional phase and 20 minutes delayed hepatobiliary excretory phase.RESULTS: After the injection of gadoxetic acid, the enhancement patterns of focal nodular hyperplasias usually early hypervascular enhancement and constant enhancement on portal venous phase and transitional phase, but variable on delayed hepatobiliary excretory phase. Typical high or iso SI pattern on hepatobiliary phase showed in only 4 cases (31%). 9 cases (69%)

showed an atypical pattern during the delayed hepatobiliary phase, 2 cases (15%) showed a total defect, and 7 cases (54%) showed a peripheral ring-like enhancement with central defect, so called target appearance mimicking hepatocellular carcinoma.CONCLUSION: In conclusion, cases of small (less than 3 cm) focal nodular hyperplasia showed variable findingsonhepatobiliaryphase.

SE 01 AB-32Non-mucocele type appendiceal neoplasm: an approach to differential diagnosis between malignant and benign neoplasmYoung jong Cho, Hyuk jung Kim, Suk ki Jang, Jae woo Yeon, Byeong Geon Jeon, So ya Paik Bundang Jesaeng General Hospital, Korea. [email protected]

PURPOSE: To analyze the feasible CT findings for differentiating malignant lesions from benign ones in cases of non-mucocele type appendiceal neoplasms.MATERIALS AND METHODS: The data from registered patients with pathologically confirmed appendiceal neoplasms were obtained over a 14-year period from January2000throughDecember2014.Fromtotal80patients with tumorous appendiceal neoplasm, those with borderline malignancy (n = 36) are excluded by the pathologic reports. Among the remaining patients, pre-operative CT scans were available for 32 patients. Those with mucocele-type appendiceal neoplasms (n = 4) are excluded through the radiologic analysis. Total 28 patients with non-mucocele type appendiceal neoplasms havefinallyformedthestudysample.Thepatientsareclassifiedintobenignandmalignantgroupsdependingon their pathologic reports. The colonic type adenoma (n = 3), mucinous cystadenoma (n = 10), benign appendiceal NETs (n = 4), and ganglioneuroma (n = 1) are included in the benign group and the colonic type adenocarcinoma (n = 4), malignant appendiceal NETs (n = 3), lymphoma (n = 1) and metastasis (n = 2) fall into the malignant group. Two experienced radiologists have analyzed CT scans for the presence of the mass-like lesion, irregular wall thickening, perforation, cecal wall thickening, appendicolith, peritoneal thickening, ascites, lymphadenopathy suggestive of malignancy, and periappendiceal fat infiltrations in consensus reading. The CT results from both malignant and benign groups are closely compared.RESULTS: The research findings have indicated statistically significant difference in irregular wall thickening, mass-like lesion and perforation between the benign and malignant groups (p < 0.05). Cecal wall thickening, appendicolith, peritoneal thickening, ascites, lymphadenopathy suggestive of malignancy, and

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periappendiceal fat infiltrations do not have significant difference between the benign and malignant groups (p >0.05).CONCLUSION: It is difficult to distinguish underlying malignancy from benign condition in terms of non-mucocele type appendiceal neoplasms. However, irregular wall, mass-like lesion and perforation are considered to be useful CT features associated with malignancy.

SE 01 AB-33Splenomegaly: useful clues to expanding the differential diagnosisHyung Joon Cho, Na yeon Han, Min Ju Kim, DeukJaeSung,BeomJinPark,SungBumChoKorea University Anam Hospital, Korea. [email protected]

TEACHING POINTS: The size of the spleen can increase owing to the disease of spleen itself, however in most cases, splenomegaly occurs in connection with pathologic conditions of other organ systems including blood, liver and heart. Therefore, splenomegaly can be usedasafirstindicatorofotherdiseases,anditshouldnot be ignored. CT not only enables to measure splenic size accurately, but also may provide important clues for diagnosis of various diseases which are associated with splenomegaly.1. To understand the anatomy and function of the

spleen.2. To compare suggested methods to measure the

splenic size.3. To understand the pathophysiology of splenomegaly

and accordingly classify the splenomegaly.4.Todemonstrateimagefindingsofeachdiseasesand

to suggest useful points for diagnosis.TABLE OF CONTENTS: 1. Anatomy, structure and function of the spleen2. Measurement of the spleen and determination of

splenomegaly3. Classifications of splenomegaly by mechanism and

their image features1) Congestive disease2) Hematologic disease3) Infectious disease4) Storage diseases5)Immunologic-inflammatorydisease6) Primary neoplasms and cysts7) Secondary neoplasms8)MiscellaneousDisorders

SE 01 AB-34Predictive value of the target appearance on the hepatobiliary phase of Gd-EOB-DTPA MRI in the patients of colorectal cancer hepatic metastasisHyun Ji Lee, Chang Hee Lee, Yang Shin Park, Jong Mee Lee, Jae Woong Choi, Kyeong Ah Kim Korea University Guro Hospital, Korea. [email protected]

PURPOSE: To determine the prognostic value of hepatobiliaryphase (HBP) inGd-EOB-DTPAMRIofcolorectal cancer liver metastasis in predicting response to chemotherapy.MATERIALS AND METHODS: Thirty-three colorectal cancer patients with 79 metastatic nodules in liver were retrospectively reviewed. We evaluate the appearance on HBP and classified them into “target” and “non-target”. Signal intensity (SI) was measured and SI ratio of tumor to liver parenchyma was calculated on HBP. Tumor response was assessed by RECIST at 12 weeks after chemotherapy and further classified into “clinicalresponder”(CR,PR,andSD)and“clinicalnon-responder”(PD).TherelationshipofappearanceandSIratio on the HBP with tumor response was analyzed.RESULTS: Seventy nine metastatic lesions were classifiedinto“target” in22lesions(27.8%),and“non-target” in 57 lesions (72.2%). Thirty nine lesions (49.4%) were “clinical responder” and 40 lesions (50.6%) were “clinical non-responder”. “Target” appearance was more frequent in “non-responder” than “responder” (14/22 [63.6%] vs. 8/22 [36.4%]). “Non-target” appearance on HBP tend to be more frequent in “clinical responder” than of “target” appearance in metastasis of colorectal cancer (31/57 [54.4%] vs. 8/22 [36.4%], p = 0.151). The mean SI ratio in 4 response groups were 0.37 in CR, 0.38 inPR,0.48inSD,and0.51inPD.Therewassignificantcorrelation between SI ratio and chemotherapy response, theworseresponsegrouphashigherSI(ρ= 0.346, p = 0.002). The non-responder group shows higher SI ratio than responder group (0.51 vs. 0.49, p = 0.012)CONCLUSION: High SI ratio on HBP of EOB MRI of hepatic metastasis from colorectal cancer were predictive of poorer response, and metastasis showing "target" appearance tend to respond poorer than those showing "non-target" appearance.


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SE 01 AB-35Rapid progression of HCC after RF ablation: what to know and how to avoid?Jin Woong Kim1, Sang Soo Shin2, Sook Hee Heo1, Yong Yeon Jeong1, Heoung Keun Kang1 1Chonnam National University Hwasun Hospital, 2Chonnam National University Hospital, Korea. [email protected]

TEACHING POINTS: 1.TodefinearapidprogressionofHCCafterRFA2. To discuss possible patho-mechanism and risk factors

for rapid progression of HCC after RFA3. To suggest strategies to decrease the risk of rapid

progression of HCC after RFATABLE OF CONTENTS:1. Current concepts of rapid progression of HCC after

RFA2. Frequency and clinical significance of rapid tumor

progression3. Possib le patho-mechanisms of rapid tumor

progression1) Intravascular spread of the tumor during the

procedure2)Creationofarterio-venousfistula3) Sarcomatous change of HCC related to the

procedure4. Risk factors for rapid tumor progression

1) Tumor location2) Presence of micro-vascular invasion3) Biologic feature of the tumor4) Pre-procedural aFP value5) Age

5. Strategies to avoid a potential rapid tumor progression1)Tosecuresufficientablativemargin (1) Combined TACE and RFA (2) Segmental ablation technique (3) Microwave devices2) To prevent intravascular tumor seeding (1) Gradual increase of RF energy (2) No-touch technique (3) Bypass targeting technique (4) Parallel targeting technique

SE 01 AB-36Evaluation of subepithelial lesions of stomach with three-dimensional multi-detector CT gastrography: emphasis on differential diagnosisSang Soo Shin1, Jin Woong Kim2, Sook Hee Heo2, Yong Yeon Jeong2, Heoung Keun Kang2 1Chonnam National University Hospital, 2Chonnam National University Hwasun Hospital, Korea. [email protected]

TEACHING POINTS: 1. To list common and uncommon gastric subepithelial

lesions (SELs)2. To correlate imaging features of various gastric SELs

in CT gastrography with endoscopy and EUS3. To discuss differential diagnosis of various gastric

SELsTABLE OF CONTENTS: 1. Introduction2. Frequency and location of various SELs in stomach3.DiagnosticapproachtogastricSELs

1) Comparison among conventional endoscopy, EUS and CT gastrography

2) Role of CT gastrography for evaluation of gastric SELs

3) Comprehensive guidelines for imaging diagnosis of SELs

4.ImagingfindingsofvariousSELsinCTgastrographywith endoscopic and EUS correlation1) True neoplasia a. GIST, b. leiomyoma, c. schwannoma, d. glomus

tumor,e.lipoma,f.hemangioma,g.inflammatory fibroidpolyp,h.carcinoidtumor

2) Non-neoplastic lesions a. ectopic pancreas, b. gastritis cystica profunda, c.

varices3)Diagnosticpitfalls

5. Summary of useful imaging findings in differential diagnosis of various SELs in stomach

6. Suggested diagnostic algorithms for various gastric SELs

SE 01 AB-37All about classification systems for the severity of acute pancreatitis: from past to futureJimi Huh1, Kyung Won Kim2, Jae Ho Byun2, Jong Hwa Lee1, Yoong Ki Jeong1 1Ulsan University Hospital, 2Asan Medical Center, Korea. [email protected]

TEACHING POINTS: 1. To review evolution of clinical and radiological

classification systems for severity of acute pancre-

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atitis.2.Todiscusstheroleofseverityclassificationsfortriage

patients and guide management.TABLE OF CONTENTS: 1. History of severity classification systems of acute

pancreatitis.2. Clinical severity classification systems: Atlanta, Determinantbased,andRevisedAtlantaclassifi-cation.

3. Radiological severity classification systems: CT severityindex(CTSI)andmodifiedCTseverityindex(MCTSI).

4. Comparative evaluation of radiological and clinical severityclassifications.

- CTSI versus MCTSI -ClinicalversusRadiologicalclassificationsystem5. Management of patients with acute pancreatitis based onseverityclassificationsystems.

-BasedonRevisedAtlantaclassification - Interventional treatment: percutaneous versus

endoscopic approaches

SE 01 AB-38CT imaging characteristics of gastric lymphoepithelioma-like carcinomaHee Jeong Shin, Kyung Sook Shin, June Sik Cho, Jeong Eun Lee, Ah Yeong Kim, Kyu Sang Song, Jin Hee Seo, Hye Soo Shin Chungnam National University Hospital, Korea. [email protected]

PURPOSE: To evaluate the computed tomography (CT) imaging characteristics of gastric lymphoepithelioma-like carcinoma (LELC).MATERIALS AND METHODS: Between January 2006 andDecember2015,CTimagingcharacteristicsof40gastric LELCs were analyzed, which were divided into two groups, advanced gastric cancer (AGC) and early gastric cancer (EGC). In each groups, detectability, location, multiplicity, gross features, thickness and long diameter, margin, pattern and degree of contrast enhancement of the tumors were evaluated. Also, we confirmedtheEBVpositivityonsurgicalspecimensbyEpstein-Barr Virus (EBV) in situ hybridization (ISH).RESULTS: Of total 40 patients, the 23 patients were positive for EBV-ISH and the 8 patients were negative. The 9 patients were not performed EBV-ISH test. All lesions of AGC (n = 23) of LELCs, however, only 9 lesions of EGC (n = 17) were detected on CT. The most common location of LELCs was the upper third of the stomach (n = 21, 52.5%). On AGC of LELCs, a high percentage of cases demonstrated well-defined and fungating lesions (14/23, 60.87%). Additionally, of that cases, the 9 cases (9/14, 64.29%) show the characteristicappearanceresembles‘crater’whichhasthe convex and elevated edge with central ulceration. The homogeneous (21/23, 91.30%) and high (14/23, 60.87%) enhancement were common in AGC group of the LELCs.CONCLUSION: Understanding of the above-mentioned the radiologic features that may suggest the possibility of LELCs in AGC is important in the preoperative diagnosis and in differentiating this entity from other gastric cancers.


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SE 01 AB-39Role of volume perfusion CT in diagnosis of pancreatic pathologyAjay Kumar Yadav, Raju Sharma, DevasenathipathyKandasamy,ShivanandGamanagatti,Ashu Seith Bhalla, Pramod Kumar Garg All India Institute of Medical Sciences (AIIMS), New Delhi,[email protected]

PURPOSE: Perfusion CT (PCT) provides quantitative and qualitative information regarding the tissue hemodynamics noninvasively based on the contrast kinetics. The purpose of this study was to evaluate the utility of PCT in diagnosis, characterization and follow up of different pancreatic pathologies.MATERIALS AND METHODS: In this ethically approved study, dynamic PCT was performed in 79 patients with different pancreatic pathologies along with normal controls (n = 25) using a 256 slice dual source scanner. The spectrum of pancreatic pathology included acute pancreatitis (n = 15), mass forming chronic pancreatitis (n = 10), adenocarcinoma (n = 25), cystic pancreatic tumor including pseudocyst (n = 15), neuroendocrine tumor (n = 8), metastasis (n = 3) and tubercular mass (n = 3). Perfusion parameters studied included blood flow(BF),bloodvolume(BV),permeabilitysurfaceareaproduct (PS), time to peak (TTP), peak enhancement intensity (PEI) and mean transit time (MTT).RESULTS: Amongst the perfusion parameters BF and BV were found to be the most reliable for differentiating different pancreatic pathologies. Perfusion parameters in different parts of pancreas did not show any statistically significantdifferenceincontrolgroup.BFandBVweresignificantly lower in acute pancreatitis (BF - 11.47 ± 5.56 ml/100 ml/min and BV - 3.79 ± 2.44 ml/100 ml) and mass forming chronic pancreatitis (BF - 29.47 ± 9.47 ml/100 ml/min and BV - 8.19 ± 2.95 ml/100 ml) compared to the control group (BF - 94.13 ± 24.02 ml/100 ml/min and BV-35.98 ± 10.66 ml/100 ml). In the center of adenocarcinoma tumors, low blood flow (16.73 ± 13.40 ml/100 ml/min) and blood volume (5.10 ± 3.52 ml/100 ml) was observed, gradually increasing toward the tumor rim; perfusion values in pancreatic parenchymaadjacenttothetumorwerenotsignificantlydifferent from the control population. In neuroendocrine tumors, significantly increased perfusion values were observed (BF - 204 ± 39.07 ml/100 ml/min and BV - 31.68 ± 8.42 ml/100 ml). Cystic pancreatic tumor including pseudocyst showed the lowest perfusion values (BF - 2.71 ± 1.92 ml/100 ml/min and BV - 0.62 ± 0.92 ml/100 ml).CONCLUSION: Significantly decreased perfusion values were observed in all pancreatic pathologies under study, except in neuroendocrine tumors compared

to the normal control group. Cystic tumors showed the lowest perfusion values while neuroendocrine tumors showed the highest perfusion values. Perfusion CT parameters can be used as an additional parameter to differentiate pancreatic pathologies.

SE 01 AB-40Confidence level determining factors to define valid liver stiffness measurement using the shear-wave elastographySanghyeok Lim1, Yongsoo Kim1, Youngseo Cho1, Woo Kyoung Jeong2

1Hanyang University Guri Hospital, 2Samsung Medical Center, Korea. [email protected]

PURPOSE: To determine the significant factors that hasabadinfluenceonconfidencelevelofnon-invasiveliver stiffness measurement using the shear-wave elastography (SWE).MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board of our hospital and the requirement for written informed consent was waived. Between April 2015 and February 2016, 1322 liver stiffness measurements using the SWE were performed for 1260 patients. A total of 1294 studies wereenrolled.Thepatients’characteristicsaboutage,sex, height, weight, body mass index (BMI), underlying liver disease and its etiology were acquired from electronic medical records. Two radiologists performed all liver stiffness measurement as usual fashion and represented the value by median and interquartile range divided by median (IQR/M), in addition to abdominal wall thickness measurement according to following sections: layer 1, skin to subcutaneous fat layer; layer 2, abdominal wall muscle including intercostal muscle; layer 3, peritoneum to liver capsule (adding omental fat layer, if exist) and ascites. Multiple regression test was performedtodefinethefactorsthatincreasingIQR/M.RESULTS: Mean age of the patients was 51.8 year and male was 61.6% (n = 776). The most common liver disease and etiology were hepatitis (n = 654) and hepatitis B virus (n = 544), respectively. Average BMI was 24.4 kg/m2. According to the multiple regression test, both BMI (ß = 0.005, p < 0.001) and fat layer (layer 1+3) to total abdominal wall thickness (layer 1+2+3) ratio (ß = 0.105, p < 0.001) affects IQR/M (R2 = 0.074). The amount of ascites, total and each layer abdominal wall thickness or other factors did not affect to confidence level.CONCLUSION: BMI and fatty layer to total abdominal wall thicknessratiodefinedasreducingtheconfidencelevel of liver stiffness measured by SWE. The results may be similar for transient elastography and acoustic

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radiation force impulse elastography that based on the ultrasonic technique.

SE 01 AB-41Echinococcus: detection of rapidly-growing parasitic cyst at screening USTugsjargal Purevsukh1, Purevsukh Sugar2, Erdembileg Tsevegmid2,MunkhbaatarDavgasumberel2, TuvshinjargalDashjamts2 1Health Sciences University of Mongolia, 2MNUMS, Mongolia. [email protected]

CASE PRESENTATION: A 38-year-old man complained about enlarging mass palpating in epigastrium, nausea. The patient was nomadic herder, breeding dogs. Since 10 years, he felt discomfort after meal. He was admitted for screeningexamination to theMNUMS’hospital“Erkhes”. US examination revealed large 10.5 × 11.2 cm sized thick-walled mass with heterogeneity in liver II, III, IV segments.

Abdominal CECT showed large, well-delineated 12.0 × 13.5 cm sized thick-walled mass with multiple focal wall thickenings and attenuation of +9+11 HU. The mass showed enhancement at arterial, portovenous and delayed phases.

TREATMENT: At partial hepaticectomy, the eccinococ-cus cavity showed greenish thick, bad-stinking fluid content, wall are thickened.INTRAOPERATIVE PHOTO:

HISTOLOGY:

DIAGNOSIS: Hydatid/ecchinococceal /cyst in left liver lobeDISCUSSION: Parasitic liver cysts are commonly caused by E.granulosus, E.multilocularis, E.oligathrus, E.vogeli, E.shiquicus, from which E.granulosus is the commonest and prevalent in countries north to 38. According to 1980 survey, from 1917 liver patients 486(25.4%) had ecchinococcus cysts. In 2014, from total 1000 screening US examinations four were diagnosed with parasitic cysts. These data demonstrate high endemic prevalence of ecchinococcus in Mongolia. Echinococcus cyst has 5 US stages; depending on which either PAIR\Puncture, aspiration, injection, reaspiration\or palliative hepatectomy in combination with anti-infective parasitic drugs are to perform. On CECT, it presents as single or multiple cysts with well-defined margins, peripheral enhancement and dense/thickfluid.Differentialdiagnosisincludespyogeniccyst,embryogenic sarcoma etc.CONCLUSION: Our case received palliative surgical treatment due to its delayed diagnosis. This case underl ines the need for regular screening US examinations in populations with high-risk endemic zone and with occupational risks of contamination to avoid disease advancement. Moreover, the health promotion programs still need to educate patients on persisting danger of ecchinococcus in Mongolia.

SE 01 AB-42Pancreatic lymphoma from head to tailBohyun Kim, Jei Hee Lee, Jai Keun Kim Ajou University Hospital, Korea. [email protected]

1. Clinical features of pancreatic lymphoma 1) Primary/secondary pancreatic lymphoma 2) Pathologic diagnosis 3) Current treatment guidelines2.Keyradiologicfindingsofpancreaticlymphoma

1) US2) CT3) MR

3. Top radiologic differentials and tips for correct diagnosis1) AIP2) Focal pancreatitis


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3) Metastasis4) High grade NET5) SPT6) Pancreatic ductal adenocarcinoma

SE 01 AB-43Comparison of low- and standard-dose CT for diagnosing appendicitis: meta-analysisNa Young Choi, Chang-Woo Ryu, Hyun Cheol Kim, DalMoYang,SangWonKimKyung Hee University Hospital at Gangdong, Korea. [email protected]

PURPOSE: This study was a head-to-head comparison of low-dose CT and standard-dose CT in diagnosing acute appendicitis with an emphasis on diagnostic value.MATERIALS AND METHODS: We searched the online databases,includingMEDLINE,EMBASE,theCochraneLibrary, and Google scholar from inception through 31 April 2016. We selected studies that compared low dose CT with standard dose CT in symptomatic patients with suspected appendicitis, surgery (histopathologic results) was used as reference standard. We used bivariate random-effects nonlinear regression model for the analysis and pooling of diagnostic performance measures across studies, and plotted estimates of the observed sensitivities and specificities for each test in summary receiver operating characteristic (SROC) curve. Meta-regression was used to make statistical comparisons of low-dose and standard dose CT.RESULTS: Out of 4483 studies, nine studies investigat-ing a total of 2438 patients were included in this meta-analysis. The pooled sensitivity, specificity and AUC of SROC of low-dose CT were 0.945 (95% CI: 0.925-0.961), 0.919 (0.901-0.935), and 0.9785. The pooled sensitivity and specificity of standard-dose CT were 0.958 (0.940-0.972) and 0.909 (0.889-0.926), and 0.9795. In joint model estimation, low- and standard-doseCTdidnotshowsignificantdifference.CONCLUSION: The pooled analysis suggests that low-dose CT matches the diagnostic performance of standard-dose CT, has low radiation exposure, and is a potentially valid alternative to standard-dose CT for diagnosing acute appendicitis.

SE 01 AB-44Efficacy and safety of US-guided percutaneous core biopsy of pancreatic massJeong Kyong Lee1, Kyungmin Lee2, Minjung Kim2 1Ewha Womans University School of Medicine, 2Ewha Womans University Mokdong Hospital, Korea. [email protected]

PURPOSE: To evaluate the diagnostic efficacy and safety of ultrasound (US)-guided percutaneous core biopsy of pancreatic mass.MATERIALS AND METHODS: From January 2010 to December2015,69consecutivepatients(M:F=38:31;mean age, 61.9 years) with pancreatic mass underwent US-guided percutaneous core biopsy in one institute. US-guided biopsy was decided on 1) inoperable pancreaticcancershowingtypical imagingfindings,2)pancreatic mass showing equivocal imaging findings with necessities to acquire pathologic diagnosis for the treatment. The safest biopsy pathway without injuring major organs was chosen using real-time US-guidance. An automated biopsy gun consisted of an 18-gauge biopsy needle and 1 to 2.5-cm sized cutting groove was used.Biopsyresultswerecomparedtothefinalresultsof surgery or follow-up. The diagnostic accuracy of the US-guided percutaneous biopsy was then calculated. Biopsy complications, such as hemorrhage, were evaluated.RESULTS: Allpatientshadsufficientbiopsyspecimen.The mean diameter of pancreatic mass was 2.9 cm (range, 1.2-7 cm) and the location was in pancreatic head (n = 46), body (n = 16), and tail (n = 7). Of the 69 patients, 49 patients were diagnosed with ductal adenocarcinoma, 11 with other malignancies (squamous carcinoma, metastasis, neuroendocrine tumor, lymphoma, and sarcoma), one with pseudopapillary tumor, one with intraductal papil lary mucinous neoplasm (IPMN), five with inflammation and two with tuberculosis by surgery (n = 17) or follow-up (n = 52). 48 patients with adenocarcinoma and 11 with other malignancies diagnosed appropriately on the biopsy were confirmed finally. One with IPMN on biopsy was confirmed as adenocarcinoma by surgery, and one without abnormality on biopsy as lymphoma by follow-up. The diagnostic accuracy of US-guided percutaneous biopsy of pancreatic mass was 97%, the sensitivity and specificity was respectively 97% and 100% for the diagnosis of pancreatic malignancy. One patient experienced hemoperitoneum resolved by conservative treatment and the major complication rate was 1.4%.CONCLUSION: US-guided percutaneous core biopsy of pancreatic mass is a feasible diagnostic method with very high accuracy for confirmative diagnosis of pancreatic malignancy and low complication rate.

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SE 01 AB-45To differentiate benign versus malignant GB wall thickening using MDCT as diagnostic modalityRuchi Gupta1, Sonali Sethi2, Amit Verma3, Richa Tiwari4, Neha Nischal4, Surabhi Gupta4

1AIIMS, Patna, 2Fortis, Shalimar Bagh, 3Ottawa Hospital, Canada, 4GBPantHospital,Delhi,[email protected]

LEARNING OBJECTIVES: To elucidate the role of MDCTindifferentiatingbenignversusmalignantGBwallthickening. To describe the spectrum of diffuse as well asfocalGBwall thickeningusingMDCTasdiagnosticmodality. To correlate the findings with postsurgical follow up or histopathology. BACKGROUND: Thickening of the gallbladder wall is a relatively frequent finding at diagnostic imaging studies. This finding however is non-specific and can be found in a wide range of gallbladder diseases and extracholecystic pathological conditions. This study describes the spectrum of various causes of thickened gallbladder wall.FINDINGS AND PROCEDURE DETAILS: This is a retrospective study carried out on 50 patients diagnosed to have thickened GB wall on ultrasonography. All of them were imaged on 256 slice Siemens, Somatom CT scanner, using nonionic IV contrast with or without oral water, keeping radiation dose to lowest possible. The raw and post processed images were evaluated using ‘Singovia’toevaluatetheprimarydisease.Thevariouscauses of GB wall thickening in the study are acute cholecystitis, chronic cholecystitis, xanthogranulomatous cholecystitis, porcelain gall bladder, gall bladder carcinoma and adenomyomatosis. The other secondary causes of GB wall thickening are liver cirrhosis, pancreatitis, heart failure, hepatitis and peritonitis. Amongst the GB fossa malignancy, mass replacing GB is the most common presentation followed by focal and diffuse thickening of the wall and intraluminal polypoidal mass.CONCLUSION: Ultrasound is the first investigation to be done in cases of suspected GB pathologies, howeverMDCT is themainstay of diagnosis andhelps to distinguish benign versus malignant GB wall thickening.IncasesofGBmalignancy,MDCTprovidesthe road map to surgeons prior to surgery and helps in postsurgical follow-up as well.

SE 01 AB-46CT findings of acute pancreatitis according to revised Atlanta criteria: classifications and related complicationsIsmail Meşe1, Nagihan Inan1, Törehan Ozer1, Isa Cam2, Tugce Agirlar1 1Kocaeli University, 2DerinceEducationalResearchHospital, Turkey. [email protected]

INTRODUCTION: Acute pancreatitis is a leading cause ofacuteabdomen.Mortalityandmorbidityissignificantlyhigher than the other causes of acute abdomen. Therefore diagnosis and follow-up is crucial. Revised atlanta criteria offer detailed information about the role of radiology in acute pancreatitis and CT indications. CT is the most important diagnostic tool with widespread accessibility. MRI is required in specific cases. This retrospective study demonstrated the characteristics of acute pancreatitis and its complications.MATERIALS AND METHODS: 118 consecutive patients between January 2015 - January 2016 were referred to our department for diagnosing-evaluating pancreatitis and its complications with abdominal CT- MRI. Initial CT performed in 116 patients. Follow-up CTs and MRI were performed when needed. 2 patients had history of contrastallergies.Wedidn’tperforminitialCTinthesepatients. MRI was carried out in these patients. Revised Atlantacriteriaclassificationsanddefinitionshavebeenused for evaluating acute pancreatitis and its related complications.RESULTS: In 107 patients pancreatic volume increased significantly. In11patientstherewerenotanysignsofacute pancreatitis despite increasing blood and urine pancreatic enzim levels with abdominal pain. 91 patients wereclassifiedasinterstitial-edematouspancreatitwhileother 16 were classified as necrotizan pancreatit. 59 patients demonstrated liquid collections after clinical onset in 4 weeks. 48 of 59 was peripancreatik collection without necrosis. 11 patients had acute necrotic collection. 7 patients had perfusion anomalies in initial CT. Follow-up CT-MRs after 1 week indicated necrotizan collection in these patients. 42 patients had checked out follow-up CT-MR. We stated 37 pseudocyst and 5 wall off necrosis.CONCLUSION: By familiarizing with the revised Atlanta classification of acute pancreatitis, especially focusing on a categorization of the pancreatic collections, and knowing the various imaging features of abdominal and extra-abdominal complications manifested on CT scan,wecanget todiagnosisandplan forpatient’smanagement more precisely and rapidly. Eventually it willimprovethepatient’sprognosis.


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SE 01 AB-47Imaging findings of common and uncommon submucosal lesions of the large intestineTaehoon Ahn, Yoogi Cha, Youe Ree Kim, Kwon Ha Yoon, Young Hwan Lee Wonkwang University Hospital, Korea. [email protected]

PURPOSE: To illustrate the endoscopic and radiologic imaging findings of various submucosal lesion in the large intestine. Also, to describe the mucosal lesions whicharedifficulttodistinguishfromsubmucosallesionon radiologic images.CONTENT ORGANIZATION: Precise evaluation of submucosal lesions may be difficult with radiologic images alone because some mucosal lesions can be sometimes hard to distinguish from the submucosal lesions. Endoscopic examination can provide clues togivearisetosubmucosal lesionsbyfindingnormalmucosa covering the lesions. In this exhibition, we classify submucosal lesions of large intestine by its incidence: common neoplasms (lipoma, carcinoid tumor, lymphoma, hemangioma, GIST), and uncommon neoplasms (leiomyoma, schwannoma, leiomyosarcoma, metastasis, direct invasion by extracolonic tumor, peritoneal carcinomatosis). Then we illustrate and describe the typical CT or MR imaging features with endoscopic images of these submucosal lesions. Also, we added the radiologic findings of mucosal lesions which can mimic submucosal lesions and compared with that of submucosal lesions.CONCLUSION: Various neoplasms can be seen as a submucosal abnormality at colorectal evaluation. The combined use of colonoscopy and a radiologic imaging technique allows a more precise evaluation of most submucosal lesions. In addition, knowing the mucosal lesions mimicking the submucosal abnormality will help avoid potential diagnostic pitfalls masquerading as submucosal lesions.

SE 01 AB-48Dynamic arterial phase of motion insensitive radial volumetric imaging breath-hold examination with KWIC in the detection of hepatocellular carcinoma in patients with chronic liver diseaseMin Ah Lee, Bong Soo Kim, Jeong Sub Lee, Seung Hyoung Kim, Guk Myung Choi, Mu Sook Lee, Kyung Ryeol Lee Jeju National University Hospital, Korea. [email protected]

PURPOSE: To evaluate diagnostic performance of multiphasic hepatic arterial radial volumetric imaging

breath-hold examination (VIBE) with k-space weighted image contrast (KWIC) dynamic contrast-enhanced MRI in hepatocellular carcinoma (HCC) detection in patients with chronic liver disease.MATERIALS AND METHODS: Forty four patients (M:F = 38:6; mean age, 65.7 years) with HCC (62 lesions) underwent liver MR imaging that included radial VIBE-KWIC with full-frame image and time-resolved four sub-frame image subsets in arterial phase. All arterial phase images were reviewed independently by two radiologists in random order in retrospective fashion. They compared diagnostic performance of arterial radial VIBE-KWIC with full-frame image and four sub-frame image subsets for the detection of HCC. The overall image quality and artifactwerescoredbyusingfive-pointscale.RESULTS: Full-frame subset in arterial phase was best for HCC detection (46/62) than those obtained with time-resolved sub-frame image subsets and was followed by third subframe image subset (44.5/62). The HCCdetectionrateinfull-framesubsetwassignificantlyhigherthanfirst(40/62)andsecond(41.5/62)sub-frameimage subsets. The image quality and artifact in the full-frameimageweresignificantlyhigherthanthoseofeachsub-frame image subsets.CONCLUSION: Dynamic arterial phaseofmotioninsensitive radial VIBE with KWIC provides diagnostic image quality without image degradation and is a valid method for detection of HCC in patients with chronic liver disease. Full-frame image is superior to sub-frame image set for the detection of HCC.

SE 01 AB-49The diagnostic performance of MR elastography for non-invasive evaluation of liver fibrosisChi-Hsiang Tung, Wen-Pei Wu, Chen-Te Chou, Chih-Wei Lee, Wei-Liang Chen Changhua Christian Hospital, Taiwan. [email protected]

PURPOSE: We measured the accuracy of magnetic resonance elastography (MRE) for detection and staging of liverfibrosis inestimationof liverfibrosisstagewithhistopathologic correlation.MATERIALS AND METHODS: This retrospective study included 465 patients (M:F = 338:127; mean age, 58.0 ± 14.4 years) with chronic liver disease who underwent MRE at 1.5T MRI. On MRE, mean liver stiffness values were measured on the elastograms in kilopascals. Fibrosis stage (F0-F4) was determined histopathologically for all patients according to METAVIR scoring system. The cutoff values, sensitivity, and specificity of MRE for each fibrosis stage were determined using receiver operating characteristic (ROC) analysis.

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RESULTS: For detecting significant fibrosis (≧ F2), with a cutoff value of 2.93 kPa, MRE had a sensitivity of83.8%,aspecificityof71.4%,andtheareaundertheROC curve (Az) of 0.836 ± 0.023 (0.790-0.881). Using a cut off value of 3.95 kPa, MRE had a sensitivity of 78.0%,aspecificityof73.2%,andanAzof0.822±0.021(0.780-0.863) in predicting liver cirrhosis (F4).CONCLUSION: MRE is an accurate modality for detectingsignificantfibrosisandlivercirrhosisinpatientswith chronic liver disease.

SE 01 AB-50A case of hepatic amyloidosis: radiological features on multimodality imagingOphelia Wai, Peter Yu, Lawrence Ng United Christian Hospital, Hong Kong, China. [email protected]

Hepatic amyloidosis is a rare manifestation of amyloidosis. Imaging features are non-specific and diagnosisbyimagingisoftendifficult.Hereweillustratethese imaging features through a biopsy proven case of hepatic amyloidosis, with US, CT, MRI and angiography performed. Upon US guided biopsy, US images showed multiple scattered echogenic foci in the liver. CT of the liver demonstrated homogeneous hypoattentuation of the liver, with hepatosplenomegaly, triangular hepatomegaly, and diffuse hepatic arterial stenosis. MRI also showed hepatosplenomegaly, with diffuse T1 signal change. Angiogram of the celiac trunk revealed diffuse irregular stenosis of the hepatic arteries resembling “spider leg” appearance. We believe it is important to recognize the unique combination of these features in order to aid the diagnosis of this rare but important disease.

SE 01 AB-51Feasibility of 10-minute delayed hepatocyte phase imaging using a 30° flip angle in Gd-EOB-DTPA-enhanced liver MRI for the detection of hepatocellular carcinoma in patients with liver cirrhosisInhwan Jeon, Eun-Suk Cho, Jeong Min Choi, Junyoung Kim Gangnam Severance Hospital, Korea. [email protected]

PURPOSE: To compare 10-minute (min) delayed hepatocytephaseimaging(HPI)usinga30°flipangle(FA) (10 min-FA30) and 20-min delayed HPI using a 10° FA (20 min-FA10) or 30° FA (20 min-FA30) in Gd-EOB-DTPA-enhancedMRI inpatientswithchronichepatitis

or cirrhosis, in terms of contrast-to-noise ratio (CNR) for hepatocellular carcinoma (HCC) and detection sensitivity for focal hepatic lesions (FHLs).MATERIALS AND METHODS: One hundred and four patients with 161 HCCs and 55 benign FHLs who underwentGd-EOB-DTPA-enhancedMRIwith10min-FA30, 20 min-FA10, and 20 min-FA30 were enrolled. Patients were divided into two groups according to the Child-Pughclassification:groupAwithchronichepatitisor compensated liver cirrhosis (Child-Pugh A) and group B with decompensated liver cirrhosis (Child-Pugh B or C). CNR for HCCs was compared between 10 min-FA30 and 20 min-FA10 or 20 min-FA30 for each group. The presence of FHLs was evaluated using a four-point scale by two independent reviewers, and the detection sensitivity was analyzed.RESULTS: In group A, the CNR for HCC on 10 min-FA30 (165.8 ± 99.7) was significantly higher than that on 20 min-FA10 (113.4 ± 71.4) and lower than that of 20 min-FA30 (210.2 ± 129.3). However, there was no significantdifferenceinthesensitivityofFHLdetectionbetween 10 min-FA30 (mean 94.9% for two reviewers) and 20 min-FA10 (94.6%) or 20 min-FA30 (94.6%). In group B, the CNR for HCC (54.0 ± 36.4) and the sensitivity of FHL detection (94.0%) for 10 min-FA30 were significantly higher than those for 20 min-FA10 (41.8 ± 36.4 and 80.0%, respectively) and were not different from those for 20 min-FA30 (62.7 ± 44.4 and 93.0%, respectively).CONCLUSION: 10 min-FA30 had a suff iciently high CNR and detection sensitivity in compensated cirrhosis. In decompensated cirrhosis, CNR did not significantly increase after 10 minutes of Gd-EOB-DTPAadministration.Therefore,10min-FA30yieldeddiagnostic performance similar to or higher than 20 min-FA10 or 20 min-FA30 in both compensated and decompensatedlivercirrhosis.Thisfindingindicatesthat10 min-FA30 can potentially replace 20-min delayed HPI regardless of patient liver function, and reduce the delay time by 10 minutes.

SE 01 AB-52Protocol optimization of MR colonography for polyp detection using pig colonic phantom: influence of magnetic field strength, colonic distension technique, and MRI sequenceEun-Suk Cho, Junyoung Kim, Jeong Min Choi Gangnam Severance Hospital, Korea. [email protected]

PURPOSE: There is currently no consensus for the optimal techniques of MR colonography (MRC), in respect of magnetic field strength, colonic distension technique and MRI sequences. The aim of this study


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was to compare the diagnostic performance for polyp detection and image quality of different techniques of MRC using pig colon phantoms and to evaluate the influence of magnetic field strength (1.5T or 3.0T), colonic distension technique (bright- or dark-lumen), and MRI sequences.MATERIALS AND METHODS: Six pig colon segments (60-92 cm) with 56 artificial colon polyps (0.4-1.6 cm in diameter, flat and sessile in shape) were placed in plastic container containing soybean oil. The colon was distended using room air for dark-lumen MRC and with tapwateroragadolinium-chelatebasedenemafluidforbright-lumen MRC. Each colon phantom was scanned on both 1.5T and 3.0T scanners using the following threesequences:two-dimensional(2D)fastimagingwithsteady-state precession (True-FISP), T2-weighted fat-suppressed(FS)2Dsingle-shotfastspinecho(SSFSE),and/or T1-weighted FS three-dimensional gradient-echo (3DGRE)sequences.Wetriedtoacquire thehighestspatial resolution within a 20-s acquisition time. Two radiologists evaluated the presence of polyps based on a 4-point scale and analyzed image quality with respect to artifacts, colonic wall conspicuity, polyp conspicuity, and polyp contrast using a 5-point scale.RESULTS: For polyp detection sensitivity and image quality, MRC obtained at 1.5T was better than that obtained at 3.0 T, and a bright-lumen technique was superior to a dark-lumen technique. Bright-lumen MRC at 1.5T was most sensitive for polyp detection (p < 0.001) and gave the highest image quality (p < 0.05) regardlessofpolypsizeandshape.SSFSEand3DGRE sequences at bright-lumen MRC at 1.5T had highest sensitivity for polyp detection (83.9% and 83.0%, respectively) and highest image quality.CONCLUSION: The most effective sequences of MRC forpolypdetectionwereSSFSE-or3DGRE-basedbright-lumen MRC obtained with a 1.5T scanner. These sequences had the highest polyp detection rate and the best image quality.

SE 01 AB-53Hepatic lesions that mimic metastasis on radiological imaging during chemotherapy for gastrointestinal malignancy: recent updatesYeo Eun Han, Beom Jin Park, Min-Ju Kim, DeukJaeSung,NaYeonHan,KiChoonSim,Sung Bum Cho Korea University Anam Hospital, Korea. [email protected]

TEACHING POINTS: For multidisciplinary teams involved in cancer care, the precise imaging validation of a newly detected hepatic nodule has become crucial to achieve optimal treatment during chemotherapy

for malignancies. Hepatic incidentaloma arising from chemotherapy induced parenchymal injury, tumor-associated eosinophilic abscess, and fungal infection should be considered a mimicker of metastasis in patients with gastrointestinal malignancy. We have reviewed widely used causative chemoagents, the updated concept of chemotherapy induced hepato-pathies, and other hepatic pseudometastasis focusing on their pathological and radiological findings for accurate diagnosis.TABLE OF CONTENTS: 1. The concept of imitator of hepatic metastasis during

chemotherapy2. Chemotherapy-induced focal hepatopathy1) Chemotherapy for gastrointestinal malignancy

2) Chemotherapy-induced focal sinusoidal injury Pathophysiology/Clinical issues/ Imaging Features3) Chemotherapy-induced focal steatosis/steato-

hepatitis Pathophysiology/Clinical issues/ Imaging features

3. Tumor-associated eosinophilic abscess in the liver Pathophysiology/Clinical issues/ Imaging features4. Compromised immunity-associated fungal abscess in

the liver Pathophysiology/Clinical issues/ Imaging features5. The take-home message

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SE 01 AB-54A short breath-hold high-resolution technique may be the first step to overcoming degraded hepatic arterial phase in liver MR imaging: a prospective randomized control study Chang Hee Lee, Yang Shin Park, Jongmee Lee, Jae Woong Choi, Kyeong Ah Kim, Cheol Min Park Korea University Guro Hospital, Korea. [email protected]

PURPOSE: To assess whether a short breath-hold high-resolution technique can improve hepatic arterial phase (HAP) image quality in gadoxetic acid-enhanced magnetic resonance imaging (MRI) compared to a conventional long breath-hold technique.MATERIALS AND METHODS: Institutional review board approval and patient consent were obtained for this prospective randomized control study. One hundred nineteen patients undergoing gadoxetic acid-enhanced MRI were randomly allocated into groups A or B (long or short breath-hold techniques, respectively). Respiratory-related graphs of the precontrast and HAP were acquired. The breath-hold degree was gradedbasedonthestandarddeviation(SD)valueofrespiratory waveforms. Gadoxetic acid-related dyspnea (GARD)wasdefinedaswhentheSDvalueoftheHAPwas 200 greater than that of the precontrast phase without degraded image quality in portal and transitional phases. The overall image quality and motion artifacts of the precontrast and HAP images were evaluated. The groups were compared using Student t or Fisher exact test, as appropriate.RESULTS: The incidence of breath-holding difficulty


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during the HAP was 43.55% (27/62) and 36.84% (21/57) forgroupAandB, respectively.GARDwasseen in19.35% (12/62) of group A and 7.02% (4/57) of group B. Group B showed better precontrast and HAP image quality thangroupA(p<0.001).DegradedHAPwasobserved in 9.68% (6/62) and 3.51% (2/57) of group A and B, respectively.CONCLUSION: The short breath-hold high-resolution MR technique showed better HAP image quality with less degraded HAP and lower incidences of breath-hold difficultyandGARDthantheconventional longbreath-hold technique.

SE 01 AB-55Feasibility of automatic spectral imaging selection with iterative reconstruction and low contrast material dose at contrast-enhanced abdominal CT: initial experiencePeijie Lu, Jianbo Gao, Yaru Chai TheFirstAffiliatedHospitalofZhengzhouUniversity,China. [email protected]

PURPOSE: To evaluate the image quality and radiation dose of automatic spectral imaging selection (ASIS) technique with iterative reconstruction and low contrast material dose at contrast-enhanced abdominal CT during the late arterial-phase (LAP) and the portal venous-phase (PVP) as compared with conventional CT.MATERIALS AND METHODS: The prospective study was approved by the Institutional Review Board, and each participant provided written informed consent. One hundred patients with suspected liver disease and a body mass index (BMI) of less than 24 kg/m2 were randomly divided into two groups (n = 50 each, noise index = 10 each; group A, ASIS technique, 300 mgI/kg of contrast medium and adaptive statistical iterative reconstruction; group B, 120 kVp, 450 mgI/kg of contrastmediumandfilteredbackprojectionalgorithm).Monochromatic images with energy levels from 40 to 140 keV were generated from group A for analyses. Quantitativeparameters(imagenoiseinHounsfieldunit,CT attenuation and contrast-to-noise ratio (CNR) of the aorta, portal vein and the liver) and qualitative visual parameters (image noise and overall image quality as graded on a 5-point scale) were compared between the two groups.RESULTS: Compared with group B, monochromatic images at 60 keV in group A displayed similar or higher CT attenuation and CNR, lower image noise (p < 0.0001) and higher overall image quality (p < 0.001) during the two-phase contrast-enhanced abdominal CT scan. CT attenuation and CNR of aorta, portal vein and liver, and image noise at 50keV in group A were all significantly

higher than those in group B (p values ranging from 0.04 to < 0.0001) except for the attenuation and CNR ofliverinLAPandimagenoiseinPVP(p>0.05forallcomparisons).Despitethehigherimagenoiseat50keVin LAP, the overall image quality was acceptable. BMI and radiation dose did not differ between the groups (p = 0.325 and 0.147 respectively).CONCLUSION: Application of ASIR to monochromatic imaging at 50 keV and 60 keV in spectral CT with ASIS technique allows contrast medium reduction without affecting image quality and increasing radiation dose in patients with BMI of less than 24 kg/m2.

SE 01 AB-56Effects of automatic spectral imaging selection technique and iterative reconstruction algorithm at contrast-enhanced abdominal spectral CTPeijie Lu, Jianbo Gao, Yaru Chai TheFirstAffiliatedHospitalofZhengzhouUniversity,China. [email protected]

PURPOSE: To assess effects of automatic spectral imaging selection (ASIS) technique and iterative reconstruction algorithm on image quality and radiation dose at contrast material-enhanced abdominal spectral computed tomography (CT) for a given radiation dose.MATERIALS AND METHODS: This prospective study was Institutional Review Board approved and informed patient consent was obtained from all patients. One hundred and sixty consecutive patients suspected of having liver disease were divided into two groups. In group A (n = 80), CT spectral imaging with ASIS technique was used to generate monochromatic images with energy levels from 40 to 140 keV using adaptive statistical iterative reconstruction (ASIR); in group B (n = 80), conventional CT with a fixed tube potential of 120 kVp was used with filtered back projection (FBP) for image processing. The mean image noise; contrast-to-noise ratio (CNR) relative to muscle for the liver, pancreas and aorta; body mass index (BMI) and effective dose with each group were assessed by two-tailed independent t test. Two readers assessed the diagnostic image quality as graded on a 5-point scale.RESULTS: Highest CNRs in group A were distributed at 40-70 keV. Higher CNR values for the liver, pancreas and aorta were obtained in group A than group B (p values ranging from < 0.013 to 0.0001). Image noise on monochromatic images at 60-70 keV in group A were 14-22% lower than that on 120-kVp CT images in group B (p < 0.0001 for all comparisons), resulting higher diagnostic image quality as compared with group B (p < 0.001 for all comparisons). There was no significant difference in BMI (p = 0.66) and radiation dose (p = 0.59)

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between the two groups.CONCLUSION: Spectral CT scanning with combined use of ASIS technique and ASIR provided optimal monochromatic imaging with higher CNR and better image quality without increasing radiation dose as compared with 120-kVp CT. Monochromatic imaging at 60-70 keV yielded lower image noise and higher CNR than did 120-kVp CT for a given radiation dose.

SE 01 AB-57Hypertonic-saline to increase the radiofrequency ablation area: Ex Vivo porcine liver ablation using a novel cold-wet cluster electrode techniqueCaoye Wang1, Yi Miao2, Weiping Wang3 1ThirdAffiliatedHopistalofSuzhouUniversity,China,2FirstAffilatedHospitalofNanjingMedicalUniversity,China, 3Mayo Clinic, USA. [email protected]

AIM: To explore the possibility of hypertonic-saline to expand ablation areas using a novel cold-wet cluster radiofrequency ablation electrode.MATERIALS AND METHODS: All procedures were performed in vitro with porcine livers using cold-wet cluster radiofrequency ablation technique. The study was divided into 3 groups: group A: ablation only, group B: combined with 0.9% NaCl, and group C: combined with 6% NaCl. Each group consists of ten procedures with same ablation technique. Each specimen was measured for its short and long axis and calculate the volumes of the ablation zones. Tissue specimens were also examined under light microscopy for coagulation necrosis following HE staining. The volume and coagulation necrosis were then compared against each other among the three groups.RESULTS: All procedures were performed successfully. The short-axis diameters groups A, B, and C were 2.31 ± 0.04 mm, 3.17 ± 0.05 mm, and 3.89 ± 0.09 mm, respectively, (P<0.05, difference in group A versus B, B versus C, A versus C. The volumes of coagulation necrosis for each group were 8.99 ± 0.52 mm3, 21.79 ± 1.05 mm3, and 40.01 ± 2.86 mm3, respectively; with largest necrotic diameters seen in group C (P <0.05, difference in group A versus B, B versus C, A versus C. The damage of coagulation necrosis in group C was more severe (hapatic cell irregular, degenerated, and shrunken, hepatic cells with pyknotic nuclei) compared with the other two groups.CONCLUSION: Cold-wet cluster radiofrequency ablation technique with the 6% NaCl solution can create a larger ablation zone and more sever pathological necrosis.

SE 01 AB-58Multidisciplinary role of radiologists associated with liver transplant service in Hong Kong and its clinical implicationsChun Lee, Kai Yat Kenneth Cheung, Hiu Yin Sonia Lam, Siu Kay Ferdinand Chu Queen Mary Hospital, Hong Kong, China. [email protected]

INTRODUCTION: Liver transplantation is a cutting edge medical technology that has been saving lives of patients with end stage liver failure and advance hepatic malignancies. In Hong Kong public health system, liver transplantations are exclusively performed in Queen Mary Hospital. It has immense resources implications and it attracts widespread media attention.PURPOSE: Liver transplantation has always been viewed as a surgeons lead service, whereas the workload input from the radiology side has never been documented and quantified. We aim to retrospectively quantify the radiology workload supporting liver transplantservice.Wealsousedthesefigurestopredictliver transplant related radiology workload in the future. MATERIALS AND METHODS: We used the index year of 2013. We recorded the number of liver transplant recipients (n = 72) and donors (n = 34) for that year. We followed the imaging and interventional radiology (IR) history of these patients covering the year before (T-1), during (T), one (T+1) and two (T+2) years after liver transplant. We also worked on the assumption that the imaging and IR workload is at its maximum during the transplant year, and that it falls off towards the year before, and towards one and further peters out two years after transplant. For future prediction, we assumed that the case number do not escalate. The case number of each subsequent year is assumed to be the average of the three preceding years. We also assumed that the imaging and IR requirement for recipients and donor of three years standing and beyond are negligible.RESULTS: Our results show that for each 100 liver transplant recipients the radiology imaging and IR workload for T-1, T, T+1, and T+2 are 37.13, 109.7, 32.23, 23.41 radiologist session per year. For every 100 liver donors, the respective workload are 10.11, 83.94, 12.5and3.18sessionsperyear.Thisfindingsupportedour assumption. The actual transplant related workload required by the 2014 transplant recipient and donors were162.8radiologist’ssession.Thepredictedworkloadrequired by the 2015 and 2016 recipient and donors were 143.8 and 153.0 respectively, equating 0.3-0.32 full time radiologist.CONCLUSION: Installment of liver transplant service has a significant impact on the overall radiology resources, demanding a robust and comprehensive diagnostic and interventional service.


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SE 01 AB-59Portal vein variations in 2000 liver patients: retrospective study in a tertiary care research instituteBinit Sureka, Yashwant Patidar, Kalpana Bansal, Shalini Thapar, Shiv Kumar Sarin InstituteofLiverandBiliarySciences(ILBS),NewDelhi,India. [email protected]

PURPOSE: To evaluate the spectrum and incidence of intrahepatic portal vein branching variations on triphasic abdomenmultidetectorcomputedtomography(MDCT)and to discuss surgical and radiological implications.MATERIALS AND METHODS: A retrospective review of2067 triphasicmultidetectorCT(MDCT)abdomenscans was performed in patients sent for various liver and other abdominal pathologies between January 2014 and October 2014. After excluding the patients with our exclusion criteria, a total of 2000 patients (n = 2000) were included in the study. The variations in branching pattern of portal vein were classified according to classification used by Covey et al. and Koç et al. The incidences of various anatomic variations were then analyzed. The absolute and relative frequency expressed in percentage was calculated for the results.RESULTS: Normal anatomy (type I) was seen in 1520 patients (76.00%) out of 2000 patients in our study. Trifurcation (type II) anomaly was seen in 162 (8.1%) of cases. Right posterior vein as first branch of MPV (type III) anomaly was seen in 120 (5.98%) of cases. Type IV anomaly and type V anomaly (type IV- segment VII branch separate branch of RPV; type V - segment VI branch separate branch of RPV) was seen in 102 (5.12%) and 67 (3.34%) cases respectively. 29 cases showed other types of variations.CONCLUSION: Variations in the hepatic portal vein branching patterns are commonly seen similar to variations in hepatic artery and biliary anatomy. Knowledge of these variations is extremely important for surgeons and intervention radiologists.

SE 01 AB-60Diagnostic performance of stomach CT compared with endoscopic ultrasonography in diagnosing gastric subepithelial tumorsJoon chul Ra, Eun Sun Lee, Hyun Jeong Park, Sung Bin Park, Jong Beum Lee, Byung In ChoiChung-Ang University Hospital, Korea. [email protected]

PURPOSE: To evaluation of diagnostic ability of CT compared to EUS(endoscopic ultrasonography) as a standard reference and investigate which factors can influence on detection of small(< 5cm) gastric SETs(subepithelial tumors) on CT with stomach protocol.MATERIALS AND METHODS: We retrospectively investigated 70 patients who were suspected gastric SETsonEGDandunderwentbothEUSandCT.EUSwas performed by two gastroenterologists and location, size, echotexture, echogenicity, layer of origin were described when gastric SETs were detected on EUS. MDCTswere reviewedbasedonconsensusof tworadiologists blinded to the EUS result. Size, location, enhancement pattern, contour of the lesion detected on CT were described. We calculated diagnostic ability of CT compared to EUS about detection of gastric SETs and investigated which factors can influence on detection of SETs on CT.RESULTS: Of the 70 cases performed both CT and EUS duetosuspiciousSETonEGD,EUSdetect56casesof probably SET, and 14 cases of external compression. Thirty-nine out of the 56 cases, CT detected probable SET. Sensitivity and specificity of CT was 69.64% and 100.00%. PPV and NPV of CT was 100.00% and 45.16%.Therewasasignificantdifferenceinmeansizeof CT-detected lesions as compared with CT-invisible

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lesions (14.36 mm vs. 8.52 mm, p < 0.001), but no significant differences in terms of layer of origin and locationbetweenthesetwogroups(p>0.5).TheROCanalysis revealed that the optimal cut-off value, which ispredictingCTvisibilitywas>10mm(AUC0.82,p<0.0001). Total 26 cases out of 70 cases (37.14%) were identifiedonCTasexternalcompressionorinsignificantlesions, which need not follow regularly such as lipoma, hemangioma, lymphangioma or gastritis cystica.CONCLUSION: Stomach CT show good feasibility for depiction of small SETs, larger than 10 mm. In addition, stomach CT would be a complimentary or problem solving tool for SET in evaluating presence of external compression and characterization of tumors.

Figures of suspected SET lesions.First row: SET that was visible on both EUS and CT.Second row: SET that was only visible on EUS, not on CT.Third row: SET mimicking pseudomass lesion due to external compression (splenic artery aneurysm).A.Upper GI endoscopy, B. Endoscopic ultrasono-graphy(EUS),C.CT,D.CT3Dvolumerenderingimage.

SE 01 AB-61Gastroenteropancreatic neuroendocrine tumors: imaging and clinicopathological featuresTao Lu, Hong Pu, Guang-wen Chen Sichuan Academy of Medical Science & Sichuan ProvincialPeople’sHospital,[email protected]

PURPOSE: To discuss the imaging and clinicopathologic features of gastroenteropancreatic neuroendocrine tumors. MATERIALS AND METHODS: Between January 2013 andDecember2015,48patientswithGEP-NETs(34males and 14 females), who were surgically diagnosed, underwentpreoperativeMDCTorMRI.Theclinicalandimaging materials of the patients were reviewed and analyzed.

RESULTS: Pancreatic tumors mainly located in the head and body of the pancreas. Gastrointestinal involvement included the following: 12 cases located in the stomach, 11 cases in the rectum, 3 cases in the esophagus and colon respectively, 2 cases in the duodenum and appendix respectively. The age at diagnosis mainly involved the 5th to 7th decades with the mean age 61 years. The dominant clinical symptoms included abdominal pain, dysphagia, hematemesis or hematochezia and neuroendocrine related symptoms. 20 tumorswereclassifiedasG3tumors,12asG1tumors,11 as G1 tumors and 5 as mixed adenoneuroendocrine carcinoma. The immunohistochemical markers chromogranin and synaptophysin were positive. The pancreatic tumor was iso-to hypoatternuation on plain CT scan, iso- to hypointensity on T1WI and iso- to hyperintensity on T2WI. The enhancement pattern was variable. The CT features of GI-NETs mainly included wall thickening, nodule or mass on the wall of GI tract. The 2 main enhancement patterns were moderately homogeneous enhancement and irregularly heterogeneous enhancement. 14 cases of lymph node metastases, 9 cases of liver, 3 cases of lung and 1 case of lumbar vertebra metastases were also detected by CT. CONCLUSION: GEP-NETs easily affected elderly males. The most common sites of onset were the pancreas, stomach and the rectum in China. The imaging features of pancreatic NETs of different grade and GI-NETs were nonspecific. However, the enhancement pattern had some characteristics. Imaging modalities can provide useful information regarding the location, enhancement pattern and metastases of the disease.


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SE 01 AB-62Diagnostic Performance of surveillance US and influencing factors on US visibility of HCCs: A prospective study in patients with cirrhosis at high risk of HCC So Hyun Park1, Hyung Jin Won2, So Yeon Kim2, So Jung Lee2, Jae Ho Byun2, Seong Ho Park2 1Gil Medical Center, 2Asan Medical Center, Korea. [email protected]

PURPOSE: To investigate diagnostic performance, the characteristics of nodules detected on surveillance US and influencing factors on US visibility of HCCs in patients with cirrhosis at high risk of HCC.METHODS: A prospective surveillance study included 407 consecutive patients with an estimated annual risk ofHCC>5%whounderwentone to three,biannualsurveillance US examinations combined with US elastography between November 2011 and August 2014. The findings of lesions detected on US were recorded in a predefined standardized way using a four-point scale indicating the likelihood of HCC, i.e., suspicious, equivocal, probably benign or definitely benign/negative, corresponding to categories 4, 3, 2, and1,respectively.TheconfirmationofHCCwasbasedon the results of a histologic examination and/or typical CT images of HCC. The detection rate of HCC and the false-positive rate were calculated. The characteristics of category 4 nodules detected on US were determined using the simultaneous or follow-up gadoxetic acid-enhanced MRI and CT. We investigated clinical factors, including the Child-Pugh class and body mass index as well as imaging characteristics such as liver stiffness, US image quality, tumor location, and tumor size, all of whichpossiblyinfluencedtheUSvisibilityofHCCs.RESULTS: Among the 43 patients with HCCs found during 1100 US screening sessions, the detection rate of HCC was 27.9% (12/43) and the false positive rate was 5.6% (59/1057). Among the 71 category 4 lesions, 12 were HCC, 27 were not matched with any lesions seen on MRI or CT, 20 were confirmed as cirrhosis-related nodules, four were exophytic hepatic parenchyma, four were hemangiomas, three were complicated cysts, and one was abnormal vasculature. Among the clinical and imaging characteristics, a subcapsular location was theonlysignificantfactorrelatedtothefailuretodetectHCC on US (P=0.019). Among 20 HCCs in subcapsular locations, US detected only two HCCs.CONCLUSION: In patients with cirrhosis at high risk of HCC, surveillance US did not show satisfactory diagnostic performance. The subcapsular location of HCC can be the cause of the suboptimal detection rate.

SE 01 AB-63Feasibility of 3D MRCP with compressed sensing at 3T: comparison with navigator-triggered 3D MRCPNieun Seo, Mi-Suk Park, Jin-Young Choi, Honsoul Kim, HyeJinKim,KyunghwaHan,DongeunKim,Myeong-Jin Kim Severance Hospital, Korea. [email protected]

PURPOSE: To assess the feasibility of 3-dimensional (3D)MR cholangiopancreatography (MRCP)withcompressed sensing (CS) in clinical use compared with standard3Dnavigator-triggeredMRCPwithoutCS.MATERIALS AND METHODS: From January 2016 to March 2016, 30 patients who required MRCP for suspected pancreaticobiliary disease were prospectively enrolled in this study.All patients underwent 3Dnavigator-triggered MRCP with and without CS. Acquisition times of both sequences were recorded. Quantitative comparison including relative duct-to-periductal contrast ratio (RC) at three biliary segments and acquisition times between two sequences were performed. Qualitative evaluation regarding the visualization of the pancreaticobiliary tree and the degree of artifacts was performed by two radiologists with blinding. The data were analyzed using the paired t-test and the Wilcoxon paired signed-rank test. Interobserver agreement of qualitative evaluation was calculatedusingtheweightedκstatistics.RESULTS: The mean acquisition time of MRCP with CS (131.87±33.60sec)wassignificantlyshorterthanthatof MRCP without CS (253.63 ± 56.08 sec) (p < 0.001). On quantitative evaluation, RC at two segments using MRCP with CS was slightly lower than that using MRCP without CS (p = 0.007 and p = 0.002), and RC of one segment was similar between MRCP with and without CS (p = 0.816). On qualitative analysis, the visualization of pancreaticobiliary segments and the degree of artifacts were not significant different between MRCP withandwithoutCS (p>0.05) inboth radiologists.The interobserver agreement for duct visualization was moderate to good.CONCLUSION: MRCP with CS application can provide comparable image quality with navigator-triggered MRCP without CS in about half the acquisition time. Therefore,CS is feasible for3Dnavigator-triggeredMRCP in a clinical setting.

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SE 01 AB-64CT perfusion evaluation of gastric cancer: correlation with histologic typeDongHoLee, Se Hyung Kim Seoul National University Hospital, Korea. [email protected]

PURPOSE: To prospectively evaluate whether the perfusion parameters of gastric cancer can provide information regarding the histologic type of gastric cancers.MATERIALS AND METHODS: Our Institutional Review Board approved this study and informed consent was obtained from all patients. Between October 2015 and March 2016, 19 patients underwent preoperative per fus ion CT (PCT) and subsequent curat ive gastrectomy comprising our study population. PCT data were analyzed using a dedicated software program (VPCT body, Siemens Medical System). Perfusion parameters including blood flow, blood volume, mean transit time, time-to-peak, and permeability surface value of gastric cancers were calculated and compared according to histologic type (poorly cohesive carcinoma [PCC] versus non-PCC), tumor differentiation (well or moderately differentiated versus poorly differentiated) and N-staging (positive versus negative lymph node metastasis) using the Mann-Whitney U test. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value of significant parameters.RESULTS: Permeability surface value of PCCs was significantly higher than other histologic types (44.9 ml/100 g/min in PCC versus 25.2 ml/100 g/min in non-PCC, p = 0.005). The area under the ROC curve for permeability surface values in predicting PCC was 0.875. Sensitivity of 88.9% (8/9) and specificity of 90.9% (10/11) were achieved with a cut-off value of 37.9 ml/100 g/min. Other perfusion parameters were not significantlydifferentaccordingtohistologictype,tumordifferentiation,andN-staging(p>0.05).CONCLUSION: A preoperative imaging diagnosis of PCC type gastric cancers could be possible using permeability surface values of gastric cancers as it was shown to be significantly higher in PCCs than non-PCCs.

SE 01 AB-65Differentiating acute-on-chronic liver failure from chronic liver disease: emphasize on quantitative signal intensity analysis of T2-weighted images Tae Wook Kang, Young Kon Kim, Seong Hyun Kim, DongHyunSinnSamsung Medical Center, Korea. [email protected]

PURPOSE: To evaluate the differential feature of acute-on-chronic liver failure (ACLF) and chronic liver disease on magnetic resonance (MR) images using quantitative and qualitative analyses.MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study. Twelve patients with ACLF patients who had undergone MR images were included. These patients were compared to 36 patients with chronic liver disease who had undergone MR images. Qualitative MR imaging findings were assessed in both groups. For quantitative analysis, signal intensity (SI) was obtained on T1- and T2-weighted images (WI) using region of interest, placed in the liver and paraspinal muscles. In addition, apparent diffusioncoefficient(ADC)valuewasmeasured in theliver. All these variables were compared between both groups. The optimal cut-off level of quantitative values for ACLF was analyzed using a receiver operating characteristic analysis.RESULTS: In qualitative MR imaging, gallbladder edema, esophageal varix, and ascites, were more frequently shown in the ACLF group than in the chronic liver disease group with statistical significance. Liver tomuscleSIratioonT2-WIwassignificantlyhigher inACLF group than that in chronic liver disease group (p = 0.002). However, corresponding SI ratio on T1-WI and measuredADCvalueswerenotdifferentbetweenbothgroups. The optimal cut-off value of live to muscle SI ratio on T2-WI for the determination of ACLF was 0.29 (75%sensitivity,81%specificity,75%accuracy).CONCLUSION: Morphologic MR imaging findings and liver to muscle SI ratio on T2-WI can effectively differentiate ACLF from chronic liver disease.


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SE 01 AB-66Correlation of CT angiography with digital subtraction angiography in the evaluation of non-variceal acute gastrointestinal bleedingSheo KumarSanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. [email protected]

INTRODUCTION: Gastrointestinal (GI) bleeding is a common clinical condition that is increasingly seen in an older age and frequently requires hospitalization and intervention. There are multiple imaging modalities and therapeutic interventions being used in the evaluation and treatment of acute (GI) bleeding each with its strengths and weaknesses.PURPOSE: To analyze the role of 64 CT angiography in the localization of acute gastrointestinal bleeding. Correlation of CT angiography findings with digital subtraction angiography (DSA). Radiation doseassessment between the two modalities.MATERIALS AND METHODS: Prospective study- betweenJuly2012 toDecember2014.40patientsincluded in our study. 67.5% patients were male and 32.5% were female.INCLUSION CRITERIA: The patients between 19 and 72 years with diagnosis of acute GIEXCLUSION CRITERIA: Patients with contraindications to contrast, pregnancy RESULTS: CORRELATION BETWEEN CTA AND DSA- Sensitivity of CTA was 96.9% and specificity of CTA

was 28.5%.- Both were positive in 32/40 (80%) cases. Both were

negative in 2/40 (5%) cases.-Therewas1(2.5%)case thatwaspositiveonDSA

alone while 5 (12.5%) cases were positive on CT alone.

-Overall anagreementbetweenDSAandCTwasobserved in 34/40 (85%) cases.

- On evaluating this agreement statistically, it was found tobefair(ĸ=0.33)andsignificant(p<0.020).

Comparison of Radiation doses between CTA and DSA:- The minimum CT effective radiation dose was 16.3

mSv and maximum was 22.98 mSv. The mean CT effective dose was 19.7 mSv.

-TheminimumDSAeffectiveradiationdosewas0.89mSvandmaximumbeing3.3mSv.ThemeanDSAeffective radiation dose was 1.55 mSv.

- p value is < 0.05, we reject the null hypothesis and concludethatthereisasignificantdifferencebetweentheeffectiveradiationdosesofCTA&DSA

CONCLUSION: - CT angiography localizes the bleeding site which

determines suitable intervention and reduced interventional time.

-DSAoffersboththediagnosticandtherapeuticoption.- In our study mean CT effective dose was 19.7 mSv andinDSAwas89mSv

SE 01 AB-67Correlation with controlled attenuation parameter and MR-PDFF for hepatic fat quantification by serial examination in clinical trial settingBo-kyeong Kang1, Sang Bong Ahn2,DaeWonJun1 1Hanyang University Seoul Hospital, 2Eulji University Hospital, Korea. [email protected]

BACKGROUND:Multi-echomodifiedDixon(mDixon)sequence (MR-PDFF) isacceptedasa reasonablenoninvasive method to quantify hepatic steatosis (HS) in patientswithnonalcoholic fatty liverdisease(NAFLD).Recently controlled attenuation parameter (CAP) has been showed good correlation with HS compare to liver biopsy as well as MRS data in large cross sectional cohort. However, there is little known whether change of CAP scores can be used in clinical trial. We investigated the correlationwithCAPandMR-PDFFby serialexamination in clinical trial setting.METHODS: Sixty-fiveNAFLDpatientswereevaluatedwithMR-PDFFand transientelastography includingCAP inclinicalstudy.BothMR-PDFFandCAPwereevaluated after three month probiotic clinical trial in patientswithNAFLD.RESULTS: BaselineCAP andMR-PDFF showedgood correlation assessing HS (r=0.60, p<0.001). Also, changes of CAP value was also correlated with changesofHS%usingMR-PDFF(r=0.35,p=0.008)inclinical trial setting. Concordance rate of improvement or aggravation was comparable in both two methods. However, the less change amount was small in CAP

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value, the less concordance rate showed weaker in MR-PDFF.WhenthechangeofCAPvalueafter treatmentwaslessthan20,concordanceratewithMR-PDFFwasdecreased to 15/25 (60%).CONCLUSION: CAPandMR-PDFFhaveacomparablediagnostic value for quantification of HS as well as assessing changes of HS in clinical trial. However, a careful interpretation of the HS change using CAP score should be given when the absolute change value was less than 20 in clinical trial setting.

SE 01 AB-68Safety and efficacy of the Emprint™ microwave ablation system of hepatic tumoursJun Jie Julian Yap1, Zhi Min Lau1, Uei Pua2 1Yong Loo Lin School of Medicine, National University of Singapore, 2Tan Tock Seng Hospital, Singapore. [email protected]

The Emprint™ system (Emprint™ Microwave Ablation System, Covidien) is designed to create spherical microwave ablation zones for hepatic tumours. We noted a lack of literature and sought to study its safety andefficacyinthelong-term.We conducted a retrospective analysis of percutaneous hepatic tumour ablations using Emprint™ conducted over a two-year period comprising a total of 37 percutaneous microwave ablations of hepatic tumours.We recorded the technical success rate, ablation duration, number of passes, intra-procedure and post-procedure complications and categorized them using the Society of Interventional Radiology (SIR) Complication Grading.We analysed the efficacy of Emprint™ (as defined by treatment response and recurrence on six-week post-ablation follow-up), using the modified Response Evaluation Criteria in Solid Tumours (mRECIST) grading.32 patients received 37 Emprint™ ablation procedures. Technical success was 97.3%. Mean total ablation duration was 8.20 minutes and median number of passes made was 1.Amongst successful ablations, complication rate was 30.6% (25/36) and there was no mortality. Among those with complications (n=11), 66.7% had minor complications while the remainder 33.3% had major complications.Regarding efficacy, Complete Response, Partial Response,StableDiseaseandProgressiveDiseaserates were 77.4%, 12.9%, 3.2% and 6.5% respectively.The results support the safety and eff icacy of percutaneous Emprint™ microwave ablation technology. The low major complication rate and high Complete Responserateonfollow-upsupportsitsefficacy.

SE 01 AB-69Role of DWI in detection and characterization of the focal hepatic lesion: learning experience with 3T magnetsPrashant Sarda, Sumit Mukhopadhyay, Saugata Sen, DayanandLTata Medical Centre, India. [email protected]

RESULTS:

GENDER DISTRIBUTION

AGE DISTRIBUTION OF THE MALIGNANT LESIONS


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FOCAL HEPATIC LESIONS IN PRESENT STUDY

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PURPOSE: To clarify role of diffusion weighted magneticresonanceimaging(DWMRI)inthedetectionof hepatic focal lesions and its ability to differentiate benign from malignant hepatic focal lesions. To clarify roleofDiffusionWeightedMagneticResonanceImaging(DWMRI) intheevaluationofposttreatmentresponseof tumor --- residual/recurrenceMATERIALS AND METHODS: Patients: Fifty consecu-tive liver MRI examinations realized between August 2015 and November 2015 were retrospectively analyzed and a total number of 136 FHLs were selected.Inclusion criteria: Presence of at least one FHL with a histological analysis or consensus MRI reading by two experienced radiologists and/or had a previous scan, confirmingthatthelesionhasthesameaspectandthesame size.Exclusion criteria: Patients without histological proof and/or without a typical aspect on MRI as defined above. Cystic hepatic sols (most of them simple cysts), lesions smaller than 1 cmProtocol: All liver MRI examinations were done using the same machine (Siemens Magneta Verio 3T) and the ADCvalueswerecalculatedbasedonthreeb-values(b-50, b-500 and b-1000). After injection of contrast media, the liver scanned in the arterial, portal and late phases. Contrast used: Gd-BOPTA (Multihance)

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Image analysis: The following data were recorded for each patient: sex, age, size of the lesion, histologic diagnosisoftheassessedFLL.TheADCvalueofeachFLL was calculated within a region of interest (ROI) placed in the center of the assessed FLL, covering more than 50% of its surface. Necrotic FHLs (metastases or HCC), measurements were taken only in the solid part. TheADCratiowascalculatedusingtheobtainedADCvalues, the one for the assessed FLL, and the other one for the surrounding liver parenchyma. For patients with multiple FLLs, selected each lesion was individually analyzed.Apvalue<0.05wasconsideredsignificant.CONCLUSION: TheADCvalue, the ratiobetweentheADCvalueof the lesionandtheADCvalueof thesurrounding liver parenchyma have very good accuracy in differentiating benign from malignant FHLs. However its role is more precise if used in conjunction to other MR sequences and contrast study. In most cases, the differential diagnosis of FLLs is straightforward, as most lesionshavea typical imagingaspect.DWIhowevershows promising results for FHLs detection and characterization, being relatively quickly to be performed (two breath hold acquisitions).

SE 01 AB-70Sphericity assessment of emprint device in treatment of hepatocellular carcinomaKannan Chidambaram1, Pua Uei2 1Yong Loo Lin School of Medicine, National University of Singapore, 2Tan Tock Seng Hospital, Singapore. [email protected]

BACKGROUND: Recent advances in treating hepa-tocellular carcinoma with microwave ablation have been made with the Emprint™ device using its Thermosphere™ technology, which promises a more spherical ablation zone. Our study aims to see whether theablationfieldisindeedsphericalandhowtheablationzone changes with time.METHODS: A retrospective analysis of patients with hepatocellular carcinoma was performed. The inclusion criteria that was employed was patients had to have an Emprint™ procedure, an immediate post procedural computed tomography (CT) scan, and follow-up imaging (MR or CT scan) with an interval of atleast 4 weeks and that the tumour must not be located at a position which could confound the measurement of the ablation zones. Significant demographic, medical and surgical history and intraprocedural details were collected as well. After multiplanar reformatting of the scanned images, measurements were made in all 3 planes allowing for Roundness Indices and Sphericity Indices to be obtained. Indices closer to 1 would indicate sphericity.RESULTS: A total of 18 patients met the inclusion

criteria with 20 Emprint procedures conducted. Technical success was 100%. Mean total duration of ablation was 7.7625 minutes. The mean Immediate Roundness Index Plane was 0.774, with a mean difference -0.226 with T value of 1 (95% CI: -0.306, -0.146). The mean DelayedRoundness IndexPlanewas0.744,withamean difference -0.256 with T value of 1 (95% CI -0.319, -0.193). The mean Immediate Sphericity Index was0.507(range0.157till1.000,SD0.207).ThemeanDelayedSpherecity Indexwas0.494(range0.196 till0.864,SD0.186)DISCUSSION AND CONCLUSIONS: The results dispute the perceived sphericity using the Thermosphere™ technology as both the immediate and follow-up Roundness Index and Sphericity Index are far from ideal. A follow up study using a larger sample size would aid in confirmingtheseresults.

SE 01 AB-71Point shear wave elastography (ElastPQ) for staging liver fibrosis in patients with chronic hepatitis B Jeong Eun Lee, June Sik Cho, Kyung Sook Shin, Kyung-Hee Kim, Ah Yeong Kim Chungnam National University Hospital, Korea. [email protected]

PURPOSE: To assess the diagnostic performance of point shear wave elastography (ElastPQ) for staging liverfibrosisandtocompareittoothernoninvasivetoolsin patients with chronic hepatitis B (CHB).MATERIALS AND METHODS: A total of 49 patients with CHB who underwent liver stiffness measurements using the ElastPQ and transient elastography (TE) as well as biochemical investigations before liver parenchymal biopsy or surgery were included. Results werecomparedwithpathologicfibrosisasthereferencestandard. The diagnostic performance of ElastPQ, TE, and AST to Platelet Ratio Index (APRI) was evaluated using a receiver operating characteristic (ROC) curve analysis.RESULTS: The mean stiffness values of ElastPQ were 5.79 ± 3.09 kPa for F3 and 7.43 ± 3.51 kPa for F4. Stiffness values obtained by ElastPQ (r = 0.322), TE (r = 0.322), and APRI (r = 0.208) showed significant positivecorrelationswithpathologicfibrosisstaging(p<0.05). Areas under the ROC curve of ElastPQ, TE, and APRI were 0.834, 0.617 and 0.623, respectively, for the diagnosisofsignificantfibrosis(≥F3)and0.769,0.694,and 0.602, respectively, for the diagnosis of cirrhosis.CONCLUSION: ElastPQ is a promising ultrasound-based stiffness imaging technique for evaluation of liver fibrosis inpatientswithCHB,withdiagnosticaccuracycomparable to that of TE.


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SE 01 AB-72Imaging predictors of 1-month response to transarterial chemoembolization for hepatocellular carcinomaYeun Jeong Kim, Min Hee Lee, Seo-Youn Choi, Boem Ha Yi, Hae Kyung Lee Soonchunhyang University Bucheon Hospital, Korea. [email protected]

PURPOSE: To determine which features on pretreat-ment CT and MR imaging are associated with 1-month response to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).MATERIALS AND METHODS: Records of 49 patients with68HCCswhohadundergonethefirstTACEwereretrospectively reviewed. On pretreatment image, each

HCC was evaluated with its size, visual attenuation on the arterial phase, signal intensity on T1-, T2-, and diffusion weighted image and apparent diffusion coefficient(ADC).Treatmentresponseswereroutinelyassessed 4 weeks after TACE session using liver dynamic CT scan. HCCs were classified into either complete responder (CR) or incomplete responders (IR) based on the arterial phase enhancing tumoral area.RESULTS: In multivariate analysis, larger diameter (p = 0.015, OR = 1.068 per millimeter, 95% CI = 1.013-1.127) and iso- to high SI on T1WI (p = 0.007, OR = 5.59, 95% CI = 1.583-19.737)ofHCCwassignificantlyassociatedwith increased odds of incomplete response.CONCLUSION: Iso- to high T1 SI of HCC on pretreat-ment MRI was an independent predictor of incomplete response after TACE, in addition to larger tumor size.

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Abdomen-Informal Scientific Presentation

Presenting No.

Final Abstract No. Title Presenting

AuthorPage No.

ISP 01_AB 03 SE 01 AB-02 CYSTIC model" in common and uncommon cystic lesions of pancreas Binit Sureka 409

ISP 01_AB 04 SE 01 AB-03 Autoimmune pancreatitis: parenchymal and ductal imaging features Binit Sureka 409

ISP 02_AB 02 SE 01 AB-05Prediction of late postoperative hemorrhage after the whipple procedure using computed tomography performed during the early postoperative period

You jin Lee 410

ISP 04_AB 01 SE 01 AB-15Usual versus unusual, differentiation of epithelial tumor from non-epithelial tumor in the stomach: case based analysis

Juhee Ahn 414

ISP 01_AB 02 SE 01 AB-22Comprehensive review of congenital anomalies, anatomic variants and diagnostic pitfalls in pancreatic imaging

Jong Eun Lee 416

ISP 02_AB 04 SE 01 AB-23 Focal nodular hyperplasia: a case report Javzandolgor Nyamsambuu 417

ISP 02_AB 03 SE 01 AB-27 Castleman’sdiseaseintheabdomenandpelvis:imaging manifestations and its mimics Nam Kyung Lee 419

ISP 03_AB 04 SE 01 AB-31 Focal nodular hyperplasia: imaging patterns on gadoxetic acid-enhanced MR images Jung-Hee Yoon 421

ISP 03_AB 01 SE 01 AB-35 Rapid progression of HCC after RF ablation: what to know and how to avoid Jin Woong Kim 423

ISP 04_AB 03 SE 01 AB-36Evaluation of subepithelial lesions of stomach with three-dimensional multi-detector CT gastrography: emphasis on differential diagnosis

Sang Soo Shin 423

ISP 01_AB 01 SE 01 AB-37 Allaboutclassificationsystemsfortheseverityofacute pancreatitis: from past to future Jimi Huh 423

ISP 04_AB 02 SE 01 AB-38 CT imaging characteristics of gastric lymphoepithelioma-like carcinoma Hee Jeong Shin 424

ISP 02_AB 01 SE 01 AB-47 Imagingfindingsofcommonanduncommonsubmucosal lesions of the large intestine Taehoon Ahn 429

ISP 03_AB 03 SE 01 AB-48

Dynamicarterialphaseofmotioninsensitiveradialvolumetric imaging breath-hold examination with KWIC in the detection of hepatocellular carcinoma in patients with chronic liver disease

Min Ah Lee 429

ISP 03_AB 02 SE 01 AB-71Point shear wave elastography (ElastPQ) for stagingliverfibrosisinpatientswithchronichepatitis B

Jeong Eun Lee 444

abdomen se 01 ab-02 - conplus.co.krconplus.co.kr › ~kcr2016 › down › abstract_book › se ›...

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