syllabus & abstracts

When the contents are special... 

The container should be too! 

XENETIX 

® 

Iobitridol 

In 

Xenetix ® 350, solution for injection (350 mgI/ml); Xenetix ® 300, solution for injection (300 mgI/ml); Xenetix ® 250, solution for injection (250 mgI/ml) – COMPOSITION per 100 ml: Xenetix ® 350: 76.78 g 

of iobitridol (corresponding to 35 g of iodine), Xenetix ® 300: 65.81 g of iobitridol (corresponding to 30 g of iodine), Xenetix ® 250: 54.84 g of iobitridol (corresponding to 25 g of iodine) –Indications and 

approvals may vary in different countries. Please refer to the local Summary of Product Characteristics (SPC) before prescribing. Further information available on request. CLINICALS PARTICULARS: therapeutic 

indications: this product is for diagnostic use only. Contrast agent for use in: Xenetix ® 350 intravenous urography, computed tomography, intravenous digital substraction angiography, arteriography, angiocardiography 

– Xenetix ® 300: intravenous urography, computed tomography, intravenous digital substraction angiography, arteriography, angiocardiography, endoscopic retrograde cholangiopancreatography, arthrography, 

hysterosalpingography – Xenetix ® 250: phlebography, computed tomography, intra-arterial digital substraction angiography, arteriography, endoscopic retrograde cholangiopancreatography – Posology and 

method of administration: the doses should be adapted to the type of examination and the region to be opacified as well as the weight and renal function of the patient, especially in children – Contraindication: 

hypersensitivity to iobitridol or any of the excipients, history of major immediate or delayed cutaneous reaction (see undesirable effects) to Xenetix ® , manifest thyrotoxicosis, hysterosalpingography during pregnancy. 

General particulars corresponding to all iodinated contrast agents: in the absence of any specific studies, myelography is not an indication for Xenetix ® . All iodinated contrast media can cause minor or 

major reactions that can be life-threatening. These can occur immediately (within 60 minutes) or be delayed (within 7 days) and are often unpredictable. Because of the risk of major reactions, emergency 

resuscitation equipment should be available for immediate use – Precautions for use: intolerance to iodinated contrast media, renal insufficiency, hepatic insufficiency, asthma, dysthyroidism, severe cardiovascular 

diseases, central nervous system disorders, phechromocytoma, myasthenia, intensification of side effects: Interaction with other medicinal products and other forms of interaction – Association requiring 

precaution of use: beta-blocking agents, diuretics, metformin, radiopharmaceuticals – Association to take into account: interleukin II – Pregnancy and lactation – Undesirable effects: anaphylactoid reactions 

and hypersensibility: skin-mucosa (very rare), respiratory (very rare), cardiovascular (very rare), neurosensorial (very rare), digestive (very rare), renal (infrequent), thyroid (very rare), local effects (frequent): 1- benign and 

transient local pain and oedema can occur at the injection site in the absence of extravasation of the injected contrast agent. Following intra-arterial administration, the sensation of pain at the injection site depends on 

the osmolality of the product injected. In case of extravasation (< 0.01%), a local inflammatory reaction or even tissue necrosis may be observed. 2- thrombophlebitis (not reported with Xenetix ® ). 3- articular pain with 

arthrography. 4- pelvic pain with hysterosalpingography – French presentation and marketing authorisation number: Xenetix ® 350: 337 710.7: 20 ml vial (glass) – 337 711.3: 50 ml vial (glass) – 560 154.3: 

50 ml vial x25 (glass) – 337 910.6: 60 ml vial (glass) – 337 713.6: 100 vial (glass) – 560 156.6: 100 ml vial x10 (glass) – 337 714.2: 150 ml vial (glass) – 337 715.9: 200 ml vial (glass) - 337 718.8: 

60 ml set – 369 154.2: 100 ml bag (polypropylene:pp) – 570 816 9: 100 ml bag x10 (pp) – 369 156.5: 150 ml bag (pp) – 570 817.5: 150 ml bag x10 (pp) – 369 158.8: 200 ml bag pp) – 570 818.1: 

200 ml bag x10 (pp) – 369 160.2: 500 ml bag (pp) – 570 819.8: 500 ml bag x10 (pp) - Xenetix ® 300: 337 767.9: 20 ml vial (glass) – 337 768.5: 50 ml vial (glass) – 560 157.2: 50 ml vial x25 (glass) – 

337 769.1: 60 ml vial (glass) – 337 771.6: 100 ml vial (glass) – 560 158.9: 100 ml vial x10 (glass) – 337 772.2: 150 ml vial (glass) – 337 705.3: 200 ml vial (glass) – 337 709.2: 60 ml set – 

369 144.7: 100 ml bag (pp) – 570 820.6: 100 ml bag x10 (pp) – 369 147.6: 150 ml bag (pp) – 570 821.2: 150 ml bag x10 (pp) – 369 149.9: 200 ml bag (pp) – 570 822.9: 200 ml bag x10 (pp) – 

369 151.3: 500 ml bag (pp) – 570 823.5: 500 ml bag x10 (pp) - Xenetix ® 250: 560 159.5: 50 ml vial x25 (glass) – 337 762.7: 100 ml vial (glass) – 560 160.3: 100 ml vial x10 (glass) – 337 763.3: 200 ml vial 

(glass) – 337 766.2: 50 ml set – Guerbet – BP 57400 F-95943 Roissy CdG cedex – tel: +33.(0)1.45.91.50.00 - www.guerbet.com - For detailed information, see Dictionnaire Vidal - Revised October 2007. Terre 

Neuve - P 08 024 XEN - 03/2008. 

Selbstverlag, München ISBN 978-3-00-025479-6 ESUR 2008 

Urogenital Radiology 

Special Focus: Prostate, Pelvic Floor and Urinary Tract 

Final Programme and Syllabus of the 15th Symposium of the European Society 

of Urogenital Radiology 

Munich, Germany - September 11-14, 2008 

Chairman of the local organizing committee: 

Assoc. Prof. Ullrich Mueller-Lisse, MD, MBA 

Dept. of Clinical Radiology 

Munich University Hospitals – Innenstadt 

Munich, Germany 

Conference Venue: 

University of Munich 

HighTech Campus 

Munich-Grosshadern 

Munich, Germany 

Jahresfortbildung AG Uroradiologie 

der Deutschen Röntgengesellschaft e.V. 

Final Programme and Syllabus 

www.esur2008.org 

supported by:

Programme 

Edited by: 

Ulrike L. Müller-Lisse, MD 

Published by: 

European Society of Urogenital Radiology Deutsche Röntgengesellschaft


2 

Content 

Preface 3 

Acknowledgments 4 

ESUR 2008 Organisation 5 

ESUR 2008 Faculty 6 

Accreditation 7 

Social Programme 8 

General Information 9 

Maps of the Conference Area 13 

Programme Overview 14 

Detailed Programme 15 

Thursday, 11.09.2008 15 

Friday, 12.09.2008 16 

Saturday, 13.09.2008 23 

Sunday, 14.09.2008 24 

Poster Session 25 

Abstracts 29 

Members’ Day Sessions 30 

Scientific Session 37 

Workshops 55 

Course Lectures 68 

Posters 82


Dear colleagues and friends, 

Welcome to the 15th Symposium of the European Society of Urogenital Radiology, ESUR. 

Supported by the European Society of Radiology, ESR, the Society of Urogenital Radiology, SUR, the 

German Roentgen Society (DRG) AG, Uroradiologie of DRG, and the European Association of 

Urologists, EAU, ESUR 2008 meets in Munich, Germany. 

Scientific sessions, workshops, lectures, lunch symposia sponsored by industrial partners, the opening 

ceremony and the welcome reception, the industrial exhibition and the scientific poster exhibition 

take place from September 11th through 14 th, 2008, at the High Tech Campus of the University 

of Munich. The social programme and the accompanying persons’ programme will take you to 

interesting sites throughout the world-renowned city of Munich. 

Urogenital radiology is rapidly advancing, with new imaging and contrast technologies on the one 

hand and increasing demand for imaging and intervention services by urologists, gynaecologists, and 

radiation oncologists on the other. 

The main topics of ESUR 2008, prostate cancer, lower urinary tract, and pelvic floor, and other 

important topics, including gynaecologic imaging, upper urinary tract, urogenital trauma, and new 

developments in contrast media, are covered by internationally acclaimed specialists in interdisciplinary 

lecture sessions. The lunch symposia focus on cross-sectional imaging in urogenital radiology 

and important safety issues in the application of contrast media, including contrast-induced 

nephropathy and nephrogenic systemic fibrosis. 

We welcome physicians with a specialty or a keen interest in radiology, nuclear medicine, radiation 

oncology, gynaecology, and urology to share their knowledge and their visions with one another, to 

study together, to make new friends, and to renew old friendships across Europe, the Mediterranean 

and many other countries. 

We warmly welcome you at ESUR 2008 in Munich! 

On behalf of the local organizing committee of ESUR 2008, 

Ullrich G. Mueller-Lisse, M.D., M.B.A., 

Attending Radiologist, Associate Professor of Radiology 

University of Munich Hospitals, 

Ulrike L. Mueller-Lisse, M.D., 

Clinical Fellow in Urology 

University of Munich Hospitals 


3


4 

Acknowledgments 

ESUR 2008 gratefully acknowledges the support of the following sponsors 

Honorary Sponsor 

Prof. Maximilian Reiser, MD 

Dean-elect of the Faculty of Medicine, LMU Munich 

GE imagination at work 

Main Sponsors 

Sponsors 

Celon AG, Teltow, Germany 

Medrad Medizinische Systeme GMBH, Volkach, Germany 

Optimed Medizinische Instrumente GmbH, Ettlingen, Germany 

Terumo GmbH, Eschborn, Germany


ESUR 2008 Organisation 

ESUR Board 

S. Morcos (UK), President 

B. Hamm (D), President-Elect 

G. Heinz-Peer (A), Secretary/ Treasurer 

L. Derchi (I), Past President 

J. Jakobsen (N), Member-at-Large 

Programme Committee 

J. Barentsz (NL) 

R. Cohan (USA) 

K. Darge (USA) 

L. Derchi (I) 

T. El-Diasty (ET) 

F. Frauscher (A) 

B. Hamm (D) 

G. Heinz-Peer (A) 

K. Kinkel (CH) 

G. Malachias (GR) 

S. Morcos (UK) 

U. Mueller-Lisse (D) 

M. Riccabona (A) 

Scientific Secretariat 

Ullrich Mueller-Lisse 

Dept. of Clinical Radiology 

University of Munich Hospitals- Innenstadt 

Ziemssenstrasse 1 

80336 Munich, Germany 

Tel: +49 - (0)89 - 5160-9101 

Fax: +49 - (0)89 - 5160-9102 

info@esur2008.org 

Organizer 

Scientific Programme: 

European Society of Urogenital Radiology 

Industrial Exhibition and Sponsorship: 

EUROKONGRESS GmbH 

Local Committee 

E.M. Coppenrath 

C. Degenhart 

T. Meindl 

U.G. Mueller-Lisse 

U.L. Mueller-Lisse 

M.K. Scherr 

Organizing Secretariat 

EUROKONGRESS GmbH 

Congress + Event + Exhibition Management 

Schleissheimer Str. 2 

80333 München, Germany 

Tel. +49 (0)89/210 98 60 

Fax +49 (0)89/210 98 698 

info@eurokongress.de 

esur2008@eurokongress.de 

www.eurokongress.de 

5


Faculty 2008 

J. Barentsz (NL) 

D. Babnik-Peskar (SI) 

M.-F. Bellin (F) 

D. Beyersdorff (D) 

V. Berg-Løgager (DK) 

B. Brkljacic (HR) 

C. Chapple (UK) 


E. Coppenrath (D) 

F. Cornud (F) 

N. Cowan (UK) 

T.M. Cunha (P) 

N. Curry (USA) 

L. Dalla Palma (I) 


C. Degenhart (D) 

L. Derchi (I) 

A. Dimopoulou (S) 

V. Dogra (USA) 

T. El-Diasty (ET) 

R. Farouk El Sayed (ET) 

R. Figueiras (E) 

F. Frauscher (A) 

K. Friese (D) 

R. Forstner (A) 

J. Fuetterer (NL) 

S. Goldman (USA) 

N. Grenier (F) 

P. Hallscheidt (D) 

B. Hamm (D) 

S. Hanna (ET) 

G. Heinz-Peer (A) 

J. Jakobsen (N) 

A. Lienemann (D) 

L. Lobo (P) 

6 

J. Kemper (D) 

P. Kenney (USA) 

K. Kinkel (CH) 

A. Magnusson (S) 

G. Malachias (GR) 

T. Meindl (D) 

S. Morcos (UK) 

S. Moussa (UK) 

U.G. Mueller-Lisse (D) 

U.L. Mueller-Lisse (D) 

C. Nolte-Ernsting (D) 

R. Oyen (B) 

P. Pavlica (I) 

R. Pozzi-Mucelli (I) 

P. Ramchandani (USA) 

M. Reiser (D) 

M. Riccabona (A) 

J. Richenberg (UK) 

C. Roy (F) 

E. Rummeny (D) 

C. Sandler (USA) 

J. Scheidler (D) 

M. Scherr (D) 

H. Schlemmer (D) 

K. Schneider (D) 

J. Spencer (UK) 

C. Stief (D) 

H. Thoeny (CH) 

H. Thomson (DK) 

A. Tuncay Turgut (TR) 

A. Van der Molen (NL) 

N. Wasserman (USA) 

R. Zagoria (USA) 

N. Zantl (D)


Accreditation 

The 15th European Symposium on Urogenital Radiology is accredited by the European Accreditation 

Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical 

specialists. The EACCME is an institution of the European Union of Medical Specialists (UEMS). 

www.uems.be 

The 15th European Symposium on Urogenital Radiology is designed for a maximum of 18 hours of European 

external CME credits. Each medical specialist should only claim those hours of credit that he/ she 

actually spent in the educational activity. 

EACCME credits are recognized by the American Medical Association towards the Physician´s Recognition 

Award (PRA). To convert EACCME credits to AMA PRA category I credit, please contact AMA. 

The 15th European Symposium on Urogenital Radiology has been awarded 26 CME points by the Bavarian 

Chamber of Physicians (Bayerische Landesärztekammer). 

Distribution of CME Credits for ESUR 2008 is as follows: 

September 11, 2008: 6 Credits 




You may earn a total of 26 category "A" credits if you attend ESUR 2008 on all 4 days. 

The CME credit certificate will be handed out with your congress documents. 

7


Accompanying Persons’ Programme 

The fee for accompanying persons includes a guided walking tour in the Munich city centre, 

the Welcome Reception and a 3-day-ticket for the public transport (inner circle Munich). 

The guided walking tour will take place on Friday, September 12, 2008, from 16:00h to 18:00h. 

The language of the tour is English. 

Please meet the guide directly in the city centre at the “Fish Fountain” located on the famous 

“Marienplatz”. The walking tour includes the most famous sights of Munich: the city center Marienplatz, 

Munich´s oldest church St. Peter and the cathedral, the Opera House and the home of the Bavarian 

Rulers – the Residenz. You will have a look at the most elegant avenue Maximilianstreet, at the 

Hofbräuhaus and the most popular foodmarket “Viktualienmarkt”. 

Evening Programme 

Members´ Dinner 

On Thursday, September 11, 2008 the traditional ESUR-Members´ Dinner will be held at “Der Pschorr”. 

The restaurant is located in the historical city center at the famous “Viktualienmarkt”. 

The entrance tickets will be handed out on site at the conference venue (if registered). 

On site registrations are subject to availability. 

Welcome Reception 

All participants are warmly invited to join the Welcome Reception at the conference 

venue on Friday, September 12, 2008 at 20:00h. The entrance is free of charge for all registered 

participants. 

Course Dinner 

On Saturday, September 13, 2008 the Course Dinner, a “Bavarian Evening”, will be held at the 

“Augustinerkeller”. The “Augustinerkeller” is one of the most popular beer gardens in Munich and offers 

typical Bavarian specialties. The entrance tickets will be handed out on site at the conference venue 

(if registered). On site registrations are subject to availability. 

Please contact the conference office by Friday, September 13, 2008, 13:00 at the latest. 

8 

Social programme


General Information 

Abbreviations 

MS Members´ Session 

LS Lecture Session 

WS Workshop 

ScS Scientific Session 

P Poster Session 

YR Young Radiologists´ Forum 

Badges 

It is mandatory for all participants to wear their 

badges visibly throughout the meeting as it is the 

entrance ticket to all sessions. In the event of 

badge loss, please contact the registration desk. 

Banks 

There are several banks near the conference 

venue at both sides of the subway station 

“Großhadern”. 

Cancellation/ No-show 

A refund on the registration fees less an administrative 

fee of 40,00 € has been made when a 

written cancellation was received by 

August 11, 2008 . 

Thereafter no refunds can be made. 

Cash Bar 

Outside the official coffee breaks beverages, 

snacks and food can be purchased at a Snack 

Bar on the ground floor. 

Certificate of Attendance 

A certificate of attendance including a CME 

credit certificate as well as an UEMS certificate 

will be handed out with your congress 

documents. 

Coffee Breaks 

Coffee, beverages and food will be available 

for registered participants during the designed 

coffee break times on the ground floor. 

Conference Language 

Conference language is English. 

Conference Venue 

University of Munich 

High Tech Campus Munich-Grosshadern 

Institutes of Chemistry and Pharmacy 

Butenandtstr. 5-13 

81377 Munich, Germany 

Conference hours 

Thursday, September 11 

(Members’ Day) 

14:00 - 19:00 

Friday, September 12 08:30 - 20:00 

Saturday, September 13 09:00 - 18:00 

Sunday, September 14 09:00 - 13:30 

Conference Office/ Registration 

Registration is possible at the Registration Desk in 

the foyer. 

On site registrations and day tickets are subject 

to availability. 

Opening hours: 

Thursday, September 11 10:00 - 19:00 




9


Registration fee 

ESUR / SUR Member 390,00 € 

Non-Member 440,00 € 

Residents and Technologists 290,00 € 

Accompanying Persons 135,00 € 

Members’ Dinner 60,00 € 

Course Dinner 70,00 € 

The conference fees include the participation in 

the scientific sessions, coffee breaks, lunches, the 

Welcome Reception as well as a 3-day-ticket for 

public transportation (inner circle Munich). 

Hotel Reservation 

Eurokongress has reserved special room 

allotments close to the conference and in the 

city center. For detailed information, booking 

and/or changes, please contact Eurokongress at 

the conference office on site. A city map of the 

respective hotels is included in this programme 

(see page 12 ). 

Industrial Exhibition 

The industrial exhibition is located in the foyer in 

front of lecture hall “Buchner”. Please refer to the 

floor plan. The exhibition is open during conference 

hours. 

Lecture Halls 

The lecture halls are named as follows: 

Lecture hall Buchner Ground Floor 

Lecture hall Baeyer Lower Level 

Lecture hall Willstätter Lower Level 

Lecture hall Wieland Lower Level 

Lecture hall Butenandt Lower Level 

10 

Liability 

The organizer cannot be held responsible for any 

personal injury, accident, damage to private 

property or additional expenses incurred to a 

result of changes of dates, venue, programme 

or else. 

Lunches 

Lunches on Friday, September 12 and Saturday, 

September 13 are included in the registration 

fee. Lunch packages will be handed out at the 

Lunch Symposia. Please follow the announcement 

and signs. 

Photographing/ Recording 

It is strongly prohibited to take pictures, record 

or tape any presentations or sessions without 

official permission of the organizers. 

Poster Exhibition 

Scientific posters are exhibited in the poster area 

on the lower level of the conference venue in 

front of the lecture halls. 

The Poster exhibition is open from Thursday, 

September 11, 2008, 12:00 until Sunday, September 

14, 2008, 12:30. All poster presenters are 

kindly asked to be available at their respective 

poster during “Best of ESUR” to allow poster 

discussion. 

Poster Prizes 

The three best scientific exhibits will be awarded 

a diploma during the opening ceremony. 

Evaluation of the posters will be based on novelty, 

accuracy, educational value and design.


Preview Centre 

The preview center is located on the lower level in 

front of lecture hall “Butenandt”. 

Opening hours: 

Thursday, September 11 11:00 - 17:00 




All lectures, workshops, and scientific papers have 

to be submitted to the presentation center at 

least 2 hours prior to the beginning of the respective 

session. It will not be possible to use your own 

laptop computer. Please adhere strictly to restrictions 

on Powerpoint software (no younger than 

Powerpoint 2003 for Windows) and Windows operating 

systems (no younger than Windows 2000 

or XP). For example, it will not be possible to make 

a presentation based on Windows Vista or on 

Powerpoint 2007 for Windows. Please note that 

if you have prepared your presentation on a 

Macintosh computer, you should convert it such 

as to match with Windows programmes as mentioned 

above. 

There will be no chance of presenting conventional 

slides or overhead sheets or other lecture 

modalities. 

Please refrain from bringing your own personal 

computer for your presentation, since it may not 

be compatible with the equipment on site. 

The preferred data storage device to carry your 

scientific presentation, lecture or workshop would 

be a memory stick or similar device which is USB-2compatible; 

however, if you prefer, you may bring 

a CD ROM. 

Public Transportation 

All registered participants receive a 3-day-ticket 

for public transportation at the conference 

office on site. 

To get to the conference venue we recommend 

using underground line U6, direction to ‘Klinikum 

Grosshadern’ and get off at the stop ‘Grosshadern’. 

The underground line U6 takes you also to 

the city centre and Marienplatz. For detailed 

information about public transportation please 

have a look at the brochure handed out at the 

conference office on site. Participants arriving by 

car have the possibility to park close to the congress 

venue. 

Wardrobe 

The wardrobe for jackets and bags can be found 

on the lower level of the conference venue 

(please follow the signs). Please note that the 

organizers cannot provide security staff or other 

means to attend property left at the wardrobe 

and cannot be held responsible for damage or 

loss of property left at the wardrobe. 

Young Radiologists´ Forum 

Young radiologists are defined as radiologists in 

training, or recently accredited radiologists not 

older than 35 years. To encourage and promote 

research, the three best abstracts submitted by 

young radiologists as first authors will be 

honoured and awarded. 

11

City Map Munich 

List of Hotels 

1 Eden Hotel Wolff, Arnulfstr. 4, 80335 Munich 

2 Anna Hotel, Schützenstr. 1, 80335 Munich 

3 Hotel Exquisit, Pettenkoferstr. 3, 80336 Munich 

4 Hotel Carmen, Hansastr. 146-148, 81373 Munich 

5 Hotel Neumayr, Heiglhofstr. 18, 81377 Munich 

6 Hotel Thalmair, Heiglhofstr. 3, 81377 Munich 

7 Hotel am Klinikum, Würmtalstr. 99, 81375 Munich 

12 

Conference Venue 

A University of Munich 

HighTech Campus Munich-Grosshadern 

Butenandtstr. 5-13, 81377 Munich 

Evening Programme 

B Augustinerkeller, Arnulfstr. 52, 80335 Munich 

C Der Pschorr, Viktualienmarkt 15, 80331 Munich

Lecture Halls on the lower level 

Poster Exhibition Industrial Exhibition 

Lecture Halls on the ground level 

13


14 

ESUR 2008 Programme Overview 

8:00 

8:30 

9:00 

9:30 

10:00 

10:30 

11:00 

11:30 

12:00 

12:30 

13:00 

13:30 

14:00 

14:30 

15:00 

15:30 

16:00 

16:30 

17:00 

17:30 

18:00 

18:30 

19:00 

19:30 

20:00 

20:30 

21:00 

Registration & Poster Exhibition 

Thursday, September 11 th Friday, September 12 th 

Members' Day 

Session I 

Coffee Break 

Members' Day 

Session II 

General Assembly 


Scientific Sessions I-IV 

Coffee Break 

Workshops I-IV 

Best of ESUR 2008* 

Lunch / 

Lunch Symposia 

Bayer Schering Pharma 

Guerbert 

Workshops I-V 

repetitions 

Coffee Break 

Opening Ceremony 

Lecture Session I: 

Prostate Cancer 

SUR Honorary Lecture 

Members' Dinner Welcome Reception 


Saturday, September 13 th Sunday, September 14 th 

Lecture Session II: 

Upper Urinary Tract 

Course Dinner 

Poster Exhibition 

Coffee Break Coffee Break 

Lecture Session III: 

Lower Urinary Tract 


Lunch / 

Lunch Symposium 

GE HealthCare 

Lecture Session IV: 

Pelvic Trauma 

Coffee Break 

Lecture Session V: 

Contrast Media and 

Beyond 

ESUR Subcommittee 

meetings 

Lecture Session VI: 

Female Pelvic Cancers 

+ Guidelines For 

Imaging 

Lecture Session VII: 

Pelvic Floor 


Closing Ceremony 

Programme subject to change *Best of ESUR 2008 includes on site Discussion of Posters 

8:00 

8:30 

9:00 

9:30 

10:00 

10:30 

11:00 

11:30 

12:00 

12:30 

13:00 

13:30 

14:00 

14:30 

15:00 

15:30 

16:00 

16:30 

17:00 

17:30 

18:00 

18:30 

19:00 

19:30 

20:00 

20:30 

21:00

Scientific Programme 

Thursday, September 11, 2008 

10:00 – 18:00 Registration 

12:00 – 18:00 Poster Exhibition 

Lecture Hall: Buchner 

ESUR Members Day 

14:00 – 15:30 Members’ Day Session I 

Moderators: L. Derchi (I), J. Jakobsen (N) 

Abstracts M1-M9 

14:00 – 14:10 M1 Trends in urogenital radiology research: a survey of publications from ESUR Members 

L. Derchi (Genova, Italy) 

14:10 – 14:20 M2 Pregnancy after uterine artery embolization for symptomatic fibroids: a series of 15 

pregnancies among 119 patients 

K. Firouznia, H. Ghanaati, R. Bohloul, A. Jalali, M. Shakiba (Teheran, Iran) 

14:20 – 14:30 M3 Usefulness of Contrast-Enhanced Sonography (CEUS) to characterize solid renal masses 

(angiomyolipoma excluded) 

C. Roy, B. Sauer, L. Gengler, H. Lang (Strasbourg, France) 

14:30 – 14:40 M4 Furosemide CT urography: is a routine CT KUB necessary? 

J.Y. Keanie, D. Alcorn, S.A. Moussa (Edinburgh, United Kingdom) 

14:40 – 14:50 M5 Compex renal stones - the benefit of an extended preoperative planning with 3D CT 

A. Magnusson, M. Brehmer, M. Beckman (Uppsala, Sweden) 

14:50 – 15:00 M6 US, IVU and CT findings in patients with renal small calyx stones and papillary calcification 

V.M. Builov, Y.N. Patrunov, Y.B. Smolyakov (Yaroslavl, Russia) withdrawn 

15:00 – 15:10 M7 Contrast-induced nephropathy following the intravenous injection of iso-osmolar and lowosmolar 

contrast media: a pooled analysis 

H.S. Thomsen, S.K. Morcos, C.M. Erley, L. Romano, D. Sahani (Herlev, Denmark) 

15:10 – 15:20 M8 Functional semi-automated segmentation of renal DCE-MRI sequences: preliminary results 

M. Claudon, D. Mandry, B. Chevaillier, C. Pasquier, J.L. Collette, O. Pietquin (Nancy, France) 

15:20 – 15:30 M9 Renal lesions associated with autoimmune pancreatitis 

C. Triantopoulou, G. Malachias, P. Maniatis, J. Anastopoulos, I. Siafas, J. Papailiou 

(Athens, Greece) 

15:30 – 16:00 Coffee break 

16:00 – 17:30 Members’ Day Session II 

Moderators: A. Magnusson (S), G. Malachias (GR) 

Abstracts: M10-M18 


16:00 – 16:10 M10 The endocrine and hematologic meaning of adrenal myelipoma: a new evidence requiring 

a different attention 

F.M. Danza, E. Sacco, G. Regine, G.M. Latagliata, L. Bonomo (Rome, Italy) 

16:10 – 16:20 M11 Dedicated testicular MRI (dtMRI) in adults with congenital adreno-genital syndrome 

(AGS) and testicular adrenal rest tumors (TARTs) 

M.K. Scherr, N. Reisch, M. Bartenhauser, M. Reincke, M.F. Reiser, U.G. Müller-Lisse 

(Munich, Germany) 

15


16:20 – 16:30 M12 Localisation of non palpable prostate cancer by quantitative dynamic contrast-enhanced 

MRI at 1.5T: correlation with results of whole-mount radical prostatectomy specimens 

examination 

F. Cornud, F. Beuvon, F.Thévenin, A.Vieillefond, T.Flam (Paris, France) 

16:30 – 16:40 M13 Prostate cancer patients younger than 55 years 

P. Pavlica, M. De Matteis, L. Barozzi, M. Valentino (Bologna, Italy) 

16:40 – 16:50 M14 Comparison of real-time gray-scale TRUS and T2-weighted endorectal MR imaging at 3T in 

local staging of prostate cancer 

S.W.T.P. Hejmnk, T. Hambrock, C.A. Hulsbergen-v.d. Kaa, J.A. Witjes, J.O. Barentzs 

(Nijmegen, The Netherlands) 

16:50 – 17:00 M15 Value of Diffusion-weighted MR In staging of urinary bladder carcinoma 

M.E. Abou El-ghar, A.M. El-Assmy, H.F. Refaie, T.A. El-Diasty (Mansoura, Egypt) 

17:00 – 17:10 M16 Noninvasive Detection of Pelvic Lymph node Metastases in Patients with Bladder and 

Prostate Cancer by DW-MRI: Correlation with Histology as Gold Standard 

H.C. Thoeny, M. Triantafyllou, F. Birkhaeuser, T. Binser, A. Fleischmann, U.E. Studer, 

P. Vermathen (Bern, Switzerland) 

17:10 – 17:20 M17 Role of MDCT in evaluation of the urethral lesions 

S.A.Z. Hanna, S.F. Abd El-Rahman (Cairo, Egypt) 

17:20 – 17:30 M18 Intraluminal optical coherence tomography of the human upper urinary tract in vivo: initial 

experience 

U.L. Mueller-Lisse, M. Bader, Y. Hocaoglu, M. Pühls, C.G. Stief, M.F. Reiser, U.G. Mueller- 

Lisse (Munich, Germany) 

17:30 – 19:00 General Assembly 

20:00 Members’ Dinner at “Der Pschorr” at the Viktualienmarkt 

08:00 – 18:00 Registration/ Poster Exhibition 

Lecture Hall: Baeyer 

08:30 – 10:30 Scientific Session I: Young Radiologists’ Forum 

Moderators: B. Hamm (D), A. Dimopoulous (S) 

Abstracts YR1-YR12 

08:30 – 08:40 YR1 3 Tesla MR Guided Biopsy to Detect Prostate Cancer Recurrence following Radiotherapy 

T. Hambrock, D. Yakar, J. Fütterer, H. Huisman, E. van Lin, J.O. Barentsz (Nijmegen, The 

Netherlands) 

08:40 – 08:50 YR2 Transgluteal CT-guided prostate needle biopsies in men without a rectum: a retrospective 

review of 70 cases 

W.G. Alleman, T.J. Welch, B.F. King, J.R. Karnes (Rochester, MN, U.S.A.) 

08:50 – 09:00 YR3 MR Imaging of prostate cancer: Diffusion Weighted Imaging and MR Spectroscopy in 

Comparison with Histology 

J. Yamamura, G. Salomon, J. Graessner, G. Adam, U. Wedegaertner (Hamburg, Germany) 

09:00 – 09:10 YR4 Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Detection of Local 

Recurrence after Radical Prostatectomy and Radiation Therapy for Prostate Cancer 

D. Yakar, T. Hambrock, E. Van Lin, J.A. Witjes, J.O. Barentsz, J.J. Futterer (Nijmegen, The 

Netherlands) 

09:10 – 09:20 YR5 Dynamic contrast-enhanced MR imaging in evaluating Placental Perfusion 

G. Masselli, E. Casciani, E. Polettini, G. Gualdi (Rome, Italy) 

16 

Friday, September 12, 2008

09:20 – 09:30 YR6 Accuracy of Preoperative MRI in Staging Primary Cervical Cancer - 3 year experience 

S. Rajaram, A. Chopra, S. Abdi (Sheffield, United Kingdom) 

09:30 – 09:40 YR7 Diffusion-Weighted MR imaging in endometrial cancer 

M. Vrang, H. H. Johannesen, V. Løgager, J.M. Møller, Berit J Mosgaard (Herlev, Denmark) 

09:40 – 09:50 YR8 1H-Magnetic Resonance Spectral Analisys in Different Adnexal Lesions 

A. Iotti, Federica Fiocchi, G. Ligabue, I. Di Monte, V.M. Iasonni, Pietro Torricelli (Modena, Italy) 

09:50 – 10:00 YR9 Dynamic Magnetic Resonance Imaging for Grading Pelvic Organ Prolapse using Three 

Reference Lines: Intra- and Interobserver Variability 

J.J. Fütterer, Suzan Broekhuis, Mark Vierhout, Jelle O. Barentsz (Nijmegen, The Netherlands) 

10:00 – 10:10 YR10 Small renal masses: assessment of dynamic contrast enhanced MRI 

M.M.H. Abd Ellah, L. Pallwein, C. Kremser, R. Peschl, G. Bartsch, M. Gregor, W. Jaschke, 

F. Frauscher (Innsbruck, Austria) 

10:10 – 10:20 YR11 Evaluation of renal transplant vascularization with contrast-enhanced ultrasonography (CE-US) 

I. Mancarella, A. Grossi, N.Caproni, P. D’Alimonte, G. Cappelli, P. Torricelli (Modena, Italy) 

10:20 – 10:30 YR12 Excretory MR-urography at 1.5 and 3 Tesla: Comparison with MDCT-urography 

M. Regier, C. Nolte-Ernsting, G. Adam, J. Kemper (Hamburg, Germany) 

Lecture Hall: Willstätter 

08:30 – 10:30 Scientific Session II: Members and Young Radiologists 

Moderators: P. Pavlica (I), L. Dalla Palma (I) 

Abstracts YR13-YR16 und M19-M26 

08:30 – 08:40 YR13 MR imaging in the evaluation of pregnant patients with acute pelvic pain 


08:40 – 08:50 YR14 Intraindividual Comparison of Image Quality in MR-Urography at 1.5 and 3 Tesla 

using an Animal Model 


08:50 – 09:00 M19 Assessment of acute unilateral ureteral obstruction by functional MRI 

H.C. Thoeny, T. Binser, T.M. Kessler, U.E. Studer, P. Vermathen 

(Bern, Switzerland) 

09:00 – 09:10 YR15 Experimental study – bladder phantom and mixture of Iohexol 

P. Dahlman, J. Tilly (Uppsala, Sweden) 

09:10 – 09:20 M20 Diffusion-weighted MR imaging in patients with gross hematuria 

M.E.Abou El-Ghar, A.M.El-Assmy, H.F.Refaie, T.A.El-Diasty (Mansoura, Egypt) 

09:20 – 09:30 M21 Primary vesicoureteral reflux associated with mild antenatal hydronephrosis-Usefulness 

of voiding urosonography in the diagnosis 

F. Papadopoulou, E. Siomou, A. Charisiadi, V. Giapros, G. Makridimas, S. Andronikou, 

C. Tsamboulas (Ionnanina, Greece) 

09:30 – 09:40 M22 Contrast enhanced Ultrasonography in the evaluation of renal trauma 

P. Pavlica, M. Valentino, L. Barozzi (Bologna, Italy) 

09:40 – 09:50 M23 A cohort study demonstrating improved survival in patients with relapsed FIGO stage 

IIIC ovarian cancer with CT pattern of ‘lymph node only’ disease compared to those 

with additional peritoneal disease 

N. Tahir, C. Haigh, G. Hall, J.A. Spencer (Leeds, United Kingdom) 

09:50 – 10:00 M24 Size, location & number of fibroids are not associated with success rate & 

complications in uterine artery embolization 

K. Firouznia, H. Ghanaati, R. Bohloul, A.H. Jalali, M. Shakiba (Teheran, Iran) 


10:00 – 10:10 M25 Radiologic and Ultrasonographic aspects of Cowper’glands and ducts pathology 

P. Pavlica, M. De Matteis , L. Barozzi, M. Valentino (Bologna, Italy) 

10:10 – 10:20 M26 Prediction of subsequent biopsy results after negative prostate biopsy: comparison of 

DRE, PSA, and MRI and MR spectroscopy of the prostate 

U.G. Mueller-Lisse, M.K. Scherr, M. Seitz, C.G. Stief, M.F. Reiser (Munich, Germany) 

17


10:20 – 10:30 YR16 Value of 3 Tesla Multi-modality directed MR Guided Biopsy to Detect Prostate Cancer in 

high-risk patients after at least two previous negative biopsies 

T. Hambrock, R. Somford, J.J. Fütterer, H.J. Huisman, J.P. van Basten, I. van Oort, 

F.J.A. Witjes, J.O. Barentsz (Nijmegen, The Netherlands) 

Lecture Hall: Wieland 

08:30 – 10:30 Scientific Session III: Genital tract 

Moderators: R. Figueiras (E), V. Dogra (USA) 

Abstracts ScS1-ScS12 

08:30 – 08:40 ScS1 Preliminary experience of cadence contrast-pulse sequence ultrasound technique in 

prostate cancer diagnosis 

J. Gradl, E. Pallwein, L. Pallwein, V. Spiss, F. Aigner, W. Jaschke, G. Bartsch, 


08:40 – 08:50 ScS2 Quantitative Perfusion Analysis Using DCE-DSC-MRI: Differentiation of Normal Prostate 

from Low-grade and High-grade Prostate Cancer 

T. Franiel, L. Lüdemann, B. Rudolph, H. Rehbein, A. Staack, M. Taupitz, B. Hamm, 

D. Beyersdorff (Berlin, Germany) 

08:50 – 09:00 ScS3 US guided transrectal prostate biopsy: how many samples? 

M. Valentino, M. De Matteis, L. Barozzi, P. Pavlica (Bologna, Italy) 

09:00 – 09:10 ScS4 Is real-time elastography targeted biopsy able to enhance prostate cancer detection? 

An analysis of detection rate using an elasticity-scoring system 

E. Pallwein, F. Aigner, L. Pallwein, V. Spiss, W. Horninger, W. Jaschke, G. Bartsch, 


09:10 – 09:20 ScS5 Prostate cancer (PCa) detection in patients with a total PSA (tPSA) < 10 ng/ml: 

targeted biopsy with a sonographic triple approach and a reduced number of cores 

versus systematic 10 core biopsy 

F. Aigner, E. Pallwein, L. Pallwein, V. Spiss, W. Horninger, W. Jaschke, G. Bartsch, 


09:20 – 09:30 ScS6 Can T2w endorectal MRI play a role in MRI guided prostate interventions? – A 

histopathologic correlation with whole-mount sections in 70 patients with prostate cancer 

M.P. Lichy, L. Jurgschat, U. Vogel, D. Schilling, A. Anastasiadis, C.D. Claussen, H.-P. 

Schlemmer (Tuebingen, Germany) 

09:30 – 09:40 ScS7 Detection of prostate cancer recurrence with 11C-Acetate PET-CT in patients with early 

biochemical failure after prostatectomy 

A. Bergman, I. Verbiene, D. Kudrén, I. Turesson, J. Sörenssen (Uppsala, Sweden) 

09:40 – 09:50 ScS8 Percutaneous Intensity-modulated Irradiation of Prostate Cancer: Monitoring Radiation-induced 

Tissue Changes Using DCE-DSC-MRI 

T. Franiel, L. Lüdemann, B. Rudolph, C. Stephan, M. Taupitz, D. Böhmer, B. Hamm, 

D. Beyersdorff (Berlin, Germany) 

09:50 – 10:00 ScS9 Prostate MRI: Tissue Characterization Using Volume and Perfusion Parameters and 

Correlation with the Histologic Prognostic Factor Mean Vessel Density 

T. Franiel, L. Lüdemann, M. Taupitz, C. Stephan, B. Hamm, D. Beyersdorff 

(Berlin, Germany) 

10:00 – 10:10 ScS10 Testicular Masses: Value of Sono Elastography for Differentation of Neoplastic and 

non-Neoplastic Disease – a Preliminary Study 

R. Faschingbauer, L. Pallwein, F. Aigner, G. Bartsch, H. Steiner, F. Frauscher 

(Innsbruck, Austria) 

10:10 – 10:20 ScS11 Testicular ultrasound: Are we helping? 

S.B. Nair, N. Venkatanarasimha, J. Isaacs (Plymouth, United Kingdom) 

10:20 – 10:30 ScS12 Pre-treatment tumor necrosis evaluated by magnetic resonance dynamic contrastenhanced 

subtraction imaging as a predictor of chemoradiotherapy response in 

advanced cervical cancer 

L. Mannelli, E. Sala, A. Priest, D. Lomas (Cambridge, United Kingdom) 

18


08:30 – 10:30 Scientific Session IV: Urinary tract 

Moderators: D. Babnik-Peskar (SI), R. Pozzi-Mucelli (I) 

Abstracts SCS13-SCS24 

08:30 – 08:40 ScS13 Imaging and Doppler finding in dual kidney transplantation (DKT) from “marginal” 

donors ( MD) 

M.B. Damasio, D. Rolla, G. Cittadini, M. Gherzi, G. Cannella, L.E. Derchi (Genova, Italy) 

08:40 – 08:50 ScS14 Preoperative assessment of potential live kidney donors from IV-DSA to 64 

multidetector CT: Single center experience 

H.F.Refaie, M.E. Abou El-Ghar, T.A. El-Diasty, A.F.Refaie, A.A. Shokeir, M.A.Ghoneim 

(Mansoura, Egypt) 

08:50 – 09:00 ScS15 Evaluation of Randall’s plaque theory with CT attenuation value an observational study 

N. Bhuskute, W.W. Yap, T.M. Wah (Leeds, United Kingdom) 

09:00 – 09:10 ScS16 Quantative Enhancement Washout Analysis of Solid Malignant and Benign Cortical 

Renal Masses Using MDCT 

H.M. Shebl, T.A. El-Diasty, K.Z. Sheir, H.M. Abou El Atta, A. Mosbah, A.A. Shaaban 

(Mansoura, Egypt) 

09:10 – 09:20 ScS17 Differentiation of renal carcinoma subtypes by multislice computed tomography 

M. El-Saied El-Azab, T. Abd El-Moniem El-Diasty, K.Z. Sheir, 

A.A. Shabaan (Mansoura, Egypt) 

09:20 – 09:30 ScS18 Efficacy of post-CT KUB in patients with traumatic and non-traumatic genitourinary Disease 

S. Namkung, J.Y. Lee, J.Y. Jang, I.K. Hwang, M.S. Hong, H.C. Kim (Chuncheon, South Korea) 

09:30 – 09:40 ScS19 Excretory Urography: Trends in Clinical Usage Since CT Urography 

W.M. Pabon-Ramos, E.M. Caoili, R.H. Cohan, T. Stephens, I.R. Francis, J.H. Ellis, 

M. Korobkin, M. Schipper (Ann Arbor, MI, USA) 

09:40 – 09:50 ScS20 Multi-Detector row CT urography using a 16-row CT scanner, in the evaluation of 

patients presenting with hematuria 

K.G. Chlapoutakis, S.D. Yarmenitis, G. Hatzakis, F. Sofras, N.C. Gourtsoyiannis 

(Heraklion, Greece) 

09:50 – 10:00 ScS21 Incidence of contrast induced nefropathy (CIN) in a general CT population: A 

retrospective cohort study. 

H.J. Kingma, R.W.F. Geenen, P. Algra, T. van der Ploeg, I.M.M. van Haelst (Alkmaar, 

The Netherlands) 

10:00 – 10:10 ScS22 Delineation of intra-renal arteries with ultra high resolution flat panel based volume CT 

– outer limits of spatial resolution 

M. Neukamm, M. Palmowski, S. Schawo, S. Bartling, U. Rietdorf, J. Kuntz, H.U.Kauczor, 

P. Hallscheidt (Heidelberg, Germany) 

10:10 – 10:20 ScS23 The Broad Spectrum Images of Bladder Rupture 

H.J. Jeon, S.Il Jung, Y.J. Kim, S.W Park, H.J. Shin, Y.C. Choi, K. Kim (Seoul, South Korea) 

10:20 – 10:30 ScS24 CT Urography after Bladder Reconstruction 

O. Portnoy, S. Apter, J. Ramon (Tel-Aviv, Israel) 



11:00 – 12:30 Workshop I: Prostate cancer: a case-based approach 

Moderator: J. Richenberg (UK) 

11:00 – 11:30 Ultrasonography and ultrasound-guided biopsy of the prostate 

N. Wasserman (USA) 

11:30 – 12:00 MRI and MRS of the prostate 

U.G. Mueller-Lisse (Germany) 


19


12:00 – 12:30 Local Recurrence and metastases in prostate cancer 

H. Schlemmer (Germany) 


11:00 – 12:30 Workshop II: Pelvic Floor and gynaecologic tumors: a case-based approach 

Moderator: V. Berg-Løgager (DK) 

11:00 – 11:30 Pelvic floor disorders 

R. Farouk El-Sayed (Egypt) 

11:30 – 12:00 Uterine corpus and cervical tumors 

T.M. Cunha (Portugal) 

12:00 – 12:30 Ovarian lesion characterization 

K. Kinkel (Switzerland) 


11:00 – 12:30 Workshop III: Imaging the urinary tract: limits to radiation exposure 

Moderator: J. Kemper (D) 

11:00 – 11:30 CTU and IVU Radiation Dose 

A v.d. Molen (The Netherlands) 

11:30 – 12:00 CT urography: clinical indications and protocols 

E. Coppenrath (Germany) 

12:00 – 12:30 Examinations of the urinary tract in children: highlights from the EU study 

K. Schneider (Germany) 


11:00 – 12:30 Workshop IV: Renal and adrenal imaging: a case-based approach 

Moderator: H. Thoeny (CH) 

11:00 – 11:30 Adrenal imaging 


11:30 – 12:00 Renal imaging 

P. Hallscheidt (Germany) 

12:00 – 12:30 Minimal-invasive treatment 


13:00 – 14:30 Lunch break 

Lunch Symposia organized by Bayer Schering Pharma and by Guerbet 


13:00 – 14:30 BAYER SCHERING PHARMA 

Moderator: P. Hallscheidt (D) 

„Modern Urological Imaging and Patient Safety” 

Safety Issues of Contrast Media: CIN and NSF 

P. Persson (Germany) 

MRI and CT in Urogenital imaging 


20


13:00 – 14:30 GUERBET 

Moderator: C. Loewe (A) 

“How to optimize the use of iodinated contrast Agents” 

Introduction and objectives 

C. Loewe (Austria) 

Abdominal vascular imaging in MSCT - Xenetix 350 concentration: the good choice 


Dynamic CT imaging in the anti-angiogenic answer in kidney tumors 

C. A. Cuenod (France) 

C.I.N. (Contrast-Induced Nephropathy): what’s new 

L. Juillard (France) 

Questions and conclusion 



14:30 – 16:00 Workshop I repetition: Prostate cancer: a case-based approach 

Moderator: N.N. 

14:30 – 15:00 Ultrasonography and ultrasound-guided biopsy of the prostate 

A. Tuncay Turgut (Turkey) 

15:00 – 15:30 MRI and MRS of the prostate 

J. Scheidler (Germany) 

15:30 – 16:00 Local Recurrence and metastases in prostate cancer 

M. Scherr (Germany) 


14:30 – 16:00 Workshop II repetition: Pelvic Floor and gynaecologic tumors: a case-based approach 

Moderator: A. Lienemann (D) 

14:30 – 15:00 Pelvic floor disorders: perineal ultrasound 

C. Roy (France) 

15:00 – 15:30 Staging of cervical cancer 

B. Hamm (Germany) 

15:30 – 16:00 Ovarian tumors 

R. Forstner (Austria) 


14:30 – 16:00 Workshop III repetition: Imaging the urinary tract 

Moderator: S. Moussa (UK) 

14:30 – 15:00 Images of the urinary tract: a case-based approach to endoscopy and CT urography 

N. Cowan (United Kingdom) 

15:00 – 15:30 Images of the urinary tract: a case-based approach to conventional urography 

T. Meindl (Germany) 

15:30 – 16:00 Images of the urinary tract: a case-based approach to CT urography 

C. Degenhart (Germany) 


21



14:30 – 16:00 Workshop IV repetition: Renal and adrenal imaging: a case-based approach 

Moderator: F.M. Danza (T) 

14:30 – 15:00 Adrenal imaging 

G. Heinz-Peer (Austria) 

15:00 – 15:30 Renal mass characterization by CT 


15:30 – 16:00 Renal interventions 

B. Brkljacic (Croatia) 

Lecture Hall: Butenandt 

14:30 – 16:00 Workshop V: Science to practice: new methods in urogenital imaging 

Moderator: E. Rummeny (D) 

14:30 – 15:00 Genitourinary MRI at 3T: science to practice 

J. Fuetterer (The Netherlands) 

15:00 – 15:30 USPIOs for lymphadenopathy: science to practice 

S. Takahashi (Japan) 

15:30 – 16:00 Optical coherence tomography of the urinary tract: science to practice 

U.L. Mueller-Lisse (Germany) 



16:30 – 17:30 Opening Ceremony 

Moderator: U.G. Mueller-Lisse (D) 

Introduction 


Greetings from the president of ESUR 

S. Morcos (United Kingdom) 

Greetings from the Dean-elect of the Faculty of Medicine, LMU Munich 

M.F. Reiser (Germany) 

“Lending wings to a radiologist” 

T. El-Diasty (Egypt) 

Award-winning Presentations 

tba 


17:30 – 19:00 Lecture Session I: Prostate cancer 

Moderators: R. Oyen (B), F. Cornud (F) 

17:30 – 18:00 Imaging of prostate cancer: the urologist’s perspective 

C. Stief (Germany) 

18:00 – 18:30 Prostate cancer: ultrasonography 

F. Frauscher (Austria) 

18:30 – 19:00 MRI in Prostate cancer 

J. Barentsz (The Netherlands) 


19:00 – 19:45 SUR Honorary Lecture 

Moderators: S. Morcos (UK), U.G. Mueller-Lisse (D) 

19:00 – 20:00 Bladder cancer and Bladder cancer Imaging 


20:00 – 22:00 Welcome Reception at the Conference Venue kindly supported by 

22

Saturday, September 13, 2008 

08:00 – 18:00 Registration/ Poster Exhibition 


09:00 – 10:30 Lecture Session II: Upper Urinary Tract 

Moderators: N. Cowan (UK), A. v.d. Molen (NL) 

09:00 – 09:30 Imaging of the upper urinary tract: the urologist’s perspective 

N. Zantl (Germany) 

09:30 – 10:00 Imaging of the upper urinary tract: current status in adults 

C. Nolte-Ernsting (Germany) 

10:00 – 10:30 Imaging of the upper urinary tract: current status in children 



11:00 – 12:30 Lecture Session III: Lower Urinary Tract 

Moderators: P. Prassopoulos (GR), E. Coppenrath (D) 

11:00 – 11:30 Imaging of the lower urinary tract: the urologist’s perspective 

C. Chapple (United Kingdom) 

11:30 – 12:00 Imaging of the lower urinary tract: current status in adults 

D. Beyersdorff (Germany) 

12:00 – 12:30 Imaging of the lower urinary tract: current status in children 

M. Riccabona (Austria) 

13:00 – 14:30 Lunch break 

Lunch Symposium organized by GE Healthcare 


13:00 – 14:30 GE Healthcare 

Moderator: U.G. Mueller-Lisse (D) 

“Managing the risk of CIN and NSF in radiology practice: Interpreting the evidence” 

Chairman’s Welcome & Introduction 


How to interpret CIN trials and their impact on patient care 

M. Laville (France) 

NSF: Facts, theories, speculation, and implications for clinical practice 

D. Reddan (Ireland) 

14:30 – 16:00 Lecture Session IV: Pelvic and Urinary Trauma 

Moderators: S. Goldman (USA), S. Hanna (ET) 

14:30 – 15:00 Radiological managment in trauma of the upper urinary tract 


15:00 – 15:30 Imaging in trauma of the adult genital and lower urinary tract 


15:30 – 16:00 Imaging in trauma of the pediatric genital and lower urinary tract 

L. Lobo (Portugal) 


23



16:30 – 18:00 Lecture Session V: Contrast media and beyond 

Moderators: M. Reiser (D), S. Morcos (UK) 

16:30 – 17:00 ESUR 2008 update on contrast media safety 

H. Thomsen (Denmark) 

17:00 – 17:30 ESUR 2008 update on molecular imaging and new contrast media 

N. Grenier (France) 

17:30 – 18:00 Use of Ultrasmall Superparamagnetic Iron Oxide in Lymph Node MR Imaging 


18:00 – 19:00 ESUR subcommittee meetings 

20:00 Course Dinner “Bavarian Evening” at the “Augustinerkeller” 

08:00 – 13:00 Poster Exhibition 


09:00 – 10:30 Lecture Session VI: Female pelvic cancers and guidelines for imaging 

Moderators: K. Kinkel (CH), K. Friese (D) 

09:00 – 09:10 Introduction 


09:10 – 09:30 ESUR 2008 update on Endometrial Cancer 


09:30 – 09:50 ESUR 2008 update on Cervical Cancer 


09:50 – 10:10 MR imaging of the US indeterminate adnexal mass: an algorithmic approach 

J. Spencer (United Kingdom) 

10:10 – 10:30 ESUR 2008 update on Ovarian Cancer Staging 



11:00 – 12:30 Lecture Session VII: Pelvic Floor and Functional Imaging 

Moderators: T. El-Diasty (ET), M.F. Bellin (F) 

11:00 – 11:30 Functional Imaging of the Urinary Tract in Children: morphology of the urinary bladder, 

bladder neck and the urethra 


11:30 – 12:00 Functional Anatomy of the Pelvic Floor 


12:00 – 12:30 Functional Imaging of the Pelvic Floor: MRI and its alternatives 

A. Lienemann (Germany) 

12:30 – 13:00 Best of ESUR 2008 

13:00 – 13:30 Closing Ceremony 

24 

Sunday, September 14, 2008

Poster Session 

P1-P17: Female Imaging 

P1 Magnetic Resonance Imaging versus Double Contrast Barium Enema for the assessment of rectal or colonic 

localization of endometriosis 

G. Restaino, M. Occhionero, M. Missere, E. Cucci, M. Ciuffreda, G. Sallustio (Campobasso, Italy) 

P2 MR Images of endometriosis: 8 years of experience 

L. Buñesch, M. C. Sebastià, S. Rafael, F. Carmona, C. Nicolau (Barcelona, Spain) 

P3 MR imaging of non-squamous cervical cancer: discriminant features 

R.E. Hyland, S.E. Swift, N. Wilkinson, J.A. Spencer (Leeds, United Kingdom) 

P4 Multidetector CT features of benign adnexal masses 

A.C. Tsili, A. Charisiadi, O. Papanikolaou, I. Ntova, Ev. Paraskevaidis, K. Tsampoulas (Ioannina. Greece) 

P5 Adnexal Masses In Women with Acute Abdomen: Differential Diagnosis and Diagnostic Pitfalls On CT 

Imaging 

Y. Lee, H.P. Hong, H.W. Park (Seoul, South Korea) 

P6 Problem solving MR imaging pathway: an algorithmic approach to the sonographically ‘indeterminate’ 

adnexal mass 

S. Ghattamaneni, N. Bhuskute, F. Lang, J.A. Spencer (Leeds, United Kingdom) 

P7 Fallopian tubal diseases: discriminant morphologic characteristics and manifestations on MR imaging 

S. Ghattamaneni, N. Bhuskute, J.A. Spencer (Leeds, United Kingdom) 

P8 CT Findings of Tuboovarian Abscess 

J. Kim (Daejeon, South Korea) 

P9 Management impact of CT in women undergoing neoadjuvant chemotherapy and interval debulking 

surgery for ovarian cancer 

N. Bhuskute, S. Ghattamaneni, J.A. Spencer (Leeds, United Kingdom) 

P10 Role of a Computed Tomography derived score (PIrad) for the prediction of optimal cytoreduction at 

primary surgery in patients with ovarian cancer 

E. Cucci, L. Aquilani, M. Missere, G. Restaino, M. Ciuffreda, G. Sallustio (Campobasso, Italy) 

P11 Ovarian metastasis in endometrial carcinoma: incidence and imaging findings with Computed Tomography 

and Magnetic Resonance in a referral center for Gynaecological Oncology. 

G. Restaino, M. Occhionero, S. Giambersio, E. Cucci, M. Guerriero, G. Sallustio (Campobasso, Italy) 

P12 Comparison of 18F-FDG PET/CT and CT or MRI for the preoperative staging of ovarian cancer 

J.Y. Byun, Y.J. Lee, G.W. Jung, S.N. Oh, S.E. Rha, I.R. Yoo, S.H. Kim, S.K. Chung (Seoul, South Korea) 

P13 Review of imaging in cases of pelvic actinomycosis masquerading as gynenocological malignancy 

N. Bhuskute, S. Ghattamaneni, S. Munot, S. Osborn, J.A. Spencer (Leeds, United Kingdom) 

P14 Radiological Findings of Gynecologic Conditions that Cause Chronic Pelvic Pain 

H. C.Henriques, M. Duarte, T.M. Cunha (Lisboa, Portugal) 

P15 Imagiological features of gynecologic pathology in women with acute pelvic pain 

M. Duarte, H. C.Henriques, T.M. Cunha (Lisboa, Portugal) 

P16 A Case Report of Angiomyofibroblastoma Arising from the Posterior Perivesical Space: MR Findings 

K.J. Lim, J.H. Moon, D.Y. Yoon, J.H. Cha (Seoul, South Korea) 

P17 Magnetic Resonance Imaging in the diagnosis of suspected placental invasion: correlation with color 

Doppler ultrasound 


P18-P24: Paediatric Imaging 

P18 What’s that retrovesical cystic structure? A rare sonographic finding in childhood 

M. Vakaki, E. Dagiakidi, C. Karanikas, N. Evlogias, C. Koumanidou (Athens, Greece) 


P19 Acute idiopathic scrotal edema in children: why should we be aware of its sonographic appearance? 

M. Vakaki, G. Pitsoulakis, R. Sfakiotaki, D. Berati, C. Koumanidou (Athens, Greece) 

25


P20 Testicular epidermoid cyst or teratoma? A state of the art review of sonographic findings 

M. Vakaki, G. Pitsoulakis, R. Sfakiotaki, D. Berati, C. Koumanidou (Athens, Greece) 

P21 Bilateral nephroblastoma - case report 

E. Łuczynska, J. Aniol, A. Stelmach (Cracow, Poland) 

P22 All types of congenital hydrocele, from testicular to abdomino-scrotal: embryology, state of the art US 

imaging and differential diagnosis 

M. Vakaki, G. Pitsoulakis, C. Koumanidou (Athens, Greece) 

P23 High-resolution US and multicystic dysplastic kidney: what is the pediatric radiologist looking for? 

M. Vakaki, G. Pitsoulakis, E. Dagiakidi, C. Karanikas, N. Evlogias, C. Koumanidou (Athens, Greece) 

P24 Unsual pelvic mass in a adolescent girl 

S.M P. Palma, J. Leitão, L. Lobo, M. Abecasis, I. Távora, A. Melo, D. Nogueira (Lisboa, Portugal) 

P25-P40: Imaging of the Urinary Tract 

P25 An approximation algorithm is useful for evaluating split renal function from CT 

H. Björkman, P. Dahlman, A. Magnusson (Uppsala, Sweden) 

P26 Renal malignancies with sarcomatous elements: MDCT features 

A.C. Tsili, K. Christakis, D. Giannakis, A. Zioga, N. Sofikitis, K. Tsampoulas (Ioannina, Greece) 

P27 Synchronous renal tumors of different histology in the same kidney: report of seven cases 

E. Capaccio, V. Varca, A. Simonato, C. Toncini, G. Carmignani, L.E. Derchi (Genova, Italy) 

P28 Diffuse Renal Involvement: Differential diagnosis based on Imaging findings 

R.G. Figueiras, C.V. Martin, S.B. Gonzalez, A.G. Figueiras, M.A. Rego, A.N. Parga, I.R. Isidro 

(Santiago de Compostela, Spain) 

P29 Primary small cell carcinomas arising from the genitourinary tract: imaging features 

A.C. Tsili, V. Malamou-Mitsi, D. Giannakis, A. Charisiadi, N. Sofikitis, Ev. Paraskevaidis, K. Tsampoulas 

(Ioannina, Greece) 

P30 Synchronous primary malignancies of the genitourinary tract: imaging features 

A.C. Tsili, A. Charisiadi, G. Koliopoulos , M. Doukas, Ev. Paraskevaidis, K. Tsampoulas (Ioannina, Greece) 

P31 Papillary Renal Cell Carcinoma: Radiologic and Clinical Spectrum 

R. Vikram, C.S. Ng, P. Tamboli, N.M. Tannir, S.F. Matin, E. Jonasch, C.G. Wood, C.M. Sandler (Houston, Tx, USA) 

P32 The Treated Kidney: A Pictorial Review of Imaging Findings Following Kidney Directed Interventions, Short 

and Long Term Follow-up. 

C.M. Sandler, C.A. Farinas, M. Patnana, S. Carter, J. Szklaruk (Houston, Tx, USA) 

P33 MR urography with a new negative oral contrast agent 

T. Gokan, M. Kawahara, Y. Ohgiya, M. Hirose (Tokyo, Japan) 

P34 Virtual Pyelo-ureteroscopy: Role of 16-row MDCT 

S.D. Yarmenitis, K.G. Chlapoutakis, A. Papadakis, F. Sofras, N.C. Gourtsoyiannis (Heraklion, Greece) 

P35 Benefit vs Risk in patients with acute flank pain examined with CT 

M. Lönnemark, S.A. Hamdeh, L. Jangland (Uppsala, Sweden) 

P36 Usefulness of MDCT urography after excretory urography in obstructed kidneys 

C. Sebastià, L. Buñesch, C. Nicolau, S. Quiroga, R. Salvador, R. Boyé (Barcelona, Spain) 

P37 Usefulness of curved multiplanar reconstructions (MPR) and curved thin maximum intensity projection 

(thin-MIP) reconstructions in urinary tract studies by means of MDCT 


P38 Assessment of renal vascular changes after ESWL: measured by Ultrasound Resistive Index (RI), ASL 

(FLASH-STAR) and contrast perfusion MRI 

M.M.H. Abd Ellah, L. Pallwein, F. Aigner, C. Kremser, M. Schocke, C. Wolf, G. Bartsch, F. Frauscher 


P39 Percutaneous nephrostomy under CT guidance in mild hydronephrosis and complicated cases 

P. Maniatis C. Triantopoulou, I. Siafas, D. Papadimitriou, I. Fagadaki, J. Papailiou (Athens, Greece) 

P40 The diagnostic performance of Urethrocisto-MR in the evaluation of male urethral stenotic lesion 

G. Regine, C. Pace, C. Parola, M. Atzori, M. Gaffi, F.M. Danza (Rome, Italy) 

26

P42-P50: Male Imaging 

P42 The value of perfusion CT in evaluation the locoregional staging in post-radical prostatectomy patients with 

elevated PSA level in blood serum 


P43 Correlation between 3T MRI Apparent Diffusion Coefficient and Prostate Cancer Gleason Score in radical 

Prostatectomy Specimens 

T. Hambrock, R. Somford, H.J. Huisman, C. Hulsbergen-van de Kaa, I. van Oort, F.J.A. Witjes, J.O. Barentsz 


P44 Effect of Computer Assisted Diagnosis on Characterization of Prostate Lesions on Dynamic Contrast 

Enhanced MR Imaging 

T. Hambrock, P. Vos, H.J. Huisman, F.J.A. Witjes, C. Hulsbergen-van de Kaa, J.O. Barentsz (Nijmegen, 


P45 Contrast enhanced colour Doppler targeted prostate biopsy for prostate cancer detection: 

Results of 2008 men 

F. Aigner, E. Pallwein, L. Pallwein, V. Spiss, M. Mitterberger, W. Jaschke, G. Bartsch, F. Frauscher 


P46 Case Report: GIST masquerading as a prostatic mass 

J.Y. Keanie, C. Reddy, S.A. Moussa (Edinburgh, United Kingdom) 

P47 MR imaging of scrotal masses 

A.C. Tsili, K. Christakis, D. Giannakis, I. Ntasiou, N. Sofikitis, K. Tsampoulas (Ioannina, Greece) 

P48 Effect of vasectomy on testicular blood flow evaluated by color Doppler Ultra-sound resistive index 

measurement 

R. Faschingbauer, E. Pallwein, L. Pallwein, F. Aigner, M. Mitterberger, F. Frauscher (Innsbruck, Austria) 

P49 Erectile Dysfunction: Spectrum of Penile Doppler US Findings 

N. Bhuskute, M.J. Weston (Leeds, United Kingdom) 

P50 Neurinoma of the penis: a case report with radiologic-pathologic correlation and review of the literature 

G.M. Argiolas, G. Catani, S. Mallocci, D. Sirigu, G.T. Bitti (Cagliari, Italy) 

P51-P52: New Developments in Imaging 

P51 Signal intensities in whole-body MRA at 3T: a randomized trial of gadofosveset and gadoterate 

Y.W. Nielsen, V.B. Løgager, H.S. Thomsen (Herlev, Denmark) 

P52 The Internet portal dedicated to urologic ultrasound as a multidisciplinary educational space 

W. Bialek P. Michalak, K. Bar, J. Michalak (Lublin, Poland) 


27

Scientific Abstracts 

Selbstverlag, München 

ISBN 978-3-00-025479-6 

29


14:00 – 15:30 Members’ Day Session I 


Abstracts M1-M9 

M1 Trends in urogenital radiology research: a survey of publications from ESUR Members 

L. Derchi (Genova, Italy) 

Purpose: 

To analyze trends in urogenital radiology research basing on the scientific publications of ESUR Members. 

Materials and Methods: 

We interrogated the PubMed database for publications from ESUR Members (Membership list Sept 06). E.mail asking for a 

publications list was sent to all those in whom difficulties were encountered due to coincidence of names. The % of papers 

on GU was calculated for each Member. Papers were then classified according to their topics. Paper from multiple members 

were counted only once. 

Results: 

Data were available from 170/230 Members (73.9%). There were 9242 hits in PubMed; 4054 (43.8%) were on GU. A total of 

3454 papers were classified according to topics. Kidney (830), Contrast Media (446), Female imaging (322) Prostate (225), Urinary 

Tract (211), Pediatrics (154) and Kidney Transplantation (147) were the most common topics of research. Among clinical 

ones, tumor imaging was the most frequent argument. In Contrast Media research, iodinated contrast media were the most 

studied, and bench and bedside research shared 50% of these titles. Most papers were published in radiological journals 

(2385 – 69%). Of the 1069 (31%) papers in clinical journals, there were 11 printed in the NEJM and 13 published in The Lancet. 

Only 3 papers were dealing with patient information in contrast media and only 7 were on cost/effectiveness evaluation. 

Conclusions: 

ESUR Members are highly productive in research. They cover both basic and clinical research, deal with a large variety of 

topics and publish in highly respected journals. Oncology is the most frequent clinical argument. 

M2 Pregnancy after uterine artery embolization for symptomatic fibroids: a series of 15 

pregnancies among 119 patients 

K. Firouznia, H. Ghanaati, R. Bohloul, A. Jalali, M. Shakiba (Teheran, Iran) 

Purpose: 

To report on pregnancies and their outcome after uterine artery embolization (UAE) for uterine fibroids. 


119 patients managed with bilateral UAE by 500-710 µm polyvinyl alcohol particles for their symptomatic 

uterine fibroids from 2001 to 2005. The mean age of patients was 36±6.4 years(20-49). The mean uterus 

volume was 576±632 cm 3 (41-4656) and dominant fibroid size was 234±349 cm 3 (14-2618) before the 

procedure. 

We followed the patients for two years; whether they had been trying to achieve pregnancy and whether 

they had been successful. In women who reported pregnancies, we reviewed their pregnancy and 

obstetric records. 

Results: 

25 women (21%) had been seeking to become pregnant and 14 (56%) of them became pregnant (nine were 

nulliparous). One case had two times pregnancies. Fourteen pregnancies were spontaneous and one was by 

using zygote intrafallopian transfer (zift). We had two miscarriages in 12th and 16th weeks in gestational age. 

Thirteen pregnancies were full-term and non-complicated which delivered by elective cesarean. All newborns 

were healthy with apgar scores higher than eight. The mean weight of neonates was 3274±514.4g. One 

newborn was small for gestational age (2100g). 

Conclusions: 

Despite the small sample size, UAE does not seem to affect fertility in women treated for uterine fibroids; 

thus, this procedure may provide new hopes to the patients as a substitution for previous invasive operations 

like hysterectomy or myomectomy. 

Additional studies including randomized trials comparing UAE with myomectomy should be performed to 

prove UAE as a safe procedure for women who desire future fertility. 

30 

Scientific Sessions 

Thursday, September 11, 2008

M3 Usefulness of Contrast-Enhanced Sonography (CEUS) to characterize solid renal masses 

(angiomyolipoma excluded) 

C. Roy, B. Sauer, L. Gengler, H. Lang (Strasbourg, France) 


Purpose: 

Assess the performance of CEUS to characterize solid renal masses after indeterminate CT or MR examination. 


30 patients (33 renal lesions, 1.5 – 7.5 cm) studied with CEUS after indeterminate CT (29), MRI (4) or both (14). Subjective 

analysis was focused on dynamic aspect of tumoral enhancement in comparison with adjacent renal parenchyma. 

Two readers independently reviewed digital dynamic data with knowledge of CT or MR examinations. 

Results were correlated with final pathological diagnosis obtained by surgery (28) or biopsy (3). It was 20 RCC (7 CC, 

13 Papi), 4 metastasis, 7 oncocytomas. 2 pseudo-masses were confirmed directly by CEUS. 

Results: 

CCRCC had early diffuse heterogeneous (8) or homogeneous (1) enhancement. PapiRCC presented delayed enhancement 

with more homogeneous pattern except in one case. Metastasis presented heterogeneous intermediate enhancement. 

On delayed analysis (3 min) all malignant masses were hypoechoic to normal parenchyma. Oncocytomas presented 

a very early and radiated enhancement and then homogeneous pattern with central or eccentric hypointense stellate scar. 

On delayed analysis (3 min), an isoechoic appearance of the lesion to the adjacent renal parenchyma was present for all 

oncocytoma . One of those criteria was lacking for one CCRCC diagnosed as oncocytoma (case of renal insufficiency) and 

for one PapiRCC diagnosed as CCRCC. Image quality was excellent. Sensitivity to discriminate benign from malignant masses 

was high (23/24). 

Conclusions: 

CEUS is highly accurate to differentiate malignant from benign solid tumor. The main criteria for oncocytoma seems to be a 

low wash-out of contrast in the contrary to rapid wash-out for malignancy. 

M4 Furosemide CT urography: is a routine CT KUB necessary? 

JY Keanie, D. Alcorn, S.A. Moussa (Edinburgh, United Kingdom) 

Purpose: 

CT urography (CTU) is rapidly replacing the conventional IVU for investigation of haematuria due to its superior imaging 

qualities, but this has resulted in significantly increased radiation dose to the patient population. Recommended protocols 

involve an unenhanced scan (CT KUB), chiefly to identify calculi, followed by one or more post-contrast scans. The purpose 

of this study was to determine whether the CT KUB could be routinely omitted when furosemide is used as an adjunct. 


The scans of 100 consecutive patients who underwent furosemide-assisted CTU at a single institution were retrospectively 

analysed. All examinations were carried out on the same 16-slice MDCT. A two-phase protocol was used: one plain and one 

split-bolus post-contast scan through the urinary tract. Three reviewers with a special interest in uroradiology (two consultants 

and one specialist registrar) independently evaluated the post-contrast examination before making comparison with the 

CT KUB. Hounsfield values of opacified urine and calculi were also measured. 

Results: 

All calculi demonstrated on the CT KUB had already been seen on the post-contrast scan when viewed on “wide windows”. 

This is accounted for by the higher density of calculi compared to the relatively dilute opacified urine obtained by using 

furosemide. (Results subject to final analysis) 

Conclusions: 

The CT KUB can be routinely omitted in furosemide CTU, allowing a reduction in dose to the patient population. The small 

minority of patients found to have possibly complex cysts can be recalled for a plain scan of the renal areas only. 

M5 Compex renal stones - the benefit of an extended preoperative planning with 3D CT 

A. Magnusson, M. Brehmer, M. Beckman (Uppsala, Sweden) 

Purpose: 

To evaluate the impact of an extended radiological planning with 3D CT in patients with complex renal stones. 


29 consecutive patients with complex renal stones were included in a prospective study. Initially the patients were examined 

with IVP or abdominal CT. In consensus an endourologist and a radiologist decided an optimal track from these images. All 

patients were then examined with CT with thin slices and 3D reconstructions of the collecting system and the stone/stones. In 

order to simulate positioning during surgery the patients were scanned in a prone position and with a wedge cushion under 

the lower part of the abdomen. In consensus and blinded for the result from the initial decision a track was estimated from 

the 3D CT. All patients underwent percutaneous nephrolithotripsy (PNL). 

Results: 

From the initial examination a track was planned in 22 patients. The decision was changed in 13 patients after the 3D CT. With 

3D CT it was possible to estimate a track for all patients. In 8/9 patients a track for PNL was established in agreement with the 

decision from the initial examination and in 19/20 patients in agreement with the 3D CT-exmination. 23 patients were successfully 

treated with one PNL session and in 20 of these patients only one track was established. 6 patients required further treatment 

with ESWL (3), PNL (1) ureteroscopy (2). 

Conclusions: 

An extended preoperative planning with 3D CT results in successful treatment of most complex renal stones through one 

track. 

31


M6 US, IVU and CT findings in patients with renal small calyx stones and papillary calcification 

V.M. Builov, Y.N. Patrunov, Y.B. Smolyakov (Yaroslavl, Russia) withdrawn 

Purpose: 

To estimate criteria for differential diagnosis of calyx stones (CS) and papillary calcifications (PC). 


US, IVU, un-enhanced polypositional (in the back and on the stomach) CT with 1-2 mm scans were performed in 43 patients 

with 2-4 mm CS and 23 patients with PC. 

Results: 

US data in patients with CS and PC was the same: small hyperechoic structures with acoustic shadow and/or twinkling 

artifact in color doppler. The same was their density – 250-750HU depending on the size. On plane X-ray PC were always of 

triangle shape with the apex directed inside that differed them from round-shaped CS. Un-enhanced polypositional CT 

reveal CS movement. On the contrary PC always kept their place. IVU showed that both small CS and PC “disappear” 

mimicking contrast agent, but fornix and calyx shape in case of PC never change. In CS there appeared calicoectasia 

and fornix smoothing. Orthostatic reaction in patients with PC didn’t change differing from always incomplete contrast 

evacuation out of ca-lyx in case of CS. 

Conclusions: 

Small calyx stones and papillary calcifications may be differentiated on the data of plane X-ray, IVU and unenhanced 

polypositional CT that is necessary for treatment strategy. 

M7 Contrast-induced nephropathy following the intravenous injection of iso-osmolar and 

low-osmolar contrast media: a pooled analys 

H.S. Thomsen, S.K. Morcos, C.M. Erley, L. Romano, D. Sahani (Herlev, Denmark) 

Purpose: 

To compare the incidence of contrast-induced nephropathy (CIN) after administration of low-osmolar contrast media 

(iomeprol-400 or iopamidol-370) or iso-osmolar iodixanol-320 in patients with chronic kidney disease undergoing multidetector 

computed tomography (MDCT). 

Materials, Methods and Procedures: 

301 patients with creatinine clearance (CrCl) < 60 mL/min received iopamidol or iomeprol (LOCM Group, N=153), or iodixanol 

(IOCM Group, N=148) in two double-blind studies. All patients received a similar CM dose (40 gI) IV at 4 mL/s. Blood 

samples were collected predose and at 2-3 days postdose for serum creatinine (SCr) measurements. All laboratory investigations 

were performed by the same central laboratory for all patients. CIN endpoint was an increase in SCr >/= 0.5 mg/dL from 

baseline for the entire population and for the subset of patients (N=67 in LOCM Group, N=52 in IOCM Group) with CrCl < 40 

mL/min and SCr >/= 2.0 mg/dL. Baseline patient characteristics were compared using a chi-square test or the unpaired 

t-test, as appropriate. CIN rates were compared using a chi-square test. 

Results: 

The two groups were comparable at baseline for all the variables tested (age, sex, body weight, presence of diabetes, CM 

dose, hydration, premedication, concomitant use of nephrotoxins, renal function). Baseline SCr was 1.62±0.51 mg/dL in 

Group A and 1.62±0.62 in Group B (p=0.9). A significantly greater change in SCr from baseline was seen in patients receiving 

iodixanol compared with patients receiving low-osmolar CM (0.05±0.25 vs. -0.02±0.18 mg/dL, p=0.008). The rate of post dose 

SCr increases >/= 0.5 mg/dL was 4.7% (7/148) after iodixanol and 0/153 in the LOCM Group (p=0.007). In patients with CrCl < 

40 mL/min and SCr >/= 2.0 mg/dL, the rate of CIN was 11.5% (6/52) in the IOCM group, 0/67 in the LOCM Group (p=0.006). 

Significance of the Conclusions: 

In high-risk patients receiving IV doses of contrast, the rate of CIN may be higher following the IOCM iodixanol than the 

LOCM iopamidol and iomeprol. 

M8 Functional semi-automated segmentation of renal DCE-MRI sequences: preliminary results 

M. Claudon, D. Mandry, B. Chevaillier, C. Pasquier, J.L. Collette, O. Pietquin (Nancy, France) 

Purpose: 

In contrast-enhanced MRI (CE-MRI), manual segmentation of cortex, medulla and pelvo-caliceal cavities is necessary for 

functional assessment, but appears time-consuming and is subject to interoperator variability. The objective of the present 

study was to evaluate the interest of a new, semi-automated functional method, based on time-intensity curves of renal 

pixels, for renal compartments. 


Eight CE-MRI sequences of normal kidney perfusion, obtained with a 2562 matrix and for 10’ after gadolinium chelates injection, 

were analyzed after rigid registration. Manual segmentation, performed independently by two radiologists, was considered 

as the reference method. The tested functional method associated a classification of kidney pixels in several clusters 

according to their contrast evolution using a vector quantization algorithm, followed by a merging process to get the three 

renal compartments. To compare manual and functional segmentation methods, four discrepancy indices were calculated 

for each compartment (percentage overlap, percentage extra, similarity index and mean distance between contours). 

Results: 

For manual segmentation, mean variation coefficients between radiologists were 17.7%, 24% and 6.2% for respectively the 

cortex, medulla and cavities, while the values range depending on the number of clusters classes were 8.3-11.1%, 4.1-11.9%, 

3.3-19.4% for the functional method. Segmentation time ranged from 12 to 15 minutes for the manual registration versus 30 

seconds for the semi-automatic method. 

32


Conclusions: 

These preliminary results indicate that the present functional semi-automatic method shows lower variability and much higher 

efficiency than the manual method for the segmentation of renal cortex, medulla and cavities in CE-MRI. 

M9 Renal lesions associated with autoimmune pancreatitis 

C. Triantopoulou, G. Malachias, P. Maniatis, J. Anastopoulos, I. Siafas, J. Papailiou (Athens, Greece) 

Purpose: 

Autoimmune pancreatitis (AIP) is a chronic inflammatory condition characterized by IgG4-positive plasma cells. Recent evidence 

suggest that it is a systemic disease affecting various organs. Tubulointerstitial nephritis has been reported in association 

with AIP. The purpose of our study was to investigate renal involvement in patients with AIP. 


13 patients with no history of renal disease and diagnosis of AIP (on the basis of histopathologic findings or a combination of 

characteristic imaging features, increases serum IgG4 levels and response to steroid treatment) were included. All patients 

underwent CT imaging and the follow-up duration ranged from 6 months to 2 years. CT images were reviewed for the presence 

of renal lesions. 

Results: 

5 patients had renal involvement (38.5%). None of the lesions were visible on non-contrast enhanced CT scan. Parenchymal 

lesions appeared as multiple peripheral nodules showing decreased enhancement (3 cases). In the differential diagnosis 

pyelonephritis, lymphoma or metastases were considered. An ill defined low-attenuation mass-like lesion was found in one 

patient, while diffuse thickening of renal pelvis wall was also evident in the last case. Renal lesions regressed in all patients 

after steroid treatment, the larger one leaving a fibrous cortical scar. 

Conclusions: 

Renal lesions in patients with AIP are relatively common. These findings support the proposed concept of IgG4-related 

systemic disease. Autoimmune disease should be suspected in cases of renal involvement in association with pancreatic 

focal or diffuse enlargement. 

16:00 – 17:30 Members’ Day Session II 


Abstracts: M10-M18 

M10 The endocrine and hematologic meaning of adrenal myelipoma: a new evidence requiring a 

different attention 

F.M. Danza, E. Sacco, G. Regine, G.M. Latagliata, L. Bonomo (Rome, Italy) 

Purpose: 

To analize the clinical and radiological aspects of 7 giant myelolipomas (ML), with particular attention to their differential diagnosis 

criteria, searcing for their endocrinologic and haematologic correlations. 


the authors review the clinical and radiological data of a group of 7 patients with myelolipomas (ML) bigger than 5 cm, in 

one case associated with an endocrinological syndrome, to analize in primis the radiological differential diagnosis of these 

rare forms, that can create problems with liposarcomas (cysts, haemorrhage, solid areas mixed with a lipid stroma). The 

radiological appearence of such neoplasms has some similarities with the estrusive form of extra medullary ematopoiesys . 

The authors also reviewed the known physio-pathological mechanisms that can play a role in the development of such particular 

masses, not to be considered as simple amartomas: 

Results: 

The results of a re-evaluation of the clinical and radiological reports of a compreensive group of 7 cases with MLs over 5 cm 

in dimensions are reported. In four of our cases a possibile association with problems of erythropoiesis was investigated. Two 

molecules are probably involved, ACTH and erythropoietin: the chronic stimulation by ACTH iper-incretion or broadly speaking 

the co-existence of an iper-corticism, are probably at the base of the development of MLs. In our case with a-drenogenital 

sindrome caused by 21-alfa-hydroxylase deficiency, this stimulation is probably expanded by the chronic ipoxia due to 

the associated thalassemic trait of the patient. The ACTH is also involved in the erythropoiesis regulation (anemias associated 

to the ipopitituarism), and stimulates the iuxtaglomerular cells to produce erythropoietin. Some others teories are proposed to 

explain the association with the syndromes with ipercorticism. 

Conclusions: 

The old vision of ML as a benign amartoma lacking clinical interest and only present in the differential diagnosis list, is to be 

reviewed, due to interesting correlations with the adrenal function and with the erythrogenesis. So this rare lesion, must be 

investigated in a different way: a banal morphologic finding becomes indicator of a complex clinical condition with hematologic 

and endocrine implications. 

33


M11 Dedicated testicular MRI (dtMRI) in adults with congenital adreno-genital syndrome 

(AGS) and testicular adrenal rest tumors (TARTs) 

M.K. Scherr, N. Reisch, M. Bartenhauser, M. Reincke, M.F. Reiser, U.G. Müller-Lisse 

(Munich, Germany) 

Purpose: 

Testicular adrenal rest tumors (TARTs) and their influence on fertility are rare and occur in the small population 

of young males suffering from congenital adreno-genital syndrome (AGS). The aim of our study was to evaluate 

presence, extent, morphology, and influence on fertility of TARTs using dedicated testicular MRI (dtMRI). 


18 Patients with congenital AGS were examined at 1.5T. Patient age at time of MRI was 19 to 48 years (mean 

30.8 years). Thin slice TSE series (3mm T1w cor/ax, T2w cor/ax and two consecutive T1w cor/ax after 

administration of Gadolinium) were acquired using a 14 cm loop flex coil placed on the elevated testicles. MRI 

data were evaluated for TART presence, extent and relative signal intensity in pre and post contrast sequences 

compared to surrounding parenchyma. Segmentation of testes and presenting TARTs revealed volumes of 

remaining functional testicular tissue. Sperm count was correlated with volume of functional testicular tissue. 

Results: 

MRI revealed TARTs in 9/18 patients, with a total volume of 0.37 to 21.56 ccm of TART per patient, resulting in a 

functional testicular volume of 11.86 to 35.25 ccm. Spermatozoal concentration (1 azoospermia, 8 patients with 

0.8 to 187.2 million/ccm) correlated with remaining functional testicular volume (r=0.84, p0,2cc of the prostatectomy specimen 

map. The dynamic parameters included Ktrans, Kep and the concentration of gadolinium ([Gd]) in the first 60 seconds after 

injection. Tumor volume was estimated on a per patient basis and correlated with the pathological volume. 

Results: 

Mean values of Ktrans, Kep and [Gd] were significantly higher in malignant foci of the OG (p


Conclusions: 

These results underline that prostate cancer can be observed in young patients when clinical or US signs are suggestive of a 

neoplastic lesion, independently of serum PSA values. Prostate biopsy is mandatory when PSA is higher to 4 ng/ml because 

of the high incidence of carcinoma. There was no correlation between serum PSA values and mean Gleason score. 

M14 Comparison of real-time gray-scale TRUS and T2-weighted endorectal MR imaging at 3T in 

local staging of prostate cancer 

S.W.T.P. Hejmink, T. Hambrock, C.A. Hulsbergen-v.d. Kaa, J.A. Witjes, J.O. Barentzs (Nijmegen, 


Purpose: 

To compare the local staging accuracy of real-time gray-scale transrectal ultrasound (TRUS) and T2-weighted 3T endorectal 

(ERC) MRI with whole-mount section histopathology. 


After written informed consent, 25 consecutive patients with biopsy-proven and clinically localized prostate cancer underwent 

3T MRI and TRUS before radical prostatectomy. Three-directional T2-weighted ERC imaging was obtained (TR/TE 

5000/153ms; voxel size: 0.26x0.26x2.50mm 3 ). Real-time axial gray-scale TRUS using tissue harmonic imaging (6 MHz probe frequency, 

Aplio system, Toshiba) movie clips were recorded. Radiologist A and B, with different levels of experience, independently 

read all imaging sets and scored the local disease stage on a 5-point probability scale. Whole-mount section histopathology 

was the standard of reference. Areas under the ROC curve (AUC) were determined and diagnostic performance 

parameters were calculated. P



Nineteen patients with bladder cancer (n=8), prostate cancer (n=7) or both (n= 4) underwent MRI of the pelvis on a 3T MRsystem. 

Axial DW-MRI was performed covering the entire pelvis (slice-thickness 4mm, gap 1mm, 3 b-values (0, 500, 

1000sec/mm 2 ), isotropic, 6 acquisitions, respiratory-triggering when indicated). 

All patients underwent template lymphadenectomy (n=16) or biopsy (n=3). The analysis of DW-images and ADC-maps was 

performed blinded to histology results. Lymph nodes with high intensities on DW-images and low ADC values (

Friday, September 12, 2008 

08:30 – 10:30 Scientific Session I: Young Radiologists’ Forum 


Abstracts YR1-YR12 


YR1 3 Tesla MR Guided Biopsy to Detect Prostate Cancer Recurrence following Radiotherapy 

T. Hambrock, D. Yakar, J. Fütterer, H. Huisman, E. van Lin, J.O. Barentsz (Nijmegen, The Netherlands) 

Purpose: 

To assess the potential value of 3T MR guided prostate biopsy of tumor suspicious regions on Dynamic Contrast Enhanced 

(DCE) MRI to detect prostate cancer recurrence following radiotherapy. 


In this pilot study, 14 patients with prostate cancer previously treated with radiotherapy (> 1 year before) underwent an 

endorectal 3T MRI (Siemens, Germany) following 3 consecutive rises in PSA. Two radiologists in consensus determined tumor 

suspicious regions (TSR) from DCE-MR images. A prototype MR biopsy device (Invivo, Germany) was used in conjunction with 

a 32 channel phased array coil, to perform prostate biopsies under 3T MR guidance. Anatomical landmarks and features on 

T2-weighted Turbo Spin Echo and TRUE-FISP images were used to relocate prior determined TSRs. In total 13/14 patients had 

TSR’s on DCE-MR images. 8 Patients received MR guided biopsies while 4 due to evidence metastatic disease, subsequently 

did not . One patient refused the MR guided biopsy. 

Results: 

The average duration of MR guided biopsies was 30 min. In total 26/26 TSR representative biopsies were obtained. Prostate 

cancer was found in 7/8 patients. 21/26 (81%) of biopsies from TSR regions were positive for tumor. One biopsy showed 

normal tissue while 4/26 (1 patient) remaining biopsies showed radiotherapy induced reactive atypia. No complications 

occurred. 

Conclusions: 

This pilot study shows, that 3T MR guided biopsy of DCE-MRI tumor suspicious regions has a potential value to improve detection 

of local prostate cancer recurrence following radiotherapy. 

YR2 Transgluteal CT-guided prostate needle biopsies in men without a rectum: a retrospective review of 70 cases 

W.G. Alleman, T.J. Welch, B.F. King, J.R. Karnes (Rochester, MN, U.S.A.) 

Purpose: 

Diagnosis and staging of prostate cancer in men without a rectum is particularly challenging, for standard procedures such 

as digital rectal examination and transrectal ultrasound-guided biopsy are unavailable. CT-guided transgluteal biopsies of 

the prostate have become the preferred method of prostate cancer diagnosis in these patients at our institution. The purpose 

of this study is to evaluate the procedure and results of CT-guided transperineal prostate biopsies in men without a viable 

rectum. 


We retrospectively reviewed all patients at Mayo Clinic, Rochester, MN, U.S.A. who underwent transgluteal CT-guided 

biopsies between 1988 and 2007. Multiple variables were assessed, including PSA at time of biopsy, core biopsy needle size, 

total number of biopsies, pathologic results, and documented complications. Treatment in patients with positive results and 

clinical follow-up if negative were documented. False negative studies and non-diagnostic studies were examined to determine 

an underlying cause of failure. 

Results: 

70 biopsies were performed in 56 patients. Prostate adenocarcinoma was diagnosed in 27 samples (39%). Eight patients 

subsequently underwent radical retropubic prostatectomy, of which 4 were graded up, 1 graded down, and 3 concurred. 

Nine of the biopsies (13%) were unsuccessful (5 false negative and 4 non-diagnostic samples). The number of core samples 

taken in unsuccessful procedures was significantly less than successful procedures (mean of 4.4 samples compared to 7.1, 

P=0.003). No significant complications were recorded. 

Conclusions: 

CT-guided transperineal prostate biopsy is a valid method for diagnosing pro-state cancer in men without an accessible 

rectum. Diagnostic accuracy is im-proved with increased number of core specimens. 

YR3 MR Imaging of prostate cancer: Diffusion Weighted Imaging and MR Spectroscopy in 

Comparison with Histology 

J. Yamamura, G. Salomon, J. Graessner, G. Adam, U. Wedegaertner (Hamburg, Germany) 

Purpose: 

The purpose of this study was to evaluate the impact of diffusion weighted imaging (DWI) and MR spectroscopy in the 

detection of prostatic cancer in comparison to histology. 

37



40 patients with clinical suspicion of prostate cancer underwent a combined endorectal-body-phased-array MRI at a 1.5T 

MRI scanner (Siemens, Erlangen, Germany). DWI was performed using b-values of 50, 400, 800 s/mm 2 . For MR spectroscopy a 

3D CSI sequence was used (8 slices; FOV 120 mm). The prostate was divided in sixtants including the apex, middle aspect 

and base of the left and right side separately to evaluate the ADC-values for DWI and the choline+creatine/citrate ratios for 

spectroscopy. The results of DWI and spectroscopy were compared with the findings of the histological examination of radical 

prostatectomy specimens or endorectal sonographically guided sextant biopsy, erspectively. For statistical analysis a 

t-test was used. 

Results: 

Histology revealed no cancer in 25 patients and cancer in 15 patients. For DWI ADC mean values were 1.67x10-3 mm 2 /s 

[standard deviation (SD): ±0.08] for healthy tissue and 1.08x10-3 mm 2 /s [SD: ±0.1] for cancer. The ADC value was significantly 

higher in benign tissues than in cancer (p

YR6 Accuracy of Preoperative MRI in Staging Primary Cervical Cancer - 3 year experience 

S. Rajaram, A. Chopra, S. Abdi (Sheffield, United Kingdom) 


Purpose: 

To evaluate the diagnostic accuracy of preoperative MRI in predicting parametrial invasion, differentiating localized from 

advanced disease and lymph node involvement in patients with primary cervical cancer. 

Materials and methods: 

A retrospective study of 92 patients with primary cervical cancer referred to our Hospital between January 2003 to December 

2006. All patients in the study had histologically confirmed cervical malignancy. The preoperative MRI staging was 

compared with post operative histolopathology. The outcome was measured as specificity, sensitivity, positive predictive 

value, negative predictive value and accuracy of MRI in staging cervical cancer. 

Results: 

Of the 92 cases analysed there were 67 patients with localized disease and sensitivity and specificity of MRI in predicting this 

stage were 94% and 92% respectively. The sensitivity for identifying advanced disease was 96% and specificity was 95%. For 

staging parametrial involvement the sensitivity of MRI was 93% with specificity of 69%. 57 patients had lymph node histologically 

analysed and accuracy of MRI based on size criteria was 79%. The overall accuracy of MRI in identifying local and 

advanced cervical cancer were 93% and 95% respectively. 

Conclusion: 

Our study shows that MRI is highly accurate in differentiating local from advanced cervical cancer. However preoperative 

MRI showed a low PPV for parametrial invasion in cervical cancer. Detecting metastatic Lymph Node involvement by using 

the accepted size criteria for nodal involvement has a poor PPV and sensitivity. 

YR7 Diffusion-Weighted MR imaging in endometrial cancer 

M. Vrang, H. H. Johannesen, V. Løgager, J.M. Møller, Berit J Mosgaard (Herlev, Denmark) 

Purpose: 

MR imaging is increasingly being used in the planning of surgery and treatment of endometrial cancer. Recent studies have 

shown that Diffusion-Weighted MRI (DW-MRI) has a potential in distinguishing between normal tissue and cancer tissue in the 

endometrium. The purpose of this retrospective study is to investigate whether the ADC (Apparent Diffusion Coefficient) 

value of endometrial cancer differ from the value of the normal endometrium. 


DW MR images of 46 females, mean age 69 years, with surgically proven macroscopic endometrial cancer were examined. 

The control group included 14 females, mean age 61 years, with no known endometrial disease, but MR-scanned because 

of vulva or rectum cancer. The ADC values of the endometrial cancer and the normal endometrium were calculated and 

compared. The distributions were checked using the Anderson-Darling test and found to confirm their normality. For statistical 

analysis an unpaired t-test was used. A p-value of less than 0.05 was considered statistically significant. 

Results: 

The mean ADC value of the endometrial cancer was 0.80 (* 10-3 mm 2 /second), 95% CI 0.73 to 0.86, which was significantly 

lower than the mean ADC value of the normal endometrium, 1.3 (* 10-3 mm 2 /second), 95% CI 1.2 to 1.4. There was an 

overlap between the cancer group and the control group distributions. The range was from 0.49 to 1.3 in the cancer group 

and 1.0 to 1.8 in the control group. 

Conclusions: 

Since there is a significant difference between the ADC values of the two groups, the DW MRI can be used to facilitate the 

detection of macroscopic tumor in the endometrium in pelvic MRI and as a supplement to gadolinium contrast enhanced 

and non-enhanced MR images to outline the tumor from normal endometrial tissue in known endometrial cancer cases. 

YR8 1H-Magnetic Resonance Spectral Analisys in Different Adnexal Lesions 

A. Iotti, F. Fiocchi, G. Ligabue, I. Di Monte, V.M. Iasonni, P. Torricelli (Modena, Italy) 

Purpose: 

To explore the in vivo Magnetic Resonance (MR) spectral features of adnexal lesions and to characterize the spectral patterns 

of various pathologic lesions 


Thirty patients with undefined lesions underwent contrast enhanced MR ( ce-MR) and MR spectroscopy (MRs) prior to surgery. 

Histopathology was considered the reference standard 

Results: 

26 among 30 patients underwent surgery. In 4 patients ce-MR and MRs identified benign lesions : 3 lymphoceles and 1 normal 

ovary, in which MRs revealed only water peak at 4.5 ppm. MRs revealed the presence of choline at 3.2 ppm and lipid in 6 

serous carcinomas, 1 immature teratoma, 2 granulose-theca cell tumors, 6 metastases (4 form bowel and 2 from cervix 

carcinomas). MRs revealed lactate at 1.3 ppm and lipid in 3 endometrioid carcinomas.In 2 cases of serous cystoadenoma 

and in 3 cases of non-malignant lesion MRs detected water peak only 

Conclusions: 

1H-MRs demonstrates significant differences in metabolite concentration between benign and malignant ovarian tumors. 

MRs may therefore be helpful in the differential diagnosis of adnexal lesions, but further investigation is required. 

39


YR9 Dynamic Magnetic Resonance Imaging for Grading Pelvic Organ Prolapse using Three 

Reference Lines: Intra- and Interobserver Variability 

J.J. Fütterer, S. Broekhuis, M. Vierhout, J.O. Barentsz (Nijmegen, The Netherlands) 

Purpose: 

To assess the intra- and interobserver variability of dynamic MR imaging in grading pelvic organ prolapse using three different 

reference lines. 


Fifty patients with genital prolapse were enrolled in this study. They underwent physical examination and dynamic MR imaging 

using a 3T MR scanner. The rectum was filled with ultrasound gel (100-150ml). MR images were obtained in the midsagittal 

plane using a Half-Fourier acquisition single-shot turbo spin-echo sequence (temporal resolution of 1 second). 

Standard manoeuvres consisted of several repeated cycles of maximal and sustained straining. Two observers performed the 

MR imaging measurements of pelvic organ prolapse using three different reference lines: the mid-pubic line, pubococcygeal 

line and the horizontal line. Measurements were repeated twice according to each line. The intra-class coefficient was used 

to estimate intra-observer and inter-observer variability. 

Results: 

The intra-observer and inter-observer agreement of dynamic MR imaging measurements for pelvic organ prolapse were in 

general excellent for all lines. The intra-class correlation coefficient for the mid-pubic line, pubococcygeal line and the 

horizontal line ranged from 0.84-0.99, 0,75-0.98 and 0.67-0.99, respectively. Intra-class coefficients were better for the pubococcygeal 

line compared to the mid-pubic and horizontal line, however not significant. 

Conclusion: 

Dynamic MR imaging demonstrated excellent inter- and intra-observer agreement using reference lines in pelvic organ 

prolapse grading. 

YR10 Small renal masses: assessment of dynamic contrast enhanced MRI 

M.M.H. Abd Ellah, L. Pallwein, C. Kremser, R. Peschl, G. Bartsch, M. Gregor, W. Jaschke, 


Purpose: 

We evaluated dynamic contrast MRI for differential diagnosis of small renal masses. 


We examined 15 patients with small renal masses (size < 3cm) (based on previous imaging studies). A T1-map dynamic 

contrast perfusion MRI was done for all patients using 1.5T Magnetom VISION (Siemens, Erlangen, Germany). All the obtained 

data were analyzed using the software ImageJ, with curves obtained for all examinations showing the pattern of enhancement. 

All patients underwent partial nephrectomy, and the histopathological findings were compared with the MRI findings. 

Results: 

Out of 16 patients, 11 showed RCC and 5 showed oncocytoma on pathohistology. Contrast dynamics (curves) of oncocytoma 

appeared different from RCC. Oncocytoma curves showed rapid enhancement with delayed wash-out. In comparison 

RCC showed also a rapid enhancement but a rapid washout. 

These differences in contrast dynamics might reflect the differences in microvasculature of these tumours. 

Conclusions: 

Dynamic contrast enhanced MRI has shown differences between RCC and oncocytoma. Even the data are obtained in a 

small series, this technique migght have the potential in differentiating small renal masses. 

YR11 Evaluation of renal transplant vascularization with contrast-enhanced ultrasonography (CE-US) 

I. Mancarella, A. Grossi, N.Caproni, P. D’Alimonte, G. Cappelli, P. Torricelli (Modena, Italy) 

Purpose: 

Compare CE-US with Power-DopplerUS(PD-US), S-creatinine clearance level and GFR in the assessment renal graft function. 


From December 2006 to April 2008, 56 patients submitted to renal transplantation (total of 62 kidneys) were enrolled. Each 

patient underwent S-creatinine (mg/dL) and GFR (ml/min)evaluation. CE-US and PD-US at day 15 post-transplant. At CE-US it 

was quantitatively analyzed the CE peak intensity (PI %=media of at least 2 ROIs located in the renal cortex) and the regional 

blood flow (RBF:ml/s). At PD-US it was evaluated the median Resistance Index (RI=media between IR of the main renal artery, 

the arcuate artery and the interlobar artery). Biopsy was indicated to confirm acute renal rejection. Correlation was considered 

significant if p

YR12 Excretory MR-Urography at 1.5 and 3 Tesla: Comparison with MDCT-Urography 



Purpose: 

To intraindividually compare the morphologic accuracy of contrast-enhanced MR-urography (MRU) and MDCT-urography 

(MDCTU) in a porcine model. 


After intravenous injection of low-dose furosemide, urographic imaging was performed in four pigs using a 1.5 and 3T MR-unit 

and a 16-row MDCT-scanner. A T1w 3D-GRE (TR/TE:5.1ms/2.3ms; matrix:256x179) and a high-resolution (HR) T1w 3D-GRE 

(TR/TE:5.4ms/2.4ms; matrix:464x354) sequence were used at both field-strengths. SENSE-imaging was additionally utilized at 3T. 

For MDCTU (collimation:16x1.5mm; tube-voltage:120kV), current-time product was set at 4 gradiations (200, 125, 70 and 30 

eff.mAs). A 4-point-grading-scale was applied for comparing both modalities regarding the depiction of the urinary tract. 

Statistics included kappa-analysis and Wilcoxon`s-test. 

Results: 

Anatomical depiction of the upper urinary tract was superior at 1.5 and 3T MRU compared to MDCTU at 30 eff.mAs. At 70 

eff.mAs, MDCTU was superior to MRU at 1.5T using a T1w 3D-GRE sequence (mean 2.56; p=0.012), but slightly inferior to HR T1w 

3D-GRE MRU at 3T (mean 3.17; p>0.05). With additional use of SENSE at 3T, the HR T1w 3D-GRE sequence was rated significantly 

higher than MDCTU at 70 eff.mAs (mean 3.44; p=0.014). With higher current-time products of 125 and 200 eff.mAs, 

MDCTU showed better delineation of pelvicalices and ureters, irrespective of sequence parameters or field strength. 

Conclusions: 

MRU with parallel image acquisition at 3T enables superior delineation of the upper urinary tract compared to low-dose 

MDCTU. Only at higher tube current-time products, MDCTU allows for a detailed depiction of the urinary tract and is superior 

to MRU at 1.5 and 3T. 

08:30 – 10:30 Scientific Session II: Members and Young Radiologists 


Abstracts YR13-YR16 und M19-M26 

YR13 MR imaging in the evaluation of pregnant patients with acute pelvic pain 


Purpose: 

The diagnosis of pelvic conditions during pregnancy can be challenging. Aim was to assess the performance of MR imaging 

in the evaluation and triage of pregnant patients presenting with acute pelvic pain. 


89 pregnant patients who underwent to MR examination because of acute pelvic pain between June 2006 and May 2008 

were included in this study. 

A US examination was performed in all patients before MR. Multiplanar HASTE, TRUE FISP and GRE MR images were obtained . 

In 71/89 (79%) of studies, gadolinium was not administered. The prospective clinical MR interpretations were compared with 

follow-up and surgical records to de-termine the correctness of the interpretation. 

Results: 

MR examinations demonstrated abnormalities in 34 patients: adnexal lesions (n = 3), ovarian torsion (n=1), urinary pathology 

(n = 5), degenerating fibroid (n = 3), placenta abruption (n=7), DVT (n = 2), hernia (n = 1), colitis (n = 1), thick terminal ileum 

(n = 1), rectus hematoma (n = 1), appendiceal abscess (n=1), appendicitis (n=2), intraabdominal and rectus muscle abscess 

(n=1), intussusception (n=1), ulcerative colitis (n=1), Crohn’s disease with diffuse peritoneal inflammation (n=3). 

The sensitivity, specificity, accuracy, positive predictive values (ppv), and negative predictive values (npv) of MR imaging 

were 95% , 96% , 96% , 95%, 94%, respectively. 

Conclusions: 

The intrinsic safety of MRI and its ability to accurately show pelvic disease in pregnant patients make it highly useful in the 

evaluation of these patients. 

YR14 Intraindividual Comparison of Image Quality in MR-Urography at 1.5 and 3 Tesla using an Animal Model 


Purpose: 

To compare image quality and anatomical depiction of the upper urinary tract using MR-urography at 1.5 and 3 T 

in a porcine model. 


Using a T1w 3D-GRE sequence (TR:5.1ms; TE:2.3ms; FOV:34.9x29.2cm; matrix:256x179) and a high-resolution 

(HR) T1w 3D-GRE sequence (TR:5.4ms; TE:2.4ms; FOV:32.9x29.8cm; matrix:464x354) four healthy domestic 

pigs were examined at 1.5 and 3 T. The MR-urographic scans were performed after intravenous injection of 

Gadolinium-DTPA (0.1 mmol/kg) and low-dose furosemide (0.1 mg/kg). Image evaluation was performed by 

two independent radiologists blinded to applied sequence parameters and field strength. Image analysis included 

grading of image quality of the segmented collecting system based on a 5-point-grading scale regarding the 

41


anatomical depiction and degree of artefacts observed. The signal-to-noise ratio (SNR) was determined. 

Statistical evaluation included kappa-analysis and Wilcoxon`s-test. 

Results: 

The mean scores for MR-urographies at 1.5 T were 2.83 for the T1w 3D-GRE and 3.48 for the HR T1w 3D GRE 

sequence. Significantly higher values were determined using the corresponding sequences at 3 Tesla, averaging 

3.19 for the T1w 3D-GRE (p=0.047) and 3.92 for the HR T1w 3D-GRE (p=0.023) sequence. Delineation of the 

pelvicaliceal system was rated significantly higher at 3 Tesla compared to 1.5 Tesla (T1w 3D-GRE: p=0.015; HR 

T1w 3D-GRE: p=0.006). At 3 Tesla the mean SNR was 45.6 % (p=0.039) higher. A Kappa of 0.67 indicated a 

good correlation among the two observers. 

Conclusions: 

In an experimental setup MR-urography at 3 T allowed for a significantly higher image quality and SNR compared to 1.5 T. 

M19 Assessment of acute unilateral ureteral obstruction by functional MRI 

H.C. Thoeny, T. Binser, T.M. Kessler, Urs E. Studer, Peter Vermathen (Bern, Switzerland) 

Purpose: 

To prospectively assess the potential of diffusion-weighted (DW-MRI) to detect changes in diffusion and micro-perfusion 

during acute unilateral ureteral obstruction. 


Sixteen patients (age 43.3+10.7years) with acute unilateral ureteral obstruction due to a calculus underwent MRI of the kidneys 

on a 1.5T-system. Next to conventional MRI (cor-onal HASTE, axial and coronal T1-w sequences), coronal DW-MRI was 

performed with the following parameters: slice thickness 5mm, gap 1mm, 6 acquisitions with isotropic diffusion-weighting, 

TE=71ms, respiratory-triggering. Ten b-values (0-900sec/mm2) were applied. Standard processing yielded ADCtot, whereas 

micro-perfusion and diffusion contributions were separated by biexponential fitting, yielding the perfusion-fraction Fp and the 

“pure” diffusion coefficient ADCD. The Wilcoxon signed rank test was used to statistically compare obstructed and nonobstructed 

kidney. P0.03), while this difference was not significant in cortex. 

The perfusion fraction Fp of the obstructed kidney was significantly lower compared to the nonobstructed kidney in medulla 

(18.0+5.9 and 21.4+6.8, respectively, P

M20 Diffusion-weighted MR imaging in patients with gross hematuria 

M.E.Abou El-Ghar, A.M.El-Assmy, H.F.Refaie, T.A.El-Diasty (Mansoura, Egypt) 


Purpose: 

To evaluate the usefulness of diffusion-weighted (DW) MRI in evaluating patients with gross hematuria of lower urinary tract 

origin. 


Between April 2007 to March 2008, 130 patients who had gross hematuria and whose upper urinary tract had a normal 

appearance on routine ultra-sound examination were prospectively included in our study. All patients were evaluated with 

T2 weighted high resolution MR of the urinary bladder, then DW MRI. Two radiologists independently interpreted the MR 

images, and discrepancies were resolved by consensus. All patients also underwent conventional cystoscopy. Using cystoscopy 

as the gold standard; the accuracy of DW MRI in identifying bladder tumors and detecting the source of hematuria 

was evaluated. 

Results: 

The causes of hematuria were bladder tumors in 106 patients, cystitis in 14, prostatic adenocarcinoma in 7, ureteric tumor in 1 

and colonic carcinoma invading the bladder in 2. In determining bladder tumors, the reviewers’ interpretations of DW MRI 

data agreed with their interpretations of cystoscopic data in 104 patients. Two malignant bladders were misdiagnosed as 

normal. The agreement between DW MRI and cystoscopic findings was excellent for identification of bladder neoplasm 

(kappa=0.94). For the identification of bladder tumors on DW MRI we found the following parameters: sensitivity, 98.1%; specificity, 

92.3%; positive predictive value, 98.1%; negative predictive value, 92.3%; and accuracy, 96.9%. For identifying the 

cause of hematuria the sensitivity and positive predictive value were 96.1% and 100% respectively. 

Conclusions: 

DW MRI is a promising imaging modality for evaluation of patients with gross hematuria. 

M21 Primary vesicoureteral reflux associated with mild antenatal hydronephrosis - Usefulness of 

voiding urosonography in the diagnosis 

F. Papadopoulou, E. Siomou, A. Charisiadi, V. Giapros, G. Makridimas, S. Andronikou, C. Tsamboulas 

(Ionnanina, Greece) 

Purpose: 

To evaluate the occurrence and severity of vesicoureteral reflux (VUR) in young infants with mild prenatal hydronephrosis 

and the usefulness of contrast-enhanced-harmonic voiding urosonography (VUS) in the diagnosis of VUR. 


Sixty infants (123 kidney-ureter-units (KUU]), with an anterior-posterior pelvic diameter of 5-9 mm and no other abnormalities 

shown on US during 21th-30th gestational week, were enrolled in the study. Postnatal ultrasound was performed within the 

first month of life. Voiding cystourethrography (VCUG) and VUS at same session, were performed at 1.5-2.5 months of age. 

Results: 

Postnatal ultrasound verified mild hydronephrosis in all infants. VUR was found on either method in 26/123KUU [21%] (grade 

I:1, II:11, III:12, IV:2) or in 19/60 (31.6%) infants. VUR was detected by both VCUG and VUS in 11/26KUU (42.4%), only by VCUG 

in 1 KUU (3.8%) and only by VUS in 14/26KUU (53.8%). VUR that was missed by VCUG was more severe (9 KUU grade II and 5 

grade III), compared with that one missed by VUS (1 grade I)[p=0.002]. Agreement between VUS and VCUG was found in 

108/123 KUU (87.8%, k=0.53). 

Conclusions: 

Mild prenatal hydronephrosis was associated with an important occurrence of VUR although of mild or moderate severity. 

Comparison between the two imaging methods showed that VUR missed by VUS was of no clinical significance (grade I), 

whereas VUR missed by VCUG was more severe. So, VUS as a more sensitive method in depicting VUR could be an alternative 

way of imaging infants with a mild prenatal hydronephrosis, thus avoiding the radiation exposure. 

M22 Contrast enhanced Ultrasonography in the evaluation of renal trauma 

P. Pavlica, M. Valentino, L. Barozzi (Bologna, Italy) 

Purpose: 

To prospectively compare the diagnostic value of ultrasound (US) and contrast-enhanced ultrasound (CE-US) with computed 

tomography (CT) for detection of renal injuries in blunt abdominal trauma patients. 


Materials and methods. US, CE-US and CT were performed to assess possible abdominal organ injuries in 152 non consecutive 

hemodynamically stable patients with blunt abdominal trauma and a strong clinical suspicion of abdominal lesions. US 

and CE-US findings were compared with CT findings, the reference standard technique. 24 out of 152 patients (15,7%) had 

renal lesions, the severity of which was graded according to the organ injury severity scale of the American Association for 

the Surgery of Trauma (AAST). 

Results: 

Eleven out of 24 traumatic parenchymal lesions had perirenal fluid collection at baseline US. 27 renal parenchymal lesions, 

with or without perirenal or retroperitoneal haematoma, were identified at contrast-enhanced US. The sensitivity and specificity 

of US were 45.8 % and 91.4 % respectively. CE-US had a sensitivity of 96.4 %, a specificity of 100 % and a positive and 

negative predictive value of 100% and 92.5 % respectively. 

43


Conclusions: 

CE-US was found to be more sensitive than US and almost as sensitive as CT in the detection of traumatic renal traumatic injuries. 

It can therefore be proposed as a useful tool in the assessment of blunt abdominal trauma. CE-US reduced radiation 

exposure and can be used also in patients with reduced renal function and/or with previous adverse reaction to iodinated 

contrast media. 

M23 A cohort study demonstrating improved survival in patients with relapsed FIGO stage IIIC ovarian cancer 

with CT pattern of ‘lymph node only’ disease compared to those with additional peritoneal disease 

N Tahir, C Haigh, G Hall, JA Spencer (Leeds, United Kingdom) 

Purpose: 

Recent work suggests that women whose only stage IIIC disease from ovarian cancer (OC) at presentation is lymph node 

metastasis have a better prognosis than those with peritoneal carcinomatosis (PC). We determined if women at our centre 

with relapsed FIGO stage IIIC ovarian cancer had a better prognosis with CT ‘lymph node only’ disease than with PC. 

Materials and methods: 

A cohort of 180 women with newly diagnosed OC were identified from 2000-2001 to allow a minimum 5-year outcome 

assessment. Women who subsequently relapsed with stage IIIC pattern were identified as having ‘lymph node only’ disease 

or PC on CT. Outcome after this first relapse was assessed with longitudinal documentation of CT patterns and sites of disease 

after retreatment. 

Results: 

Six women of the 180 had primary relapse with a CT ‘lymph node only’ disease. Average time from diagnosis to relapse was 

21 months. 5-year survival of these women was 86% compared with only 26% in the remainder of the cohort. Four of the 6 

women are still alive but with persistent disease. 

Conclusions including clinical relevance: 

Ovarian cancer which relapses with the ‘lymph node only’ CT pattern of metastasis represents a small subgroup identifiable 

by CT but one with a far more favourable prognosis than stage IIIC peritoneal relapse. These data correlate with a recent 

study at initial diagnosis of OC. The FIGO staging classification of ovarian cancer might be modified to reflect this more 

favourable outcome of ‘lymph node only’ metastatic disease. 

M24 Size, location & number of fibroids are not associated with success rate & complications in 

uterine artery embolization 

K. Firouznia, H. Ghanaati, R. Bohloul, A.H. Jalali, M. Shakiba (Teheran, Iran) 

Purpose: 

To evaluate whether the size, location, or number of the fibroids affects therapeutic efficacy or complications of 

uterine artery embolization (UAE). 


Patients with symptomatic uterine fibroids (n = 165) were treated by selective bilateral UAE using 500 to 710 µm 

polyvinyl alcohol (PVA) particles. Baseline measures of clinical symptoms, sonography, and MRI; taken before the 

procedure were compared to those taken 1, 3, 6, and 12 months later. 

Complications and outcomes were analyzed for associations with fibroid size, location, and number. 

Results: 

Reductions in mean volume of the dominant fibroid were similar in patients with single (61.5%±38.3) and multiple (65.9%±25.3) 

fibroids after 12 months (P= 0.60). Menstrual improvement was not statistically different in patients with single (93.9%) and multiple 

(81.4%) fibroids (P= 0.11). In multivariate linear regression analysis, between primary volumes of dominant fibroids, their 

location, and number, as independent variables and percentage reduction of fibroid volume after 1 year yielded a weak R2 

equal to 0.10. This analysis was not significant for uterine volume reduction too (R2=0.09, P=0.12). 

Multivariate regression models revealed no statistically or clinically significant coefficients or odds ratios for three independent 

variables (primary size of the dominant fibroid, total number, and fibroid location) and all outcome variables (percent 

reduction of dominant fibroid volumes in 1 year, improvement of clinical symptoms [menstrual, bulk related, and urinary] in 1 

year, and complications after UAE). 

Conclusions: 

UAE outcome was not statistically or clinically affected by the primary size, location, or total number of fibroids. 

M25 Radiologic and Ultrasonographic aspects of Cowper’glands and ducts pathology 

P. Pavlica, M. De Matteis, L. Barozzi, M. Valentino (Bologna, Italy) 

Purpose: 

Cowper’s glands are accessory sexual glands and are made of a main gland situated on either side of the bulbar urethra at 

the level of the urogenital diaphragm. Their long ducts are drained into the bulbar urethra by small paramedian orifices. The 

glands can be the site of cystic dilatation or inflammation and their ducts can show a dilatation that can produce voiding 

obstruction. The indicative signs of this particular pathology are not specific and voiding cystography, retrograde urethrography 

or sono-urethrography are the non invasive methods commonly employed to diagnose them. 

44



23 adult patients with Cowper’s gland or duct pathology were observed. Sonography was used in 16 cases, radiography in 

23 and cystoscopy in 7. 

Results: 

The most common symptoms (15 pts) were stranguria and post-urinary dribbling, two perineal pain during straining and six 

were asymptomatic were investigated for different pathology. In two cases small calcifications were detected at the level of 

the urogenital diaphragm on the plain film and transrectal sonography. Abscess of the gland was observed in 1 patient and 

cystic dilatation in 2 cases. The dilated Cowper’s duct or syringocele was the most frequent pathology. 

Conclusions: 

Cowper’s glands and duct pathology is considered rare but the diagnosis should be entertained in any male presenting with 

long standing irritative or obstructive symptoms when no other explanation is found. The diagnosis is obtained only with voiding 

or retrograde urethrography. Transperineal sonourethrography is very helpful in all cases prior any therapeutic procedure. 

M26 Prediction of subsequent biopsy results after negative prostate biopsy: comparison of DRE, 

PSA, and MRI and MR spectroscopy of the prostate 

UG Mueller-Lisse, MK Scherr, M Seitz, CG Stief, MF Reiser (Munich, Germany) 

Purpose: 

To assess predictive values for results of subsequent prostate biopsy of digital rectal examination (DRE), prostate-specific 

antigen (PSA), and combined MRI and MR spectroscopy (MRI+MRS) of the prostate in patients with suspicion of prostate 

cancer (PCA) and previously negative prostate biopsy (pnpbx). 

Material and Methods: 

Patients with pnpbx, continuing suspicion of PCA at DRE or PSA (>4 ng/ml), MRI+MRS of the prostate with an endorectal-coilbody-phased-array-coil 

system at 1.5T between 05/2003 and 04/2007, and subsequent prostate biopsy in our institution were 

identified. Findings at DRE, PSA, and MRI+MRS and biopsy results were retrospectively compared. 

Results: 

Among 42 patients (age+/-s.d., 64+/-6 years, PSA 11.0+/-6.7 ng/ml, 2+/-1 [1-6] pnpbx, no previous prostate treatment), subsequent 

prostate biopsy revealed PCA in 12 (29%, Gleason sums of 6+/-1). PSA did not differ significantly between patients with 

(14.7+/-9.6 ng/ml) and without PCA (9.5+/-4.2 ng/ml, t-test, p=0.1094). Respective sensitivity, specificity, positive and negative 

predictive values for PCA at subsequent biopsy were 6/12 (50%), 22/30 (73%), 6/14 (43%), and 22/78 (79%) for DRE, 12/12 

(100%), 10/30 (33%), 12/32 (38%), and 10/10 (100%) for MRI+MRS, and 11/12 (92%), 27/30 (90%), 11/14 (79%), and 27/28 (96%) 

for MRI+MRS with signs of PCA in more than one half prostate sextant of the peripheral zone. 

Conclusions: 

It appears that, after negative prostate biopsy, MRI+MRS of the prostate detect both patients who would not benefit from 

subsequent prostate biopsy and patients whose subsequent biopsy is highly likely to show prostate cancer. 

YR16 Value of 3 Tesla Multi-modality directed MR Guided Biopsy to Detect Prostate Cancer in highrisk 

patients after at least two previous negative biopsies 

T. Hambrock, R. Somford, J.J. Fütterer, H.J. Huisman, J.P. van Basten, I. van Oort, F.J.A. 

Witjes, J.O. Barentsz (Nijmegen, The Netherlands) 

Purpose: 

Determine the tumor detection rate, Gleason score distribution and location of tumors detected with MR guided prostate 

biopsies of tumor suspicious regions (TSR) identified on T2-weighted, Diffusion Weighted and Dynamic Contrast Enhanced MR 

imaging in patients with high PSA (> 4 ng/ml) and multiple previous negative biopsies. 


63 Patients with high PSA and previous negative prostate biopsies received a multi-modality 3T MRI for prostate cancer 

detection. TSRs were determined using the multi-modality images. An MR biopsy device was used to perform prostate biopsies 

of these TSRs. 

Results: 

Patients had a median PSA value of 13 ng/ml (range 4-123) and median of 2 (range 2–7) previous biopsies. 106 TSRs in 63 

patients were biopsied and 240 cores obtained. The tumor detection rate was 57% (36/63 patients). 42/106 (40%) TSRs contained 

tumor. Prevalence of Gleason 5 tumors was 5%; Gleason 6, 50%; Gleason 7, 29%; Gleason 8, 14% and Gleason 9 

tumors, 2%. Location of tumors were: transition zone 57%, peripheral zone 33% and central zone 10%. Median number of biopsies 

obtained was 4 (range 1-7) and mean duration of MR biopsies was 31 min (range 14-75 min). One transient transurethral 

hemorrhage and one urinary tract infection were the only procedure related complications. 

Conclusions: 

MR guided biopsies targeted towards multi-modality 3T MRI determined TSRs is an effective method for detecting prostate 

cancer in high risk patients with multiple previous negative biopsies. A large number (45%) of aggressive tumors (Gleason ≥ 7) 

were found and the predominant location of tumor was the transition zone. 

45


08:30 – 10:30 Scientific Session III: Genital tract and MCU 



ScS1 Preliminary experience of cadence contrast-pulse sequence ultrasound technique in prostate 

cancer diagnosis 

J. Gradl, E. Pallwein, L. Pallwein, V. Spiss, F. Aigner, W. Jaschke, G. Bartsch, F. Frauscher (Innsbruck, Austria) 

Purpose: 

Cadence contrast-pulse sequence (CPS) ultrasound technique has shown to be useful for detection of liver tumours and 

follow-up after radiofrequency ablation therapy of hepatocellular carcinomas. In a small series of 20 patients CPS was evaluated 

for detection of prostate cancer. 


CPS technique was used to assess the intraprostatic vasculature during microbubble administration. Transrectal US was performed 

using a 8C4 probe with a transmitting frequency varying between 4 and 5.0 MHz. To reduce micobubble destruction 

a low mechanical index (0.14) was used. The US contrast agent SonoVue, was administered by bolus injection, to a maximum 

dose of 4.8 ml. The blood flow of the peripheral zone was evaluated, and areas of earlier and stronger contrast enhancement 

were defined as suspicious for malignancy. Up to five targeted biopsies were performed from suspicious areas, and 

subsequently another investigator performed ten systematic biopsies in a standard spatial distribution. The cancer detection 

rates were compared. 

Results: 

CPS imaging found suspicious areas of contrast enhancement in 11 of 20 cases (55%). CPS targeted biopsy revealed cancer 

in eight of the 11 cases (73%). In comparison were in the systematic biopsy in five of 20 subjects (25%) cancer found. Overall 

CPS detected cancer in 8/20 (40%) and systematic biopsy in 5/20 (25%) subjects. Therefore cancer detection was significantly 

improved (p



The biopsy results were analysed in 2350 patients in which the procedure was performed between January 2004 

and June 2007. The patients were divided in 3 groups on the base of the sample number performed: Group A up 

to 6 cores (874 pts), Group B performed 7-8 cores (1175 pts) and Group C who performed more than 8 samples 

(310 pts). There was not a statistical difference between age and serum PSA values between the three groups. 

Results: 

The incidence of prostate carcinoma was of 43.9% in Group A, of 47,9% in Group B and of 46.4% in Group C. 

Precancerous lesions (HG PIN and ASAP) displayed the same incidence in the groups considered. 

Conclusions: 

Our data show that the detection rate of prostate cancer does not change statistically with the increase number 

of the samples performed, as is emerging from some prospective non randomized studies. Controversy continues 

to surround the optimal number and placement of biopsies for detection of cancer. The increase number of 

samples is associated to higher costs, discomfort for the patient and increased incidence of complications. 

ScS4 Is real-time elastography targeted biopsy able to enhance prostate cancer detection? 

An analysis of detection rate using an elasticity-scoring system 

E. Pallwein, F. Aigner, L. Pallwein, V. Spiss, W. Horninger, W. Jaschke, G. Bartsch, F. Frauscher 


Purpose: 

Real-time elastography (RTE) has already shown its ability to detect PCa. This prospective study was performed to evaluate 

RTE for targeted prostate biopsy in a PSA first line screening population in comparison to cancer detection rate of systematic 

biopsy. 


Included were 383 patients with elevated PSA (mean: 7.0± 13.8) and scheduled for systematic biopsy. Before systematic 

approach a targeted biopsy with a limited number of cores (maximum 5) was performed. Targeted biopsy was based on 

findings in RTE. Stiff lesions were considered malignant. Appearance of elasticity of outer gland areas was divided into: score 

1- normal (regular stiffness), score 2- indeterminate (inhomogeneously increased stiffness), and score 3-suspicious (homogeneously 

increased stiffness). PCa detection rate of each stiffness grades were compared with findings of systematic biopsy. 

Results: 

Sensitivity for PCa detection (134 of 383 patients; 35%) was 91.0% (122/134) for RTE targeted biopsy and 76.9% (103/134) for 

systematic biopsy. Score 1 elasticity pattern was found in 129 patients, 3 of them (2.3%) showed cancer, Score 2 elasticity 

pattern in 146 patients, 42 of them (28.8%) showed cancer, and Score 3 elasticity pattern in 108 patients, 89 of them (82.4%) 

showed cancer. The correlation between stiffness grade and Gleason Score was significant. The prostate volume and the 

PSA also were correlated with the stiffness grades. 

Conclusions: 

RTE has already shown its value for PCa detection. The use of a stiffness grading systems seems to be able to further enhance 

the PCa detection rate and can increase the diagnostic accuracy of RTE. 

ScS5 Prostate cancer (PCa) detection in patients with a total PSA (tPSA) < 10 ng/ml: targeted biopsy with 

a sonographic triple approach and a reduced number of cores versus systematic 10 core biopsy 

F. Aigner, E. Pallwein, L. Pallwein, V. Spiss, W. Horninger, W. Jaschke, G. Bartsch, F. Frauscher 


Purpose: 

Results of a targeted biopsy approach based on findings in grey scale (GS), color Doppler (CD) and real-time elastographical 

(RTE) imaging were compared with systematic biopsy findings for detection of prostate cancer. 


94 patients (mean age: 61, 8; range: 42-86) with a tPSA serum value lower than 10 ng/ml (mean: 5,1; range:1,3-10) underwent 

a 5 core targeted biopsy by an uroradiologist. Targeted cores only were taken from areas with pathologic patterns in 

GS ,CD, or RTE imaging (Hitachi EUB-8500). In the same session a 10 core systematic biopsy was performed by a blinded urologist. 

PCa detection rates were compared. 

Results: 

28/94 patients showed PCa (mean gleason score: 6,3; range: 5-9). Systematic approach detected 18/28 (64.2%), targeted 

biopsy approach detected 23/28 (82.1%). In the group of patients with a tPSA of < 4 ng/ml, 12 patients showed cancer and 

targeted biopsy was able to detect 10 and systematic biopsy 7 of these12. The detection rate in the group with tPSA of 4-10 

ng/ml was 15/16, for targeted biopsy and 11/16 for systematic biopsy. 

Conclusions: 

The targeted biopsy based on a sonographical triple approach with a reduced number of cores seems to increase PCa 

detection rate even in patients with a tPSA of < 10 ng/ml. Therefore the targeted technique may be able to reduce costs 

and complications of pros-tate biopsy. 

47


ScS6 Can T2w endorectal MRI play a role in MRI guided prostate interventions? – A histopathologic 

correlation with whole-mount sections in 70 patients with prostate cancer 

M.P. Lichy, L. Jurgschat, U. Vogel, D. Schilling, A. Anastasiadis, C.D. Claussen, H.-P. Schlemmer 

(Tuebingen, Germany) 

Purpose: 

To evaluate the diagnostic performance of T2w endorectal MRI in localization of tumors foci within the prostatic gland. 


70 patients with prostate cancer (PCa) were examined with endorectal MRI (endoMRI) for therapy planning before radical 

prostatectomy. MRI was performed on a standard 1.5T whole-body with T2w turbo spin echo sequences. For evaluation of 

MRI, two radiologists evaluated each tumor focus and documented localization, size and configuration. After radical 

prostatectomy, the prostates were prepared as whole-mount sections, according to the slice orientation and slice thickness 

of the transversal T2w MRI. Histology and endoMRI were compared for each slice. Based on whole-mount section, 315 slices 

were evaluated. Totally, 533 tumor lesions were documented (8+/-5 lesions per patient). 

Results: 

Based on the T2w endoMRI, 210 tumor lesions were described. In 130/211, histology could prove these lesions. For the other 

423 histological confirmed also on a separate restrospective evaluation no clear demarcation of these lesions on T2w MRI 

was observed. Additionally, the lesions were categorized according their maximal diameter on the whole-mount sections. 

MRI was able to visualize 0 / 56 lesions with a maximum size of < 0.3 cm (detection rate 0%), between 0.3–0.5cm 4/116 (3%), 

between 1–0.5cm 22/169 (13%), between 2–1 cm 61/135 (45%) and for >2cm 43/57 (75%). False positive endoMRI findings 

were: 2cm 15. 

Conclusions: 

Conventional T2w MRI is able to visualize tumor lesions down to 1cm within the prostate with acceptable diagnostic accuracy. 

ScS7 Detection of prostate cancer recurrence with 11C-Acetate PET-CT in patients with early 

biochemical failure after prostatectomy 

A. Bergman, I. Verbiene, D. Kudrén, I. Turesson, J. Sörenssen (Uppsala, Sweden) 

Purpose: 

Localisation of prostate cancer recurrence in patients with early biochemical failure after prostatectomy with conventional 

image techniques is often not possible. Treatment decisions are different for relapse in the prostate bed, pelvic lymph nodes 

and distant metastases. The main purpose of our study was to evaluate the role of 11C-Acetate PETCT in prostate cancer 

patients with early biochemical failure after prostatectomy. 


52 patients with PSA relapse underwent 11C-Acetate PETCT and uptake was interpreted as pathological, non 

pathological or equivocal. PSA ranged between 0.12 ng/ml and 4.3 ng/ml (median 0.9 ng/ml). 

Results: 

PETCT showed pathological uptake in 36 patients: 13 in prostate bed only, 24 in pelvic lymph nodes with or without uptake 

in prostate and 6 in distant metastases. Pathological uptake in pelvic lymph nodes among the 24 patients was distributed as: 

iliaca externa, iliaca interna and iliaca communis region in 86%, 17%, and 31% of cases respectively. Totally 12 patients 

underwent a new PETCT after treatment with bicalutamid, and in 10 regression of pathological 11C-Acetate uptake was 

observed. 

Conclusions: 

Our findings indicate that 11C-Acetate PETCT has the diagnostic potential in prostate cancer patients with early 

biochemical failure after prostatectomy. 

ScS8 Percutaneous Intensity-modulated Irradiation of Prostate Cancer: Monitoring Radiation 

induced Tissue Changes Using DCE-DSC-MRI 

T. Franiel, L. Lüdemann, M. Taupitz, C. Stephan, B. Hamm, D. Beyersdorff (Berlin, Germany) 

Purpose: 

To quantify pharmacokinetic parameters and their posttherapeutic course after percutaneous intensity-modulated radiotherapy 

of prostate cancer. 


Six patients with biopsy-proven prostate cancer (initial PSA, 6.0-81.4 ng/ml) and a continuous posttherapeutic PSA decrease 

(PSA 2 years after radiotherapy, 0.2-1.1 ng/ml) underwent MRI at 1.5 Tesla using a combined endorectal/body phased-array 

coil and a dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence (T1w and T2*w; temporal 

resolution, 1.65s). MRI was performed before and immediately after radiotherapy, at 3 months and at 1 year. A sequential 

3-compartment model was used to calculate the following pharmacokinetic parameters in prostate cancer and normal prostate 

for all four time points: perfusion, blood volume, mean transit time, delay, dispersion, interstitial volume, and extraction 

coefficient. A trend test with baseline adjustment was applied to evaluate parameter changes over time. 

Results: 

Prostate cancer and normal prostate tissue showed a statistically significant decrease in perfusion (p=0.006, p=0.001) and 

increase in extraction coefficient (p=0.004, p


Statistically significant differences between prostate cancer and normal prostate tissue were only observed before radiotherapy, 

when prostate cancer showed significantly higher perfusion (1.84 vs. 0.12 ml/cm 3 *min, p=0.028), shorter mean transit 

time (4.48 vs. 10.72 s, p=0.046), and a smaller extraction coefficient (0.42 vs. 0.64, p=0.028). 

Conclusions: 

Two pharmacokinetic parameters, perfusion and extraction coefficient, appear to allow monitoring changes induced by 

percutaneous intensity-modulated radiotherapy of prostate cancer. 

ScS9 Prostate MRI: Tissue Characterization Using Volume and Perfusion Parameters and 

Correlation with the Histologic Prognostic Factor Mean Vessel Density 

T. Franiel, L. Lüdemann, M. Taupitz, C. Stephan, D. Böhmer, B. Hamm, D. Beyersdorff (Berlin, Germany) 

Purpose: 

To determine and quantify MRI parameters that allow calculation of histological mean vessel density (MVD), mean vessel 

area (MVA), and mean interstitial area (MIA). 


Thirty-eight consecutive patients with biopsy-proven prostate cancer (PSA: 1.4-31.4ng/ml) were examined with a dynamic 

contrast-enhanced inversion-prepared dual-contrast gradient echo sequence (temporal resolution, 1.65s) at 1.5 Tesla using 

the combined endorectal/body phased-array coil to calculate blood volume, interstitial volume, and perfusion. In 35 

patients who underwent prostatectomy, blood and interstitial volumes and perfusion were correlated with MVD, MVA, and 

MIA in 95 areas (36x prostate cancer, 27x chronic prostatitis, 32x normal prostate tissue) in immunohistochemically prepared 

histologic sections corresponding to the MR images. For each MRI area, 5 1mm2 squares (100x magnification) of the matching 

histologic area were analyzed. 

Results: 

Blood volume correlated adequately with MVD (RS=0.252, p=0.014) but not with MVA (p=0.759). Interstitial volume did not 

correlate with MIA (p=0.507). Blood volume differed significantly between prostate cancer and normal prostate (1.49 vs. 

0.84%, p


Results: 

Only 48% of the referrals were for clinically valid indications. These were considered to include testicular masses/ swellings, 

acute scrotal pain, epididymo-orchitis, undescended and atrophic testis, postoperative complications and one case each 

of haematospermia and infertility. The urologists referred patients for valid indications in 63% of cases compared to 39% for 

GPs. Invalid indications included longstanding pain/ discomfort, epididymal cysts/lumped outside testes and hydrocele 

amongst others 

Ultrasound findings confirmed clinically suspected abnormalities in only 16% of referrals with a valid indication. Scans were 

done within a median time of 25 days. The 2 week target for suspected testicular cancer scans was met. 

Conclusions: 

Ultrasound is a valuable non-ionising tool in the assessment of testes, but referrals for sonographic examination must ideally 

be following Urologist review or follow referral guidelines in order that the department’s limited resources be directed to help 

those patients in whom there is a potential health benefit. 

ScS12 Pre-treatment tumor necrosis evaluated by magnetic resonance dynamic contrast-enhanced 

subtraction imaging as a predictor of chemoradiotherapy response in advanced cervical cancer 

L. Mannelli, E. Sala, A. Priest, D. Lomas (Cambridge, United Kingdom) 

Purpose: 

To retrospectively evaluate dynamic contrast enhanced magnetic resonance (DCE-MRI) subtracted imaging as predictor of 

chemoradiotherapy response in patients with advanced cervical cancer. 


13 patients with advanced cervical cancer treated with chemo-radiotherapy underwent DCE-MRI at 3 time-points: before 

treatment, after 2 weeks of chemoradiotherapy and at the completion of chemoradiotherapy (5 weeks) but before the start 

of brachytherapy. The MRI protocol included T1W axial and T2W sagittal, axial and axial oblique images followed by a T1W 

perfusion sequence (PWI). This consisted of a 3D T1W fast spoiled gradient echo (TR/TE = 4.8/1.5 ms, flip angle = 18o) of 4 

contiguous sagittal sections repeated every 3 seconds for a total of 180 seconds after contrast administration. Subtraction 

imaging was performed at 18, 78 and 138 seconds after contrast medium injection using GE-AW 4.2_03 Image Combination 

(Version 3.0.63) subtraction tool based on a voxel-by-voxel method. The percentage of tumour necrosis was assessed on 

subtracted images using a visual analogous scale and was correlated with radiological tumour response. 

Results: 

13 patients had a total of 38 MRI examinations. The pre-treatment percentage tumour necrosis assessed using arterial subtraction 

imaging (at 18 seconds) showed an excellent inverse correlation with percentage of tumour regression (r = -0.934, 

p < 0.001). 

Conclusions: 

This study shows that pre-treatment tumour necrosis assessed with arterial image subtraction predicts the radiation response 

in cervix cancer. This measurement may allow a tailored therapy for patients with cervix cancer. 

08:30 – 10:30 Scientific Session IV: Urinary tract 



ScS13 Imaging and Doppler finding in dual kidney transplantation (DKT) from “marginal” donors (MD) 

M.B. Damasio, D. Rolla, G. Cittadini, M. Gherzi, G. Cannella, L.E. Derchi (Genova, Italy) 

Purpose: 

To analyze imaging and Doppler findings in patients (pts) with dual kidney transplantation (DKT) from “marginal” donors (MD) 

and to compare renal volume and RI values with kidneys of pts with single kidney transplantation (SKT) from “ideal “donors. 

Methods and materials: 

We reviewed clinical and imaging (30 Doppler-US examinations, 6 MR and 1 CT) findings in 31 pts with DKT. Only three had clinical 

graft malfunction. Renal volumes and RIs of DKT were compared with those of 14 pts with SKT and comparable levels of 

renal function. 

Results: 

The 3 pts with graft malfunction had chronic rejection, encrusted pyeloureteritis of left graft and occluded main artery of left 

graft. Unilateral pathologies were seen in additional 7 cases (1 stenosis of left iliac artery, 1 terminal ureteritis, 3 pelvic dilatations 

with urothelial thickening, 2 lymphoceles). 

In asymptomatic DKT patients, no differences between right and left kidneys were observed in renal length (10,47 vs 10,37 

cm), volumes (115,23 vs 114,89 cc), cortical echogenicity and RIs (0,76 vs 0,75). Two of the pts with graft malfunction had the 

highest Ris (mean 0.89 and 0.86). At comparable levels of renal function, renal length, volumes and RIs resulted statistically 

different between DKTs and SKTs (respectively: lower length and volume, higher Ris). 

Conclusion: 

Imaging and Doppler provide useful information in patients with DKT, allowing detection of unilateral diseases not suspected 

on clinical and laboratory grounds. 

At comparable levels of renal function, DKT patients have higher RIs and lower volumes than SKTs, probably related to the 

older age of donors. 

50


ScS14 Preoperative assessment of potential live kidney donors from IV-DSA to 64 multidetector CT: 

Single center experience 

H.F. Refaie, M.E. Abou El-Ghar, T.A. El-Diasty, A.F. Refaie, A.A. Shokeir, M.A. Ghoneim (Mansoura, Egypt) 

Purpose: 

In this study we represent our experience at Mansoura Urology & Nephrology center –Egypt in preoperative evaluation of the 

potential live kidney donors . 


We retrospectively studied 1916 potential live kidney donors who underwent open surgical nephrectomy from October 1984 

till April 2008.We revised our published data about intravenous digital subtraction angiography (IV-DSA) and intra arterial- 

DSA(IA-DSA), the MR angiography(MRA) and 4 row CT angiography(CTA) and we included the results of the newly used 64 

multidetector CTA. IVU was a complimentary study in all cases of IV-DSA also CTU in cases studied with CT and MRU in cases 

studied with MRI. Functional evaluation was also tried with CT and MR and compared with Isotope renography that was 

done for all cases. 

Results: 

Among our donors there were 1521 cases underwent IV-DSA with the sensitivity, specificity and overall accuracy was 

96%,57% and 93% respectively while for 213 cases who underwent IA –DSA was 95%,75% and 90% respectively, and it was 

100% ,94% and 96 % respectively in 811 case underwent MRA.80 cases were examined using 4 row CTA with sensitivity, 

specificity and overall accuracy were 100% ,86% and 97% respectively and it was 100% ,100% and 100% for 25 cases 

examined 64 multidetector CT. 

Conclusions: 

At this study we represent our experience in preoperative assessment of potential live kidney donors from the conventional 

IV-DSA till the 64 multidetector CT. 

ScS15 Evaluation of Randall’s plaque theory with CT attenuation values- an observational study 

N. Bhuskute, W.W. Yap, T.M. Wah (Leeds, United Kingdom) 

Purpose: 

We examined the computed tomography attenuation values (HU) of renal papillae in stone formers (SF) to determine whether 

nephrolithiasis is associated with radiographic changes in renal papillae to investigate the Randall’s plaque theory. 


Two observers independently and retrospectively recorded the HU of the renal medullae in 90 patients with a unilateral single 

calculus within kidney or ureter, and in 104 cases in control group (CG) matched for age and renal functions. 

Results: 

The patient ages were similar in the stone former and control groups. However, the male-female ratio was significantly 

greater in the SF group (68:22) than in the CG (42:62, P < .0001). Left- right ratio in SF group was 50:40. The inter-rater agreement 

was = 0.53 (95% CI :0.42, 0.64). 

Mean HU of all papillae of affected side in stone-formers (ASSF) was significantly greater than that in CG (39.6 versus 29.6, 

p


ScS17 Differentiation of renal carcinoma subtypes by multislice computed tomography 

M. El-Saied El-Azab, T. Abd El-Moniem El-Diasty, K. Zaky Sheir, A.A. Shabaan (Mansoura, Egypt) 

Purpose: 

We differentiated renal cell carcinoma subtypes using multislice computerized tomography (CT). 


We reviewed the CT images of 87 patients with renal cell carcinoma. Three subtypes of renal cell carcinoma were noted, 

including clear cell in 37 cases, papillary in 26 and chromophobe in 24. Biphasic CT (unenhanced, corticomedullary and 

excretory phases ) was done in all patients . We compared patient age and sex, tumor size, enhancement degree and 

pattern ( homogenous , heterogenous and predominantly peripheral ), the presence or absence of calcification or cystic 

degeneration ( necrotic or hemorrhagic areas within the tumors ) and tumor spreading patterns, including perinephric 

change, venous invasion and lymphadenopathy, in the 3 subtypes . 

Results: 

The degree of enhancement was significantly different among the 3 subtypes in the corticomedullary and excretory phases 

(P < 0.001). Cystic degeneration was more evident in the clear cell subtype than in the other subtypes regardless of tumor 

size ( P < 0.001 ). A hypervascular pattern (higher tumor enhancement after contrast material injection due to higher 

vascularity ) was noted in 48.6% of clear cell subtype in comparison to 15.4% of papillary and 4.2% of chromophobe subtypes 

( P < 0.001 ) . The chromophobe subtype showed homogenous enhancement in 75% of cases in comparison to 29.7% and 

30.8% of clear cell and papillary subtypes (P > 0.05). Calcification was evident in 21.6%, 23.1% and 25% of clear cell, papillary 

and chromophobe subtypes, respectively (P > 0.05). 

Conclusions: 

To differentiate the subtypes of renal cell carcinoma the degree of enhancement is the most valuable parameter. The 

presence or absence of cystic degeneration, vascularity and enhancement patterns can serve supplemental role in differentiating 

renal cell carcinoma subtypes. 

ScS18 Efficacy of post-CT KUB in patients with traumatic and non-traumatic genitourinary Disease 

S. Namkung, J.Y. Lee, J.Y. Jang, I.K. Hwang, M.S. Hong, H.C. Kim (Chuncheon, South Korea) 

Purpose: 

To evaluate an efficacy of post-CT KUB (PC-KUB) for diagnosis and treatment planning in patients with traumatic and nontraumatic 

genitourinary (G-U) disease. 


We retrospectively evaluated 706 PC-KUBs obtained immediate after CT between 15 and 120 min in 678 patients 

(M:F=432:246, mean age; 47.2 years) with history of abdominal trauma (n=362) and clinical suggestion of G-U disease 

(n=344). In 228 PC-KUBs among them showed abnormal findings, which included urine leakage (n=16), G-U tumor (n=24), 

morphological change of G-U tract (n=82), urinary stone with/without obstruction (n=89), congenital anomaly (n=8) and 

post-operative/post-traumatic follow-up (n=9). In 32 patients, intravenous (IVP) or retrograde pyelourograms (RGP) were performed. 

We evaluated imaging quality of excretory urogram on PC- KUB and possible additional findings or critical finding 

over CT findings, and compared with IVP/RGP. 

Results: 

All cases showed good excretory urograms except for a little limitation of urinary bladder evaluation with indwelling Forley 

catheter. In patients with urine leakage, PC-KUB showed injured site more exactly than CT with unopacified renal pelvis and 

ureter due to early scanning time. In patients with G-U tumor, PC-KUB showed properly the size, shape and location except 

for cases (n=4) with surface spreading bladder tumor and with severe urinary obstruction. In patients with urinary obstruction, 

PC-KUB informed a possible functional impairment. PC-KUB showed comparable excretory urograms as compared with 

IVP/RGP in all cases. 

Conclusions: 

PC-KUB is very useful for evaluation of traumatic and non-traumatic G-U disease with comparable excretory urogram and 

simple and easy accessibility. 

ScS19 Excretory Urography: Trends in Clinical Usage Since CT Urography 

W.M. Pabon-Ramos, E.M. Caoili, R.H. Cohan, T. Stephens, I.R. Francis, J.H. Ellis, M. Korobkin, 

M. Schipper (Ann Arbor, MI, U.S.A.) 

Purpose: 

To assess for changes in clinical usage and diagnostic yield of excretory urography (EU) following the introduction of CT urography 

(CTU). 


We retrospectively reviewed reports from 6,313 EUs performed between 7/95 and 2/06. The clinical specialty of the ordering 

physician and clinical indication for the study were recorded, as were any collecting system, ureter, or bladder abnormalities 

identified at EU. Findings were compared prior to and after May 2000, when CTU was introduced. 

Results: 

Demand for EU by all physicians has decreased threefold. Proportional demand by urologists has not changed (p=.105). 

Since 2000, there has been a decrease in the proportion of EUs performed for the following indications: obstruction (p


nary tract infection (p60ml/min/1.73m2 and did develop CIN. 

ScS22 Delineation of intra-renal arteries with ultra high resolution flat panel based volume CT– outer 

limits of spatial resolution 

M. Neukamm, M. Palmowski, S. Schawo, S. Bartling, U. Rietdorf, J. Kuntz, H.U.Kauczor, 

P. Hallscheidt (Heidelberg, Germany) 

Purpose: 

In this study we aimed to determine the maximum spatial resolution and delineation of intrarenal vessels with a flat panel 

based volume CT system (VCT) in an experimental setting. 

53



11 porcine renal specimens were prospectively evaluated for delineation of intrarenal vessels using a prototype gantrybased 

flat-panel cone-beam CT system. The gantry incorporates an array of 40 x 30 cm2 CsI-amorphous silicon flat-panel 

detector consisting of a 2,048 x 1,536 matrix. After catheterizing the renal artery with a 5F end hole catheter a contrastenhanced 

scan was performed using barium sulfate (BaS) as a contrast medium at a dilution of 200mg/ml. Manual injection 

of 15 ml contrast media was initiated directly before the start of the respective scan, with 8 s injection time. The diameter of 

all definable arterial branches was determined using a software tool based on MITK allowing a semi-automatic segmentation 

of the vessel tree. In a fist step the vessel tree is segmented by a 3D region growing algorithm. Following its medial axis the 

vessel tree is extracted and converted to a representation including the diameters of the vessels. 

Results: 

In each kidney an average of 47454 (SD±23245) arterial branches could be delineated. The diameter of the branches ranged 

from 0,029 mm (mean 0,03245, SD±0,0026) to 3,44 mm (mean 1,8126, SD±0,6633) with a median of 0,206 mm. 2,7% of the 

intra renal arteries visible had a vessel diameter of 0,029 mm. 

Conclusions: 

The very high spatial resolution of VCT may improve the assessment of renal vessel architecture in healthy and pathologic 

conditions by visualization of intrarenal arterioles and capillaries down to a diameter of 0,03 mm. 

ScS23 The Broad Spectrum Images of Bladder Rupture 

H.J. Jeon, S.Il Jung, Y.J. Kim, S.W Park, H.J. Shin, Y.C. Choi, K. Kim (South Korea) 

Purpose: 

To illustrate various appearance of bladder rupture which resulted by many causes. 


CT images including US, Cystography from 14 patients with surgically, clinically proven bladder rupture during 30 months were 

reviewed. 14 cases of bladder rupture were found. We studied the images of 14 cases of bladder rupture respectively. The 

age range was between 34 years and 74 years 

Results: 

Out of 14 cases, 12 cases were intraperitoneal rupture, one case was extraperitoneal rupture and another one case was 

both intraperitoneal and extraperitoneal rupture. 

We missed one case of bladder rupture, which was perforated at dome site. Free fluid was seen in the pelvic cavity in all 

cases. The causes of bladder rupture were various. 9 cases of 14case were caused by trauma. Post cystoscopic perforation 

happened in one case. After radiation therapy for uterine cervical ca, bladder rupture occurred in one case. Non traumatic 

bladder rupture in one case. Bladder cancer with perforation in one case, Bladder hematoma with rupture in one case. 

Conclusions: 

Knowledge of the varied features and causes of the bladder rupture should help clinician in suggesting a diagnosis of 

bladder rupture. 

ScS24 CT Urography after Bladder Reconstruction 

O. Portnoy, S. Apter, J. Ramon (Tel-Aviv, Israel) 

Purpose: 

Imaging of patients after cystectomy and bladder reconstruction from various bowel parts is challenging. Neobladder evaluation 

using US, IVP, standard abdominal CT and cystography offers partial information. 

The purpose of this study was to assess the value of CT Urography (CTU) in demonstrating the revised anatomy and related 

complications. 


During 15 months, consecutive patients were scanned using 16 and 64 slice MDCT (GE lightspeed). CTU indications included: 

hematuria (n=4), pain (n=2), urinary obstruction (n=2), renal function deterioration (n=1), tumor recurrence (n=4), fistula or 

leak (n=2) and follow-up (n=32). CTU protocol included 3 phases: non contrast, nephrographic and excretory (10-60 min). 

Retrograde neobladder filling with diluted (4%) contrast was added in 8 patients with cutaneous diversion. Multiplanar reformats 

(MPR), maximal intensity projections (MIP) and a 360° three dimensional neobladder view were created using a workstation. 

Results: 

42 patients (37-79 years, 35 men, 7 women) underwent CTU, 10 days-7.5 years after surgery. Eight different surgical urinary 

diversions including bladder augmentation (2 patients) were observed. Visualization of the renal parenchyma, the collecting 

systems and the neobladder was optimal in 39/42 patients (92.8%). More than 80% of ureters’ length was demonstrated with 

contrast in 34/42 patients (81%). Complications involving the urinary system were seen in 13/42 patients (31%) including: stones 

(n=5), indolent abscess (n=4), fistula (n=2), mucus masses (n=5), significant hydronephrosis (n=11), stricture (n=3) ureteral 

thickening (n=4), renal mass (n=1). 

Conclusions: 

CTU offers comprehensive evaluation of patients with a neobladder. It has the potential to be a single rapid mean of 

diagnosing their pathologies. 

54

Workshops 

Friday, September 12, 2008 

11:00 – 12:30 Workshop I: Prostate cancer: a case-based approach 


Ultrasonography and ultrasound-guided biopsy of the prostate 

N. F. Wasserman (USA) 


After attending this workshop, the attendee will understand biopsy strategies for the following clinical situations: 1. Biopsy of 

the patient without a rectum. When to do it and how to do it with TRUS guidance. 2. Biopsy of the post radical prostatectomy 

patient with rising PSA. When to do it, Post-operative anatomy, and how to do it with TRUS guidance. 3. Biopsy of the 

patient with multiple negative biopsies and continuing rising PSA. TRUS biopsy strategies and role of MRI. 

MRI and MRS of the prostate 

U.G. Mueller-Lisse, M.K. Scherr (Germany) 

Purpose: 

To demonstrate basic technical and biochemical aspects and current clinical applications of magnetic resonance imaging 

(MRI) and magnetic resonance spectroscopy (MRS) of the prostate in a case-based approach. 

Material and Methods: 

Clinical cases involving combined MRI and MRS of the prostate are demonstrated and reviewed in view of pertinent radiological 

and biochemical literature as retrieved via electronic media (medline®, pubmed®). Basic concepts of MRS of the 

prostate and its clinical applications are included in the discussion of the cases. 

Background for MRS of the prostate: 

The prostate lends itself to MRS due to its unique production, storage, and secretion of citrate. While healthy prostate tissue 

demonstrates high levels of citrate and low levels of choline that marks cell wall turnover, prostate cancer (PCA) utilizes citrate 

for energy metabolism and shows high levels of choline. The ratio of (choline+creatine)/citrate distinguishes between 

healthy prostate tissue and PCA. The combination of magnetic resonance imaging (MRI) and 3-dimensional MRS (3D-MRSI 

or 3D-CSI) of the prostate localizes PCA to a sextant of the peripheral zone of the prostate with sensitivity/specificity of up to 

80%/80%. When MRS and MRI agree on PCA presence, the positive predictive value is up to 90%. 

Conclusions: 

Combined MRI and 3D-MRSI lends itself to the planning of prostate biopsy and therapy. For broad clinical application, it will 

be necessary to facilitate MRS examinations and their evaluation and make MRS available to a wider range of institutions. 

Learning Objectives: 

1. to know the technical principles of combined MRI and MRS of the prostate 

2. to understand the basics of prostate physiology as demonstrated by 3D-MRS 

3. to know potential clinical applications of combined MRI and MRS of the prostate 

Local Recurrence and metastases in prostate cancer: A Case-Based Approach 

H. Schlemmer (Germany) 

Prostate cancer encompasses a biological continuum from indolent to highly aggressive tumours. As surgery and radiotherapy 

alone will cure only a fraction of high-risk patients, testing for prostate-specific antigen (PSA) is important for monitoring 

of treatment response and detection of disease recurrence. Biochemical recurrence is defined as rising PSA after initial and 

in most cases curative intended therapy. In that case, the site(s) of recurrence have to be localized defining the therapeutic 

options including radiotherapy, hormone therapy, and chemotherapy. Imaging has an important role in diagnostic work-up 

for detection and localization of local recurrence, lymph node and distant metastasis. Dynamic contrast-enhanced MRI, 

diffusion-weighted MRI and proton MR spectroscopic imaging are helpful for detecting local recurrence. Conventional bone 

scintigraphy is currently the gold standard for detection of bone metastases. Recently it has been shown, however, that 

whole-body MRI and [18F]fluoride PET/CT are more sensitive for early detection. Whole-body MR has the additional capability 

of evaluating organ metastases with high accuracy. A dilemma is still the detection of lymph node metastases. Conventional 

CT and MRI have to rely on the weak approach of considering lymph node size. Lymph node MR imaging with ultrasmall 

superparamagnetic iron oxide particles (USPIO) has achieved superb results, but the contrast medium is not available for 

clinical use. [11C]cholin/acetate PET/CT is promising particularly for detection of local recurrence, its role for detecting lymph 

node and distant metastases has still to be evaluated in comparative clinical studies. 

Learning objectives: 

1. Clinical dilemma of managing biochemical recurrence of prostate cancer. 

2. Current role of imaging against the background of evidence-based treatment options and risk-stratified approach. 

3. State-of-the-art imaging options in treatment recommendations. 

4. Prospects of methodological advances and multimodal imaging approaches. 

55


11:00 – 12:30 Workshop II: Pelvic Floor and gynaecologic tumors: a case-based approach 


Pelvic floor Disorder: a case based approach 


Pelvic floor dysfunction (PFD) corresponds to a wide variety of clinical conditions including stress urinary incontinence (SUI), 

pelvic organ prolapse (POP), fecal incontinence, defecatory dysfunction, sexual dysfunction and several chronic pain 

syndromes. The first three conditions are the most common clinical conditions. 

Magnetic resonance imaging is a novel noninvasive imaging modality that can be used for the assessment of pelvic floor 

dysfunction. It relies on static sequences with a high spatial resolution to study the urethral supporting structures, the vaginal 

supporting structures and the anal sphincter complex, and on fast imaging dynamic sequences during contraction, rest, and 

straining for functional correlation. Prolapse of the various pelvic compartments is detected with respect to organ position 

relative to the pubococcygeal line during dynamic phases. 

The learning objectives of this workshop are 

1. To give a quick review of the normal MR imaging features of the pelvic floor supporting system (urethral, vaginal and anal 

sphincter complex) 

2. Based on a case based approach we will discuss how to identify the types of defects in each supporting structure and 

how to classify. 

3. To practice how to report the MR findings at static and dynamic images in an easy, systematic and comprehensive way. 

Uterine corpus and cervical tumors 


Endometrial carcinoma is the most common malignancy of the female reproductive tract. Therapeutic orientation should be 

modified accordingly to prognostic factors such as histological subtype, grade of differentiation and stage of the disease. 

Endometrial sampling can predetermine the morphology of the tumor but myometrial and cervical invasion data are only 

available during surgery or by imaging. Deep myometrial and cervical invasion are associated with an increase risk of pelvic 

and paraaortic lymph nodes metastases. Preoperative knowledge of these two prognostic factors allows referring patients to 

oncologic surgery centers. Significant accuracy of MRI evaluating tumoral invasion of the myometrium (superficial/deep) as 

well as cervical extension has been accepted. 

Cervical carcinoma is the third most common gynecologic malignancy. FIGO staging system provides worldwide epidemiological 

and treatment response data. However, on treatment planning there are significant inaccuracies in this staging 

system. MRI (not included in FIGO) is now widely accepted as optimal for evaluation of important prognostic factors such as 

lesion volume and metastatic lymph node involvement that will help to determine treatment strategy. In general, T2WI more 

clearly delineate cervical carcinoma and are preferred for evaluation of the lymph nodes. Dynamic T1WI may help to identify 

smaller tumors and fistulous tracts. 


1. To learn the staging classification of primary cervical and endometrial tumors 

2. To understand the implications of the staging classification on patient management 

3. To get familiar with the patterns of tumor spread and preferred imaging technique 

4. To know typical imaging findings at different stages of disease 

5. To recognize imaging pitfalls 

Ovarian lesion characterization 


Ovarian masses are divided into functional and neoplastic lesions, the latter persist three months later. Endovaginal ultrasound 

with color Doppler is the preferred imaging modality to differentiate benign from malignant masses. The negative 

predictive value of ultrasound is high enough to stop further investigation, particularly if smooth borders and a water content 

are identified. Benign sonographic features of a typical dermoid cyst or an ovarian fibroid don’t require further investigation. 

If sonography reports an indeterminate mass, MRI is the optimal method of lesion characterization including T2 and 

T1-weighted sequences with and without fat suppression. Differentiation between benign and malignant tumors requires 

injection of contrast material and may benefit from dynamic image acquisition with contrast uptake comparison between 

the normal myometrium and the solid portion of the ovarian mass. A patient with a highly suspicious sonographic mass for 

ovarian cancer containing cystic and solid portions with ascitis, peritoneal implants or other indirect signs of malignancy 

should under CT for staging to identify disease that cannot be treated by primary debulking surgery. 

MRI can differentiate the ovarian, tubal, uterine or extra-genital origin of a large pelvic mass. Incomplete septa and the 

“diaphragm sign” are excellent diagnostic arguments to confirm the tubal nature of a mass whereas subserosal leiomyoma 

exhibit surrounding myometrium extending from the uterus to the periphery of the mass (“claw sign”). 

Learning objectives 

1. Technical recommendation and diagnostic criteria to increase accuracy in ovarian lesion characterization and organ 

determination at ultrasound and MRI 

56

Workshop III: Imaging the urinary tract: limits to radiation exposure 


CTU and IVU Radiation Dose 

A.J. van der Molen (The Netherlands) 


For a long time the imaging of the urinary tract has relied on intravenous urography (IVU) as the primary imaging modality. In 

more recent times, CT urography (CTU) and (to a lesser extent) MR urography have become the primary means of urographic 

imaging. This process has been catalyzed by fast technological advancements such as the ease of use of multidetector-row 

CT. Throughout Europe, many departments have completely abolished IVU, but in others it still remains a frequently 

used examination. Since evidence-based data are lacking, this abolition is often premature and not only based on thorough 

scientific evidence. Factors such as local preferences, technical improvements, and the general trend of substituting projection 

by cross-sectional imaging techniques may play an important role. 

One of the drawbacks of multiphase CTU is its relatively high radiation dose compared to IVU. While the average effective 

dose of IVU on digital equipment is in the order of 2-4 mSv, effective doses for CTU in the range of 20-30 mSv are no exception, 

especially when image acquisition is not fully optimized. Therefore, if used as a primary examination, multiphase CTU 

should probably be limited to patients at increased risk for urologic cancer. However, the examination should always be 

tailored to the clinical question and CTU examinations with a reduced number of phases and/or CTU examinations at 

reduced dose could well play an important role in the problem-solving of benign diseases, such as chronic symptomatic 

urolithiasis. Because of its cost, low radiation dose, high in-plane spatial resolution, and the dynamic character of the examination, 

IVU could still play a role in young patients with benign diseases and for assisting (ultrasound- or fluoroscopy-guided) 

interventional procedures. For children and pregnant-patients, modern high-resolution MR Urography is probably a more 

complete and attractive alternative. 

CT urography – clinical indications and protocols 

E. Coppenrath, T. Meindl, C. Degenhart, M. Reiser, U. Müller-Lisse (Germany) 

CT urography is defined as CT imaging of kidneys and upper urinary tract including the application of intravenous contrast 

media. Imaging of excretory phase and reconstruction with thin slices are mandatory. Compared to conventional urography 

CT urography offers an uncompromised 3-dimensional imaging of kidney parenchym, renal pelvis, ureter lumen, and 

ureter wall as well as of the neighbour organs. 

The major indications are hematurie, renal congestion, tumors and compression of the ureter by adjacent abdominal tumors. 

CT urography can also be helpful in kidney trauma and in understanding of malformations. The clinical question is vital for 

chosing the proper protocol. 

For investigation of tumors in kidney and ureter three phases are necessary: native phase (without intravenous contrast 

media), nephrographic phase (90 seconds after administration of i.v. contrast media) and excretory phase (10 to 15 minutes 

after contrast media injection). The examination of an ureter compression by adjacent tumors requires either a split bolus 

technique (two boluses of contrast media 10 minutes and 2 minutes prior to data acquisition) or a portal-venous phase 

followed by the excretory phase in low dose technique. 

Suspecting kidney stones a native scan in low dose technique often suffices (but this protocol is not suggested to belong to 

CT urography). 

Dose exposition in CT urography is high especially in a three phase technique.(about 12 to 22 mSv). Dose limitation and 

reduction can be achieved by automatic mAs-modulation of modern multi-slice CT scanners or in a weight adapted reduction 

of mAs-product. A relevant dose reduction can possibly be achieved by reduction of voltage but no evident-based 

recommendations exist so far. Novel processing options like maximum intersity projection (MIP), multiplanar recontruction 

(MPR) and volume rendering technique (VRT) provide a better imaging but have no influence on total dose. Guideline 

recommendations of ESUR have recently been published (European Radiology 2008). 

Examination of the urinary tract in children: Highlights from an EU study on micturition cysturethrography (MCU) 


Introduction 

MCU is the most frequent fluoroscopy in paediatric patients. It is necessary to get all information on the renal tract, especially 

to detect vesico-ureteric reflux (VUR). The unique capability of the MCU is to visualize the entire renal tract during all phases 

of MCU if necessary simultaneously from the bladder, the urethra and the in the case of reflux including both kidneys. The 

severity of the reflux can be graded and the occurrence and extent of intra-renal reflux detected. Basically, three factors 

determine the radiation exposure of the patient. The measured dose values, preferably the dose-area product (DAP), 

depend on the equipment, beam quality and the investigation technique used by the radiologist. 

Results 

In a European wide study, a literature survey and a 30 year dosimetric survey in our department great variation of the dose 

could be found. The mean values of the DAP in infants varied in Europe wide survey by a factor of 230, minimum values 0,8 

mean 48 and max 189,8 cGy • cm 2 . Factors, that increased the dose above the 3rd quartile of this study were: no additional 

filtration, more than 4 radiographs, screening time over 60 seconds and ins some cases the use of electronic magnification. 

The image quality varied greatly. Positioning criteria (five criteria) were frequently fulfilled by all participants, but the so-called 

visibility criteria (three criteria) were often missed and only 2 of 12 departments fulfilled them in more than 70% of exams, both 

in the low dose group (1st quartile). In our own department dosimetric follow- up showed a reduction of entrance dose levels 

in MCU by a factor of 100. 

57


Conclusion 

There is a great need in optimization procedures to improve the image quality and lowering the dose. Pulsed fluoroscopy is 

the most important technical innovation to reach this goal. The other point must be reached by better education and training 

of young radiologists. The most effective way is standardization of the MCU. 


1. Standardization of the MCU investigation technique 

2. Discussion of image quality criteria 

3. Dose reduction strategies 

11:00 – 12:30 Workshop IV: Renal and adrenal imaging: a case-based approach 


Adrenal imaging 



1. Describe current protocols for MRI and MDCT for adrenal diagnosis 

2. Compare contrast MRI and MDCT for detection, localization, and characterization of functional and nonfunctional 

adrenal lesions 

3. Define potential strengths and limitations of PET/CT for adrenal diagnosis. 

4. Recognize key feature of active adrenal bleeding. 

5. Correlate imaging characteristics of unusual adrenal lesions with appearance of those entities in other organs, such as 

pseudocyst, hemangioma and oncocytoma 

The combination of advances in cross sectional and other imaging techniques and multiple investigations has improved 

noninvasive diagnosis of adrenal disorders. This workshop will utilize demonstrative cases to illustrate useful diagnostic 

approach to typical lesions but emphasize some limitations remaining. Current MRI and Multidetector CT (MDCT) techniques 

allow for very high sensitivity in detection of functional and nonfunctional adrenal lesions, and for differentiation in the majority 

of cases between common malignant lesions such as metastatic disease and primary adrenal carcinoma vs incidental 

nonhyperfunctioning adenoma. The ability to detect lipid in lesions using chemical shift MRI and CT attenuation including 

histogram analysis will be illustrated as well as potential challenge of suprarenal liposarcoma. Case based illustration of 

unusual lesions such as adrenal cysts, acute adrenal hemorrhage (with active bleeding) adrenal oncocytoma and hemangioma 

as well as unusual congenital varants will be presented. Recognition of the existence of these entities and typical characteristics 

will improve the participants ability to make diagnosis of such entities. 

Renal imaging 


With the advances of modern imaging modalities different renal tumors have to be assessed by different imaging modailites 

with its capabilities. 

Pathogenesis and Incidence 

Renal cell carcinoma is third most common genitourinary tumor and accounts for 3% of all malignancies in adults. The tumor 

usually is detected in older patients. Some known risk factors for renal cell carcinoma are von Hippel-Lindau disease and 

smoking. With the increased use of ultrasonography, MRI and CT, the detection rate of carcinomas in a asymtomatic state is 

increasing. These incidentally detected tumors usually have smaller size, a lower tumor stage and a better survival of the 

patients. 

MRI allows data acquisition with a very good soft tissue contrast and multiplanar image acquisition. Especially in patients with 

extensive tumor with invasion of the caval vein MRI determined the cranial extension of the thrombus much more effective 

than single slice computed tomography. Before the introduction of MS CT scanners, MRI used to be the image modalitiy of 

choice for delineation of tumor thrombus. Multislice helical CT scanners are able to generate multiplanar reconstructions with 

a high resolution, with similar staging results for MS-CT and MRI for staging renal cell carcinomas with extension of the thrombus 

into the IVC. MRI allows, in contrast to CT, to detect the pseudocapsule of the tumor in patients with small renal cell 

carcinomas. For nephron sparing sugery the infiltration into the perinephric fat has to be excluded and therefore the presence 

of a pseudocapsule opens the possibilities to perform a nephron sparing surgery in these small tumors. MR imaging 

showed superior results than CT in detecting cystic renal cell carcinomas, as the better soft tissue contrast allows to detect 

enhancement even in thin cystic septa or walls . 

In differential diagnosis of solid renal lesions, MRI and CT have similar advantages. The diagnosis angiomyolipoma can be 

made with CT and MRI, whereas both modalities have limitations in oncocytomas. 

MS-CT allows similar staging results as MRI, especially in extensive tumors. In earlier studies, single slice CT and MRI has similar 

staging capabilities for limited renal cell carcinomas. The introduction of MS-CT allowed to improve the staging accuracy of 

extensive tumors with caval thrombus. Althought MS CT provides images with a high spatial resolution and multiplane reconstructions, 

its role in planning nephron sparing surgery is, as MRI, still limited. Despite the high spatial resolution, it still remains 

an unsolved problem to detect infiltration of the tumor into intrarenal vessels and the renal pelvis. 

58


1. To use MRI and CT according the capabilities of each modility 

2. To learn the differentiate and to stage the different renal tumors. 

Renal and adrenal imaging: Minimal-invasive treatment 



The short- and medium-term efficacy of RFA for small (


of prostate cancer. MRI has a significantly higher sensitivity for tumor detection than TRUS, but specificity is suboptimal. The 

addition of metabolic information from magnetic resonance spectroscopy (MRS) to morphologic data from MRI may allow 

more specific diagnosis and localization of prostate cancer compared to MR imaging alone. 

The aim of this workshop is to review current techniques and applications of MR imaging and MR spectroscopy in prostate 

cancer. 

After this course, participants 

1. will be able to implement a MR protocol for endorectal MR of the prostate 

2. are familiar with the MR appearance of the normal prostate, benign prostate hyperplasia, acute and chronic prostatitis 

and prostate cancer 

3. may appropriately select patients based on clinical findings that may benefit from endorectal MR 

4. are aware of the clinical questions to radiologists with respect to initial cancer detection, localization and staging 

5. learned how to reduce false positive diagnosis of cancer and extracapsular tumor spread 

6. participated in the discussion of the value of contrast-enhancement and fat saturation 

7. gained insight into advanced techniques including 3D MR spectroscopy, dynamic perfusion imaging, diffusion imaging 

and MR lymphography 

Local Recurrence and metastases in prostate cancer 

M. Scherr (Germany) 

Detection of metastasis in proven prostate carcinoma prior to therapy decision is already a challenge. It is even more 

sophisticated to localize the origin of a post therapeutic PSA relapse after prostatectomy or irradiation. 

Radiology and nuclear medicine provide a lot of imaging procedures and make it difficult to choose the right one. 

Besides conventional X-ray of chest and skeleton, ultrasound of abdomen and pelvis, bone scan and CT, there are more 

complex imaging strategies like SPECT and PET and dedicated MR exams. Whole body imaging using modern tracers in 

PET(-CT) and the capability of covering the whole body in one MR exam are useful methods detecting distant metastases. 

There is still a lack in certainty imaging lymph nodes. Availability of iron nano particles provided, MR-Lymphography will be a 

reliable method to visualize lymph node metastasis influencing especially prior/secondary surgery or irradiation. 

Another diagnostic dilemma is the patient with a marginal PSA relapse, profiting from a reliable diagnosis of a local recurrence 

resulting in a more focused therapy. 

Dedicated pelvic MRI (with/without endorectal coil, contrast enhancement or complemented by MR-Spectroscopy) could 

contribute especially in local recurrence and are currently in competition with PET-CT using the most recent tracers. 


1. Are conventional X-Ray, ultrasound, bone scan and CT still adequate? 

2. Which findings are expected based on patient history, lab tests and clinical presentation? 

3. Choosing the appropriate imaging modality per patient 

4. Comparison of latest MRI- and PET(-CT)-based imaging procedures 

5. Influence on further patient treatment 

14:30 – 16:00 Workshop II repetition Pelvic Floor and gynaecologic tumors: 

a case-based approach 


Pelvic floor disorders: perineal ultrasound 

C. Roy (France) 

Ultrasound offers major advantages over x-rays or MRI for imaging the pelvic floor diseases. It provides good soft-tissue 

morphologic analysis of the urethrovesical junction and anal canal with in addition a dynamic bladder neck imaging with 

quantified movements. Examinations are easy, relatively quick (10 to 15 mins), and inexpensive. Evaluation is limited, however, 

to the lowest pelvic compartments, and requires operators to have experience and knowledge of urodynamics. Three 

different approaches to ultrasound are available: external ultrasound (transabdominal, perineal, and introital); endosonography 

(transvaginal and transrectal); and endoluminal (intraurethral). Perineal and introital ultrasound seem to be the easiest 

techniques using a common endoluminal probe. Evaluation is first performed at rest in lateral decubitus with knee flexion and 

in the standing position. Dynamic studies are then carried out during pelvic floor contraction and maximum straining in each 

position. The differential diagnosis between two main entities that is internal sphincter deficiency and hypermobility of the 

bladder neck is rather easy to perform. Associated or additional abnormalities are seen. After unsuccessful treatment, US will 

find the cause of this bad result.Ultrasound assessment of bladder neck descent has good reproducibility using the perineal 

approach. 


1. Understanding perineal ultrasound technique 

2. Knowledge of main pathological processes 

3. Evaluate post treatment devices 

60

Staging of cervical cancer 

U. Lemke, B. Hamm (Germany) 


Epidemiology 

Eighth most common malignancy in women. Incidence has decreased in countries with screening programs. Second most 

common cause of cancer death in developing countries. Mean age at presentation is 52 years. Two peaks in incidence: at 

35 and 70 years. 

Etiology 

Squamous cell carcinoma is the most common type (> 80%), arises in the transformation zone due to persistent infection with 

high-risk human papilloma virus and cofactors. Stepwise development: epithelial proliferation, dysplasia, precancerous 

states, carcinoma in situ, invasive carcinoma. 15% of the cases are adenocarcinomas with unknown etiology. 

Role of MR-Imaging 

Indication for MR-imaging is pre-treatment staging before surgery or radiation. For local tumor staging MR has highest accuracy 

in comparison to computed tomography, ultrasound or physical examination. Important findings for the clinician: tumor 

size (>4 cm), tumor extent, esp. suspected parametrial invasion or involvement of other pelvic organs, pelvic lymph node 

status, paraaortic nodal status in advanced disease (those all are prognostic factors). Original staging according to the FIGO 

criteria not involving MR-findings. 

MR-Protocoll 

Preparation includes moderately urinary bladder, antiperistaltic agents and vaginal filling. 

Torso-pelvic phased-array coils are recommended. 

T2-TSE sagittal and axial oblique for outlining the tumor. 

T1-TSE/ PD axial for lymph nodes. 

Optional: 

Contrast enhanced dynamic T1-FSE axial (fat saturated) for urinary bladder or rectal involvement. 

T2-TSE axial (fat saturated) with respiratory triggering for abdominal evaluation in advanced cases. 

T2-GRE (HASTE) coronal for suspected urinary retention. 

Contrast enhanced T1-TSE (fat saturated) sagittal and T2-TSE (inversion recovery) axial for suspected fistulas. 

MR-Findings 

Hyperintense cervical mass on T2-weighted images. Growth pattern: polypoid exophytic, diffusely infiltrating, necrotic 

exulcerative. 

FIGO I 

A: invasive cancer identified only microscopically, not seen on MRI. 

B: cancer not extending beyond the cervix uteri (for FIGO staging purposes infiltration of corpus uteri is not important). 

FIGO II 

A: tumor involves up to two third of the vagina (sparing of the lower third). 

B: infiltration of the hypointense cervical stroma with tumor in adjacent parametria. 

FIGO III 

A: tumor involves the lower third of the vagina, segmental high signal intensity in the otherwise hypointense vaginal wall. 

B: tumor extends to the pelvic wall or causes hydronephrosis. 

FIGO IV 

A: tumor invades mucosa of the bladder or rectum, segmental high signal intensity in the normally hypointense bladder or 

rectal wall. 

B: tumor extends beyond the true pelvis or metastatic spread to distant organs. 

Metastatic spread 

Involvement of pelvic lymph nodes is the most important prognostic factor. Metastases of paraaortic nodes are classified as 

distant metastases. Late hematogenous spread to bones, lungs, peritoneum and liver. 

Fistulas 

Rectovaginal and vesicovaginal fistulas are typical findings in locally extended cervical cancers and after radiation. A fistula 

is seen as a hypointense defect within the tumor in contrast enhanced T1-TSE and as hyperintense tubular structure with 

T2-TSE (inversion recovery). 

Prognosis 

5-year survival rate of 88% in FIGO stage I, 73% in FIGO stage IIB, and 30% in case of pelvic organ involvement. Paraaortic 

lymph node metastases reduce survival by 50%. 


1. to review the normal MRI appearance of the cervix uteri 

2. to understand the role of MRI imaging in pretherapeutic staging 

3. to learn rational planning of an MRI study including preparation, pulse sequences, imaging planes and indication for 

contrast application 

4. to become familiar with the staging criteria of cervical cancer 

Ovarian tumors 


Sonography is the first line modality in the assessment of the adnexae. In sonografically indeterminate lesions further imaging 

is warranted, as it will influence patient management including choice of treatment and referral practice. 

Purpose of further characterization of an indeterminate or suspected adnexal mass is a.) defining its origin, b.) differentiation 

of benign from malignant adnexal masses, c.) differentiation of benign lesions that require intervention from benign that do 

not and d.) staging of ovarian cancer. 

61


MDCT is useful in further characterization of cystic adnexal lesions and in staging ovarian cancer. 

However, when it comes to complex indeterminate lesions MRI has been established as the most powerful imaging modality. 

Criteria for characterization of adnexal masses depend on clinical information, morphologic features, SI, and perfusion. Lesions 

that may unequivocally be identified as benign include dermoids, cysts, endometriomas, cystadenomas, and hydrosalpinx. 

MRI allows also the differentiation of solid lesions, e.g. fibrothecomas from uterine fibroids. 

In acute pelvic pain CT may be performed alternatively to MRI to provide further information in suspected tuboovarian 

abscesses, adnexal torsion or non-gynecological masses. 

Furthermore, image guided biopsy is emerging as an additional diagnostic tool in adnexal masses and can obviate more 

invasive procedures. 


1. To learn of the role of CT and MRI in characterization of adnexal masses 

2. To become familiar with imaging findings that assist in characterization of adnexal masses with emphasis on origin and 

tissue characteristics 

3. To learn of the integrative role of Radiology in patient management. 

14:30 – 16:00 Workshop III repetition: Imaging the urinary tract 


Images of the urinary tract: a case-based approach to endoscopy and CT urography 

N. Cowan (United Kingdom) 


1. To maximize upper tract collecting system and ureter opacification on CTU. 

2. To learn how to manage patients with incompletely opacified ureters on CTU. 

3. To be able to confirm positive CTU findings of upper urinary tract 

urothelial cancer by using interventional uroradiological techniques. 

Images of the urinary tract: a case-based approach to conventional urography 

T. Meindl (Germany) 

First introduced in medicine in the early 1930s, conventional urography (intravenous urography, excretory urography) is the 

radiologic examination used most widely for detection and differential diagnosis of disease of the urinary tract. Undergoing 

steady improvement over years, the urogram demonstrates anatomic and pathologic features of the kidneys, the upper 

urinary tract and the bladder and provides additionally information about the function of the urinary system. Despite the 

advent of computed tomography in imaging the urinary tract, conventional urography can still stand any competition due 

to its availability, low radiation dose and cost. Urologists, radiologists and any referring physician should be familiar with the 

technique and clinical application and be aware of the limitations and pitfalls of this technique. 

Starting with the plain film, a complete urogram is accomplished after intravenous contrast media application and acquisition 

of several films. A properly performed conventional urogram is suited as sole imaging method for demonstration of 

urinary tract anomalies and diversions, for clarification of calculous disease and stone burden as well as giving hints on 

malignancy. Due to its superior anatomical resolution, small urothelial lesions are detected with high sensitivity. 

Although epitaphs to conventional urography have been manifold written in the last years, the usage of this favoured 

diagnostic procedure is going on routinely and successfully. 

Organization and Learning objectives of this workshop include: 

- history, definitions and technique of conventional urography in a nutshell 

- the normal urogram and anomalies of the upper urinary tract 

- Infectious diseases 

- calculous disease 

- urinary stasis and obstructive disease 

- malignancy 

- non-infectious, non-malignant disease 

- traumaImages of the urinary tract: a case-based approach to CT urography 

Images of the urinary tract: a case-based approach to CT- Urography 

C. Degenhart (Germany) 

For about one decade, CT- Urography has been used as a diagnostic tool for a multiplicity of pathologies including renal 

masses, upper urinary tract urothelial tumors, urolithiasis, infection, anatomical variations and trauma. Generally, this technique 

is defined as a dedicated multiphasic CT scanning technique, which is optimized for the imaging of the urinary tract. 

Best possible opacification and filling of the hollow organs with contrast agent is the crucial point in CTU. To obtain this, 

diverse strategies are used at different institutions. The applied techniques vary in detail, e.g. regarding positioning, 

prehydration, timing and scanning parameters. 

62



A literature survey to different imaging strategies will be given and our institution´s own experience regarding indications and 

technical considerations will be demonstrated on the basis of several cases. 

14:30 – 16:00 Workshop IV repetition: Renal and adrenal imaging: a case-based approach 


Adrenal imaging 

G. Heinz-Peer (Austria) 

The increased use of imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging has 

increased the number of incidentally detected adrenal masses. Up to 5% of abdominal CT- examinations performed for 

reasons unrelated to adrenal dysfunction or suspected dysfunction will demonstrate an adrenal mass. This percentage could 

be even increased, since we know from autopsy studies that the prevalence of adrenal masses is about 7% in those 70 years 

of age or older (1-3). In the absence of extraadrenal malignancies the majority of these lesions will turn out to be nonhypersecretory 

and benign. However, this is not true for a patient with a known malignancy. In this special case it is difficult to assess 

the relative likelihood of an adenoma and a malignant lesion. Until few years ago, adrenal biopsy, resection, or clinical follow-up 

were the only methods of distinguishing benign adenomas from malignancies. Improvements of both, CT and MRI 

techniques have increased the reliability of these imaging methods in differentiating benign and malignant adrenal masses 

(4-15). Additionally, nuclear medicine studies using specific radiopharmaceuticals have the advantage of providing functional 

metabolic information for adrenal lesion characterization. PET-CT using 18-FDG allows malignant adrenal lesions to be 

characterized and gives detailed morphological information. 

In this workshop strengths and limitations of the various imaging techniques in adrenal mass imaging and characterization of 

adrenal masses will be addressed. The clinical management of adrenal incidentalomas will be considered. Cases will be presented 

in an interactive mode. Pitfalls in adrenal imaging will be included. 


1. To learn about imaging modalities and protocols in adrenal imaging 

2. To learn how to differentiate benign and malignant adrenal masses 

3. To understand how to manage adrenal incidentalomas 

4. To show how to avoid pitfalls in adrenal imaging 

1. Lau J, Balk E, Rothberg M, Ioannidid JPA, DeVine D, Chew P, Kupelnick B, Miller K. Management of clinically inapparent 

adrenal mass. AHRQ Publication no. 02-E014. Rockville, MD, Agency for Healthcare Research and Quality. Evidence 

Report/Technology Assessment, 2002; no. 56. 

2. Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis 

and management. Endocrine Reviews 2004; 25:309-340 

3. Angeli A, Osella G, Ali A, Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiological data from the 

National Italian Study Group. Hormone Research 1997; 47:279-283 

4. Szolar DH, Kammerhuber F. Quantitative CT evaluation of adrenal gland masses: a step forward in the differentiation between 

adenomas and nonadenomas? Radiology 1997; 202:517-521 

5. Szolar DH, Kammerhuber FH. Adrenal adenomas and nonadenomas: assessment of washout at delayed contrast enhanced 

CT. Radiology 1998; 207:369-375 

6. Korobkin M, Brodeur FJ, Yutzy GG, Francis IR, Quint LE, Dunnick NR, Kazerooni EA. Differentiation of adrenal adenomas from 

nonadenomas using CT attenuation values. Am J Roentgenol 1996; 166: 531-536. 

7. Kievit J, Haak HR. Diagnosis and treatment of adrenal incidentaloma. A cost-effectiveness analysis. Endocrinology and 

Metabolism Clinics of North America 2000; 29:69-90 

8. Hahn PF, Blake MA, Boland GWL. Adrenal lesions: attenuation measurement differences between CT scanners. Radiology 

2006;240:458-463 

9. Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Londy F. CT-time attenuation washout curves of adrenal adenomas 

and nonadenomas. Am J Roentgenol 1998; 170:747-752 

10. Korobkin M, Brodeur FJ, Yutzy GG, Francis IR, Quint LE, Dunnick NR, Kazerooni EA. Differentiation of adrenal adenomas 

from nonadenomas using CT attenuation values. Am J Roentgenol 1996; 166:531-536 

11. Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, Raghupathi KI. Adrenal masses: characterization with 

combined unenhanced and delayed enhanced CT. Radiology 2002; 222:629-633 

12. Mitchell DG, Crovello M, Matteucci T, Petersen RO, Miettinen MM. Benign adrenocortical masses: diagnosis with chemical 

MR imaging. Radiology 1992; 185:345-351 

13. Krestin GP, Steinbrich W, Friedmann G. Adrenal masses: evaluation with fast gradient-echo MR imaging and Gd-DTPAenhanced 

dynamic studies. Radiology 1989; 171:675-680 

63


14. Korobkin M, Lombardi TJ, Aisen AM, et al. Characterization of adrenal masses with chemical-shift and gadolinium-enhanced 

MR imaging. Radiology 1995; 197:411-418 

15. Heinz-Peer G, Hönigschnabl S, Schneider B, Niederle B, Kaserer K, Lechner G. Characterization of adrenal masses using 

MR imaging with histopathologic correlation. Am J Roentgenol 1999; 173:15-22 

Renal mass characterization by CT 


Cystic and solid lesions of the kidney are common and may be benign or malignant. Those over 3 cm can usually be accurately 

characterized by dedicated renal CT. By analyzing lesion characteristics such as the presence or absence of calcification, 

mural thickening, internal septations, loculations or nodules, cystic masses can be grouped into those lesions which can 

be ignored, followed or require surgery. When a solid lesion is encountered, its attenuation, presence of calcification, growth 

pattern, degree of homogeneity and vascularity, and enhancement features help suggest a specific diagnosis. Occasionally, 

sonography and renal mass biopsy are necessary, however, in distinguishing between benign and malignant entities. 


1. Distinguish among surgical and non-surgical cystic renal masses by the Bosniak classification system. 

2. Recognize clinical features and CT imaging characteristics of differing histiologic subtypes of renal cell carcinoma 

3. Understand and recognize common and uncommon infiltrative solid renal masses (transitional cell carcinoma, lymphoma, 

metastases, medullary and collecting duct carcinoma) 

4. Learn when renal mass biopsy is useful and when it is best avoided. 

5. Become familiar with variant presentations of angiomyolipoma and lymphoma 

Renal interventions 

B. Brkljacic (Croatia) 


To present the indications, technique, outcome and complications of common renal interventions – nephrostomy, renal and 

retroperitoneal drainage, thermal ablation of renal tumors, renal vascular interventions. 

The indications and technique will be presented for the drainage of renal collecting system (percutaneous nephrostomy), 

as well as for the drainage of kidney and retroperitoneal abscesses; few cases will be presented. Indications and technique 

for image-guided thermal ablations of renal tumors will be discussed, with examples of ultrasound guided and CT guided 

procedures. The role of interventional image-guided procedures in the treatment of renovascular hypertension (RVHT) will be 

reviewed extensively. The relationship of renal artery stenosis to renovascular hypertension will be discussed. Indications and 

technique of percutaneous transluminal renal angioplasty and PTRA with stenting for treatment of RVHT will be reviewed. 

Examples of PTRA in patient with fibromuscular dysplasia will be presented, as well as example of PTRA and stenting in the 

patient with ostial atherosclerotic stenosis. The role of imaging, and particularly ultrasound, in the selection of patients for 

renal vascular intervention will be discussed, as well as in the follow-up of patients after endovascular interventions. Complications 

of endovascular treatment will be reviewed, as well as the results. The overview of published studies that compare 

endovascular therapy to the best medical treatment will be presented, and utility of endovascular intervention in RVHT will 

be discussed. 

Workshop V: Science to practice: new methods in urogenital imaging 

Lecture Hall: Butenandt 

Genitourinary MRI at 3T: science to practice 

J. Fuetterer (The Netherlands) 

High field strength MR scanners (i.e. 3T) are becoming more widely available in the scientific and clinical setting. The increased 

signal-to-noise ratio inherent at 3T as compared to 1.5T offers potential for clinical MR imaging like shortening of imaging 

time and increased spatial resolution or a combination of these two. Beside the increase in signal-to-noise ratio, the spectral 

resolution at 3T is intrinsically increased with a factor of two, which offers an increased potential for spectroscopic imaging. 

This workshop will address the advantages and drawbacks of 3T MR in genitourinary imaging. 


1. To describe the impact of 3T functional MR in genitourinary imaging 

2. To apply new body MR techniques in their practice 

3. Use multiparametric MRI for improved diagnosis of genitourinary diseases 

4. To provide new female pelvic and prostate protocols, introducing these methods and compare them to 1.5T 

64

USPIOs for lymphadenopathy: science to practice 

Satoru Takahashi (Japan) 



1. Review the basis of Ferumoxtran-10 enhanced MR imaging for the Prostate cancer patients 

2. Show how to evaluate MRL in combination with dedicated software for visualizing 3D localization of lymph nodes. 

Ferumoxtran-10 is an ultrasmall superparamagnetic iron-oxide nanoparticle (USPIO) MR contrast agent, which targets a 

reticuloendothelial system. USPIO is transported to the lymph nodes via the lymphatic vessels after intravenous administration, 

and then, internalized by macrophage in the normal lymph nodes. As a lymph node with metastasis lacks uptake of USPIO, 

a metastatic lymph node can be clearly visualized as a high-signal nodule on T2*-weighted MR image regardless of size. 

Recent reports show that MR lymphography (MRL) using USPIO is extremely accurate for assessing the lymph nodes status in 

the prostate cancer patients. 

In this workshop, we will discuss potential clinical usefulness of USPIO in the diagnosis, pre-treatment assessment, and followup 

in prostate caner patients. 

First, we will review current status of USPIO based on our experiences in Nijmegen, including comparison between MRL and 

11C-Choline PET, which is also highly accurate novel molecular imaging techniques for assessing the prostate cancer. Then, 

we will discuss how to utilize the findings of MRL for treatment planning; such as 3D visualization for surgeons, radiation 

oncologists. We also briefly demonstrate the feasibility of image registration between MRL and CT as a potential tool for 

highly targeted radiation planning. 

Optical coherence tomography of the urinary tract: science to practice 

U.L. Mueller-Lisse (Germany) 


1. to understand the physcial and technical principles of optical coherence tomography (OCT) 

2. to understand the principles of catheter-based optical coherence tomography (OCT) 

3. to know about current experimental and initial clinical experience in optical coherence tomography (OCT) 

Optical coherence tomography (OCT) applies physical properties of near infrared light, such as transmission, reflection, 

optical interference, and optical extinction of light waves, to demonstrate changes in optical density between different 

objects, such as, e.g., different tissue layers within a biological organ. In contrast to clinical ultrasonography, which correlates 

time between emission and reception of a sound wave with depth of reflection of that sound wave within biological tissue, 

light waves travel at too fast a speed to allow for depth resolution in this manner. Rather, to obtain information on tissue 

depth, the physical and technical properties of a Michelson Interferometer are applied. In principle, a beam of optically 

coherent light is split in two arms by means of a semi-permeable mirror, namely, a reference arm whose length is altered by 

means of a rotating reflective mirror, and a measurement arm, whose length is determined by the sum of ist technical length 

and the depth of reflection of the emitted light within the object (e.g., biological tissue) under scrutiny. Only when the length 

of both arms is equal within the limits of coherence and wave lengthof the emitted light beam is there a signal provided by 

the interference of the light waves that are reflected back into the respective arms. While initially limited to optical laboratory 

settings and ex vivo studies, OCT has since become available even as a catheter-mounted device, with light transmission 

through long glass fibers. This has allowed access to tissues arranged in the form of long, narrow tubes, such as blood vessels, 

bronchi, or the lumina of the upper urinary tract. It is now possible to distinguish between different wall layers of those biological 

structures, such that arteriosclerotic plaque imaging and the demonstration of tumorous lesions within the urinary tract 

have become accessible by means of OCT. 

65


19:00 – 19:45 SUR Honorary Lecture 

Bladder Cancer and Bladder Cancer Imaging 


Learning Objectives 

1. To review the currently understood epidemiology and histology of bladder cancer. 

2. To review the CTU and MRU appearance of bladder cancer. 

3. To review pitfalls in the CTU and MRU detection of bladder cancer (providing examples of patients in whom false positive 

and false negative diagnoses were made) 

4. To review the role of imaging in assessing patients with suspected or known bladder cancer. 

5. To review the role of imaging in following patients after treatment of bladder cancer. 

Background 

Bladder cancer is the 2nd most common cancer of the urinary tract, after prostate cancer, affecting men 3-4 times as often 

as women (1). Risk factors include cigarette smoking, exposure to aromatic amines, medication exposure (cyclophosphamide, 

phenactin), and having a first degree relative with bladder cancer (2). Alcohol, coffee, and artificial sweeteners have 

not been confirmed as risk factors (2). 

Cell types 

While it was previously thought that nearly all bladder cancers belonged to one of three cell types, with most representing 

transitional cell carcinomas, it is now known that up to 25% of bladder neoplasms have mixed histology, containing clear cell, 

glandular cell, lymphoepithelial, micropapillary plasmacytoid, sarcomatoid, small cell/neuroendocrine, and/or squamous 

cell, as well a transitional cell components (3). Identification of variant cell populations is important, as most mixed tumors 

are more aggressive than pure transitional cell neoplasms (3). Identification of a “nested” pattern of cell growth also 

indicates a worse prognosis (4). 

Superficial versus invasive tumors 

Bladder cancers are classified as superficial (confined to the mucosa) or invasive. >70% of initially diagnosed bladder cancers 

are superficial (5, 6). Most superficial tumors have a papillary growth pattern and are low-grade (Ta); however, some 

superficial tumors have a flat growth pattern. Flat superficial tumors are more often high-grade and invasive (5). Most consider 

tumors that invade through the mucosa into the lamina propria, but not into the muscularis mucosa (T1) as superficial, 

although there is some controversy about this (7). 

Superficial bladder tumors are resected endoscopically, with treatment frequently supplemented by intravesical immunotherapy 

(BCG) or chemotherapy (mitomycin) (5). While these treatments are considered curative, 70% of patients with 

superficial tumors develop new bladder tumors within 3 years of treatment, 10-20% of which are invasive (5). Thus, patients 

with superficial cancers must be followed closely after treatment (6), and even with close follow up, new bladder tumors 

may not be detected before they become invasive (7). 

Organ-confined invasive bladder tumors are treated with radical cystectomy and lymph node dissection. Despite this aggressive 

treatment, many patients develop local and/or distant recurrences, with most recurrences appearing within 2-3 years. 

Imaging of patients with suspected bladder cancer 

While most patients with bladder cancer have hematuria, most patients with hematuria do not have bladder cancer (8). 

Nonetheless, because of this association, patients with hematuria undergo cystoscopy and upper tract imaging (intravenous 

urography [IVU], CT urography [CTU], or MR urography [MRU]). 

CTU has good to excellent sensitivity in detecting bladder cancer (9-11) and can be used for this purpose and to guide subsequent 

cystoscopy. Its only disadvantage is its high radiation dose (12). Most investigators recommend that CTU be performed 

using thin section excretory phase images (i.e.- 9, 12), although several studies have shown that thin section enhanced 

CT images obtained prior to renal excretion also detects most bladder cancers, due primarily to their early hyperenhancement 

(13, 14). 

Although MRU cannot detect some tiny tumors seen with CTU (due to lesser resolution), bladder tumor enhancement with 

gadolinium-based MR contrast media is pronounced, permitting effective tumor detection even in the absence of bladder 

wall thickening. Preliminary research on use of diffusion MR imaging to detect bladder cancers has also shown promise (15). 

On CTU and MRU, bladder cancers may produce asymmetric wall thickening, focal masses, or small filling defects. Rarely, 

bladder cancers can produce symmetric bladder wall thickening. Some bladder tumors are not detected with CTU or MRU, 

particularly small tumors, tumors located at the bladder base (which can be ascribed wrongly as representing part of an 

enlarged prostate) (10, 11), and tumors in inflamed or scarred bladders. However, CTU and MRU occasionally detect tumors 

missed at cystoscopy. 

Imaging for staging of bladder cancer 

Both CT and MRI have limited efficacy in staging bladder cancer, unless bulky disease is present (5, 8). The biggest problem 

relates to limitations in determining depth of mural invasion and in detecting microscopic extravesical spread. MRI enhanced 

with iron-oxide particle contrast agents can detect metastases in normal sized lymph nodes (i.e.-16). 

66 

SUR Honorary Lecture 



Imaging follow up of patients after treatment 

The most important use of imaging after treatment of superficial and invasive bladder tumors relates to the evaluation of the 

upper urinary tracts for metachronous tumors (occurring in 2-7% of patients), and to assess patients for metastatic disease (9). 

On occasion, unsuspected recurrent bladder tumors also will be identified on follow up studies, although the treated bladder 

can be difficult to evaluate (on imaging studies and at cystoscopy), because areas of fibrosis at tumor resection sites or 

occurring as a result of intravesical therapy can obscure adjacent tumors or even mimic tumors, leading to false negative 

and false positive diagnoses. 

Conclusion 

CTU and MRU have assumed a large role in evaluating patients with suspected or known bladder cancer. Nonetheless, these 

studies have limitations that will prevent them from replacing cystoscopy completely. 

Selected references 

1. Zhang J, Gerst S, Lefkowitz RA, et al. Imaging of bladder cancer. Radiol Clin N Am 2007; 45:183-205. 

2. Murta-Nascimento C, Schmitz-Drager BJ, Zeegers MP, et al. Epidemiology of urinary bladder cancer: from tumor development 

to patient’s death. World J Urol 2007; 25:285-295. 

3. Wasco MJ, Daignault S, Zhang Y, et al. Urothelial carcinoma with divergent histologic differentiation (mixed histologic 

features) predicts the presence of locally advanced bladder cancer when detected at transurethral resection. Urology 

2007; 70:69-74. 

4. Dhall D, Al-Ahymadie H, Olgac S. Nested variant of urothelial carcinoma. 2007; 131:1725-1727. 

5. Ng CS. Radiologic diagnosis and staging of renal and bladder cancer. Semin Roentgenol 2006; 41:121-137. 

6. Bradford TJ, Montie JE, Hafez KS. The role of imaging in the surveillance of urologic malignancies. Urol Clin N Am 2006; 

33:377-396. 

7. Soloway MS, Lee CT, Steinberg GD, et al. Difficult decisions in urologic oncology: management of high-grade T1 transitional 

cell carcinoma of the bladder. Urol Oncol Semin Orig Invest 2007; 25:338-340. 

8. Beyersdorff D, Zhang J, Schoder H, et al. Bladder cancer: can imaging change patient management? Curr Opin Urol 

2008; 18:98-104. 

9. Turney BW, Willatt JM, Nixon D, et al. Computed tomography urography for diagnosing bladder cancer. BJU Int 2006; 

98:345-348. 

10. Chow LC, Kwan SW, Olcott EW, et al. Split-bolus MDCT urography with synchronous nephrographic and excretory phase 

enhancement. AJR 2007; 189:314-322. 

11. Mueller-Lisse UG, Mueller-Lisse UL, Hinterberger J, et al. Multidetector-row computed tomography (MDCT) in patients with 

a history of previous urothelial cancer or painless macroscopic hematuria. Eur Radiol 2007; 17:2794-2803. 

12. van der Molen AJ, Cowan NC, Mueller-Lisse UG, et al. CT urography: definition, indications, and techniques, A guideline 

for clinical practice. Eur Radiol 2008; 18:4-17. 

13. Jinzaki M, Tanimoto A, Shinmoto H, et al. Detection of bladder tumors with dynamic contrast-enhanced MDCT. 

AJR 2007; 188:913-918. 

14. Park SB, Kim JK, Lee HJ, et al. Hematuria: portal venous phase multi-detector row CT of the bladder – a prospective 

study. Radiology 2007; 245:798-805. 

15. Matsuki M, Inadi Y, Tatsugami F, et al. Diffusion-weighted MR imaging for uinrary bladder carcinoma: initial results. 

Eur Radiol 2007; 17:201-204. 

16. Saksena MA, Dahl FM, Harasinghani MG. New modalities in bladder cancer. World J Urol 2006;24:473-480. 

67


17:30 – 19:00 Lecture Session I: Prostate cancer 


Imaging of prostate cancer: the urologist´s perspective 

C. Stief (Germany) 

In the context of a suspected or established cancer of the prostate, the urologist’s perspective on imaging must be focused 

on the treatment options that can be offered to an individual patient. 

Of utmost importance is staging of the carcinoma of the prostate: Is there any sign that the tumor has spread beyond the 

prostatic capsule? Any sign of infiltration of the seminal vesicles, the urethra or the bladder wall? Besides local extension, 

information of the pelvic lymph node status as well as of distant metastases, especially of the bones, is crucial. 

Given a localized T2 tumor of the prostate and the planning of a nerve-sparing surgical procedure, detailed knowledge of 

the anatomy of the gland itself as well as of the adjacent structures as neuro-vascular bundles of intravesical prostatic lobes 

are most helpful for the surgical strategy. If a intrafascial nerve sparing technique (maximum preservation of autonomic nerves) 

is planned, a distribution of the cancer foci within the prostate and a precise description of their individual localization 

and Gleason grading does greatly enhance the surgical strategy. 

Thus, advanced imaging of the prostate gland does improve both the functional outcome of prostate cancer surgery as well 

as the oncological result since it enables a stratification for more aggressive and extensive surgery for lcally advanced cases 

versus a maximal nerve sparing approach in organ defined patients. 

Prostate cancer: ultrasonography 

F. Frauscher (Austria) 

Prostate cancer (PCa) is the most common cancer in men. Improvement of PCa diagnosis is a main topic of diagnostic 

imaging. Systematic prostate biopsy is the „gold standard” of PCa diagnosis but may miss cancer in up to 35%. Contrast 

enhanced ultrasonography and elastography are evolving methods that may significantly change the role of ultrasonography 

for PCa diagnosis. 

Contrast enhanced ultrasonography: Prostate cancer tissue is associated with an increased microvessel density (MVD) due to 

neovessels. Ultrasonography contrast agents enable improved detection of low-volume blood flow by increasing the signalto-noise 

ratio and therefore allow a more complete delineation of the neovasculature. Contrast-enhanced ultrasonography 

can assess the MVD in PCa. Contrast enhanced Doppler ultrasonography can improve PCa detection, and targeted biopsy 

are up to 4.1-fold more likely to detect cancer than systematic biopsy. Furthermore contrast-enhanced biopsy detected 

cancers with significantly higher Gleason scores compared with systematic biopsy, and this techniques may allow identification 

of more aggressive cancers, which is important for defining prognosis and deciding treatment. 

New contrast-specific imaging techniques, such as grey-scale harmonic ultrasonography, offer a greater temporal and 

spatial resolution, and allow for excellent microbubble detection. Halpern et al. evaluated gray-scale harmonic ultrasonography 

for directed biopsy for PCa detection. When a suspicious site was evaluated with an additional biopsy core, the site 

was five times more likely to have a biopsy with positive findings than a standard systematic site. Though contrast-enhanced 

gray-scale harmonic US improves the ultrasonographic detection of malignant foci in the prostate, and allows for targeted 

biopsy. Recently, more sensitive contrast-enhanced ultrasonography techniques came available, such as cadence contrastpulse 

sequence (CPS) technique. We have used CPS imaging for detection of PCa in 20 patients. CPS technique was used to 

assess the intraprostatic vasculature during microbubble administration. CPS imaging found suspicious areas on contrast 

enhancement in 11 of 20 cases and targeted biopsy revealed cancer in 8 of the 11 cases. Systematic biopsy found cancer 

in 5 of 20 subjects. In the 9 subjects without any abnormal findings on CPS, systematic biopsy was negative for cancer. 

Elastography: It is known that cancer tissue shows both, an increase in vessel and cell density. Krouskop et al. described that 

there is a significant difference in stiffness between normal and neoplastic prostate tissue. For detection of changes in tissue 

elasticity Ophir et al. developed 1991 an imaging technique based on static deformation and called it „strain imaging“ (= elastography). 

This technique can visualize displacements between ultrasonographic image pairs of tissue under „compression. 

Studies have demonstrated, that elastography allows for PCa detection with a high degree of sensitivity. Furthermore the 

detection rate for elastography targeted biopsy cores was significantly better than for systematic biopsy cores. Therefore 

elastography allows for assessment of the tissue elasticity and therefore for differentiation between benignity and malignity. 

In summary the new ultrasonography techniques are promising for PCa detection, grading and staging and seem to offer a 

novel and great potential in PCa diagnosis. 


1. To understand the importance of new ultrasonographic imaging techniques for prostate cancer diagnosis 

2. To learn the value of contrast enhanced ultrasonography for prostate cancer detection and grading. 

3. To understand the value of elastography for prostate cancer detection and staging. 

68 

Course Lectures 


MRI in Prostate cancer 



With the increasing number and earlier detection of men with PCa the call for adequate imaging becomes urgent, not only 

for decision making in more advanced cancers, but in particular for earlier stage cancers (specific diagnosis of significant 

tumors). Functional and molecular MR methods are excellent potential tools for this purpose. Since the introduction of MR to 

address diagnostic and biomedical questions in PCa, there is a continuing quest for better spatial resolution, sensitivity and 

specificity. Recent MR developments, such as higher field magnets in combination with approaches to assess anatomy at 

high resolution, vascularity, metabolism, cellular density and visualization of contrast targeted or loaded cells, promise to 

provide the required specifications. 

The clinical capabilities of new techniques (and contrast agents) will be shown using modern clinical MR scanners 

(3T systems), with the help of advanced post-processing tools. 

There are 4 clinical issues of importance concerning MRI of prostate cancer: 

Detection: Reliable detection of PCa without an endorectal coil (ERC) is possible at 3T using dynamic contrast enhanced 

(DCE) and diffusion weighted (DWI) MR images. The use of these functional MR exam, will be discussed. In addition, the value 

of a recently developed, clinically approved, 3T MR-biopsy device to improve PCa detection in patients with persisting 

increased PSA and negative TRUS biopsy will be shown. 

Localization: High accuracy can be obtained in localizing prostate cancer with DCE, high resolution T2-weighted images and 

MRSI at 1.5T. At 3T the use of DWI, DCE MRI, and MRSI will give even better tumor localization. This improved localization will 

yield more representative biopsy results and thus a better pre-operative prediction of tumor aggression. Also, the fusion of 

functional MR data with CT, showing the dominant lesion can be used to guide IMRT. 

Local Staging: Improved detection of even minimal (0.5 mm) capsular penetration using 3T ERC MRI (sensitivity 87%, 

specificity 96%) is currently possible at 3T. The information where minimal capsular penetration is located, will most likely alter 

surgical management and results (e.g. % of free resection margins, possibility for nerve sparing surgery). 

Nodal Staging: Using iron-nanoparticle MR-contrast to detect lymph node metastasis (MRL), results in high detection accuracy 

for small nodes. The findings of a recently completed multi-center study (sensitivity and specificity both 93%) will be shown. In 

patients with a negative MRL lymph node dissection could be safely omitted. Even better results are obtained at 3T; currently 

3 mm nodal metastases can be detected. The accuracy of this technique with high-resolution 3T MRI will be discussed. In 

addition, the role in patients with PSA relapse after therapy will be presented. By prospectively investigating the impact of 

local treatment of MRL detected metastatic lymph nodes, on patient outcome, the true additive value of MRL will be shown. 

Saturday, September 13, 2008 

09:00 – 10:30 Lecture Session II: Upper Urinary Tract 


Imaging of the upper urinary tract: the urologist´s perspective 

N. Zantl (Germany) 

The urologist’s perspective of imaging of the upper urinary tract is basically affected by clinical and practical 

issues. The most striking questions arise out of everyday’s routine patient management and can be classified into 

five categories: emergency diagnostics (stone disease, trauma), primary diagnostics (hydronephrosis, hematuria, 

small renal masses, urothelial carcinoma of the upper urinary tract), staging of urologic malignant disease and 

management of postoperative complications. Besides achievement of the best imaging result, quantified by 

sensitivity and specificity, other criterions such as side effects of contrast media (in renal insufficiency) and 

radiation exposure (most notably in children and pregnant women) or the possibility of immediate intervention 

(e.g. implantation of an ureteral catheter, insertion of a percutaneous abscess drainage or selective embolization 

of bleeding vessels) have to be considered. 

This lecture will mainly focus on the role of the cross sectional imaging techniques computed tomography (CT: 

multidetector helical CT, CT-urography) and magnetic resonance imaging (MRI, MRI-urography, MRI for imaging 

of renal function) including the significance of the MRI-contrast media in renal impairment. 

Imaging of the upper urinary tract: current status in adults 

C. Nolte-Ernsting (Germany) 

No doubt, a groundbreaking change in urographic imaging during the past decade was substantiated by the 

clinical introduction of multidetector computed tomography (CT) and magnetic resonance imaging (MRI). Both CT 

urography and MR urography are going to replace conventional urography and invasive endourologic diagnostics 

in a growing number of indications. To date, unenhanced CT is already regarded the diagnostic gold standard in 

imaging of urolithiasis providing a sensitivity and specificity of near 100%. For contrast-enhanced CT of the upper 

urinary tract, diverse examination protocols have been promoted in the literature, including intravenous singlebolus 

and split-bolus techniques, single-phase and multiphase data acquisition protocols, and supplementation of 

69


saline or low-dose furosemide. Whatever variant of CT urographic technique we prefer, it is clear that we always 

have to strive for a compromise between the best possible urinary tract opacification and the lowest acceptable 

radiation exposure. Initial studies underscore that because of its high spatial resolution, multidetector CT 

urography must be part of the diagnostic algorithm for the noninvasive detection of urothelial cancer in patients, 

older than 40 years, presenting with painless hematuria. 

As a matter of fact, MR urography provides typical urographic views without resorting to radiation exposure. 

Moreover, MR urography is the only technology featuring two inherently different, but complementary strategies 

for imaging the upper urinary tract: The first MR urographic technique uses heavily T2-weighted turbo spin-echo 

sequences for obtaining unenhanced static-water images of the urinary tract. The second MR urographic 

technique imitates conventional intravenous urography and is, therefore, referred to as excretory MR urography. 

For this purpose, a gadolinium contrast agent is intravenously injected and after its renal excretion, the 

gadolinium-enhanced urine is visualized using fast T1-weighted gradient-echo sequences. 

Static-fluid MR urograms have proved to be excellent for depicting the markedly dilated urinary tract, even if the 

renal excretory function is quiescent. Static-fluid MR urography is less suitable for imaging of disorders that occur 

in the nondilated collecting system. On the other hand, gadolinium excretory MR urography provides high-quality 

images of both nondilated and obstructed urinary tracts in patients with normal or moderately impaired renal 

function.T2- and T1-weighted MR urographic imaging strategies can be applied either seperatly or in combination 

for obtaining the best comprehensive assessment. 

MR urography has proved to be of diagnostic value in numerous urinary tract disorders in adults and children. 

However, because of cost restraints in our health care systems, it is obvious that MR urography will mainly be 

regarded as a diagnostic tool of secondary preference following ultrasonography, conventional urography and CT 

urography. Nevertheless, MR urography offers a number of first-choice applications and should not be limited to 

patients who do not tolerate iodinated contrast agents. In a growing number of radiology departments, MR 

urography has already replaced conventional urography for diagnosing urinary tract disorders in children. 

Especially MR imaging, rather than CT, suggests a great potential for combining morphologic plus functional 

imaging performed as a single-session “all-in-one” examination. Such an integrative diagnostic approach will 

probably favor the use of MR imaging in the long term in uroradiologic patient care. 

Formerly, a good uroradiologist was a radiologist who could produce a good conventional urogram. To date, a 

good uroradiologist is a radiologist who can produce good CT and MR urograms! 


1. To get reviewed the modern way of urographic imaging with use of CT and MRI. 

2. To understand the primary CT urographic imaging strategies. 

3. To learn about the differences in T2- and T1-weighted MR urography techniques. 

4. To become informed about potential clinical applications for CT urography and MR urography. 

Imaging of the upper urinary tract: current status in children 



1. To be familiar with recent advances in pediatric uroradiologic imaging of the urinary tract. 

2. To comprehend the usefulness of ultrasound harmonic, color Doppler artifact and 3D imaging modalities in pediatric 

urosonography. 

3. To learn the indications and procedural details of static and dynamic MR urographies in children. 

4. To be aware of recent recommendations on diagnostic algorithms for the upper urinary tract in children. 

The higher risk of radiation exposure in children compared to adults is a decisive factor in the selection of 

diagnostic imaging modalities of the urinary tract. Ultrasound [US] is the primary and most important one. It is 

free of radiation and widespread. Recent advances in US have reinforced and expanded its applicability. High 

resolution transducers enable the visualization of focal or diffuse parenchymal changes much easier. Harmonic 

imaging provides images of the kidneys artifact-free and with higher contrast and spatial resolution. The 

delineation of cysts is improved and concrements become more conspicuously visible. The use of color Doppler 

generating the twinkling artifact for stone detection is gaining more application in children. Three dimensional 

[3D] US provides better morphometry of kidneys with dilated pelvicalyectasis. It is possible to measure separately 

the pelvicalyceal and parenchymal volumes. MR imaging and particularly MR urography [MRU] is increasingly 

being used for the evaluation of the urinary tract in children. The pre-contrast images using 3D T2-weighted 

sequences provide excellent morphological detail. Particularly, in cases of renal duplication and complex 

pathologies such as combination of renal fusion and obstruction MRU has become invaluable. The added 

advantage of the contrast-enhanced images is improving the morphological depiction and separation of non- or 

poorly functioning part from that normally functioning. The post-contrast 3D dynamic images yield impressive 

morphological and functional information. These incorporate an MR angiography phase and thus information of 

vascular anomalies. Further post-processing of the post-contrast images can yield the split renal function based 

on volume and on the glomerular filtration rate [GFR] [Patlak split function]. The mapping of the GFR gives an 

overview of the renal functional distribution. In the end recent recommendations on imaging in urinary tract 

infection and postnatal imaging in mild-to-moderate neonatal hydronephrosis will be discussed. 

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11:00 – 12:30 Lecture Session III: Lower Urinary Tract 


Functional Imaging of the lower urinary tract: the urologist´s perspective 

C. Chapple (United Kingdom) 


The lower urinary tract acts as a single (vesico-urethral) unit during normal lower urinary tract function. The role of this unit is to: 

• adequately store urine (Storage) 

• efficiently empty urine (Voiding) 

If the function of this vesicourethral unit is disturbed then urinary dysfunction along with associated lower urinary tract 

symptoms (LUTS) may occur. Management of lower urinary tract dysfunction is based on the findings of: 

• A focussed history and physical examination 

• Appropriate laboratory studies 

• Endoscopy and radiography – to provide structural information when clinically indicated 

• Urodynamic studies – to provide functional information when clinically indicated 

LUTS are broadly categorised into 3 groups related to their timing within the bladder (voiding) cycle. The 3 stages of the 

bladder cycle are: 

Storage Voiding Post Micturition 

● Urgency 

● Increased Daytime 

Frequency 

● Nocturia 

● Urinary Incontinence 

● Altered Bladder 

Sensations 

● Hesitancy 

● Intermittency 

● Slow Stream 

● Splitting or Spraying 

● Straining 

● Terminal Dribble 

Urodynamic evaluation 

Appropriate urodynamic tests can only be interpreted after taking an adequate history, with the formation of specific clinical 

questions, Since the principal aims of the urodynamic assessment are to answer the clinical question by evaluating the 

function of the vesicourethral unit. Urodynamics is particularly of benefit in objectively identifying functional abnormalities of 

the lower urinary tract such as urinary incontinence and bladder outflow obstruction (BOO). However (particularly with video 

cystometry) it may also assist in identifying structural abnormalities such as a prolapse associated with stress urinary incontinence 

(SUI), vesico-vaginal fistulae, urethral diverticula or associated upper tract vesico-ureteric reflux; or in the context of 

the male patient, it can be useful in demonstrating attenuation of the prostatic urethra in association with prostatic outlet 

obstruction or confirming the diagnosis of bladder neck obstruction by demonstrating associated trapping of contrast in the 

posterior urethra during the “stop test”. 

The term “urodynamics” encompasses any investigation of lower urinary tract dysfunction from the simple to the sophisticated, 

these include: 

• Frequency/Volume Chart (FVC) 

• Bladder Diary 

• Pad testing 

• Uroflowmetry ± ultrasound residual estimation 

• Pressure/Flow Studies 

● - Cystometry 

● - Video Cystometry 

● - Ambulatory Urodynamics 

• Urethral Pressure Studies 

• Other Studies 

● - Intravenous Urodynamogram 

● - Ultrasound Cystodynamogram 

Generally the term “urodynamics” has become synonymous with Pressure/Flow studies, with most clinicians referring to either 

cystometry or video cystometry when they use the term “urodynamics” 

An experienced clinician with an understanding of urodynamic techniques should carry out the urodynamic study and 

should interpret the study in the context of the patient’s symptoms. As with all practical skills there is a learning curve, with 

the interpretation becoming easier with increasing experience. The true clinical value or “art” of urodynamics is in applying 

the objective findings of a well executed study to the individual patient, taking into consideration subtleties in the history and 

physical examination that may be clinically important. 

Imaging of the lower urinary tract: current status in adults 

D. Beyersdorff (Germany) 

● Feeling of 

incomplete emptying 

● Post micturition 

dribble 

In adults the reason for imaging of the lower urinary tract is the differentiation of hematuria, staging of tumors of 

the urinary bladder or other pelvic organs and to identify bladder outlet obstruction. Other reasons are pelvic 

71


trauma and recurrent urinary tract infections. Congenital malformations are a rare cause of imaging of the lower 

urinary tract in adults. 

Intravenous pyelography (IVP) has been largely replaced with multiphasic computed tomography urography 

(CTU) performed on multislice CT scanners. The new CT technique allows direct and indirect detection of 

urothelial cancer throughout the urothelium and also identifies other causes of hemorrhage in patients presenting 

with hematuria. Thin-slice and multiplanar reconstructions have improved CT staging of bladder cancer. In 

addition, CT allows evaluation for lymphatic and distant metastases in a single examination. Magnetic resonance 

imaging (MRI) continues to have a role in evaluating the depth of tumor invasion into the bladder wall but the 

assessment is difficult after transurethral resection of the bladder (TURB). Retrograde urethrography is still 

necessary to identify bladder outlet obstruction and traumatic injury. Voiding cystourethrography is used to 

evaluate for vesicoureteral reflux in adults. This diagnostic tool is also used postoperativly to exclude 

complications after prostatectomy and cystectomy. 

Imaging of the lower urinary tract: current status in children 

M. Riccabona (Austria) 

“Lower urinary tract” is a somewhat undefined area – the urethra? The bladder? The ureters or at least the distal 

ureter? And in neonates – does this not often include imaging of the (inner) genitalia? In This context I decided 

to include all these aspects in my lecture. 

This lecture will try to discuss basic imaging techniques that are used for imaging of all these structures 

mentioned above such as ultrasound, voiding cystourethrograhy, ante- / retrograde urethrography, MRI / MRU, 

rarely (contrast-enhanced) CT including some remarks on modern applications such as virtual cystoscopy. Some 

basic technical details will be presented as well as a few more general remarks concerning the various imaging 

procedures. Additionally this lecture will try to give some image examples of typical pathologies, to present 

indications and restrictions for various imaging procedures, and to discuss the changing attitude towards invasive 

or radiating imaging, as well as to recommend some imaging strategies for common and important paediatric 

lower urinary tract conditions in the light of (presently) changing management concepts. 

In conclusion, imaging plays an essential part in the assessment of the lower (genito-)urinary tract in children; 

however, procedures have to be adapted to the paediatric situations to reduce radiation burden and procedural 

hazards. Furthermore, existing imaging algorithms for common paediatric queries such as assessment of VUR or 

imaging in UTI must be adapted to new knowledge and changing therapy concepts. 


1. To understand the various imaging modalities used for assessment of the paediatric “lower urinary tract”, the 

requisites and their proper application. 

2. To appreciate the potential, the risks and the restrictions of common imaging procedures in this body area. 

3. To learn about recommendations for imaging algorithms applied to typical lower urinary tract conditions in infants 

and children. 

14:30 – 16:00 Lecture Session IV: Pelvic and Urinary Trauma 


Radiological managment in trauma of the upper urinary tract: 



1. Demonstrate key imaging findings in adrenal gland trauma and discuss the influence of imaging findings on the 

management of patients with adrenal hematomas. 

2. Demonstrate key imaging findings in renal trauma and discuss the role of imaging guided interventions in the 

management of patients with renal trauma. 

3. Discuss key imaging findings in the diagnosis of ureteral trauma and discuss the role of imaging guided 

interventions in the management of ureteral trauma. 

Trauma to the GU organs is identified in 0.5 -3.5 % of severe blunt trauma admissions with renal trauma in 

43-67% of cases, testicular trauma in 24% of cases, and bladder trauma in 16% of cases of motor vehicle collisions. 

Adrenal Trauma 

Adrenal injuries occur in patients with severe trauma and thus, association with other visceral and skeletal injuries is common. 

The majority of adrenal injuries occur on the right side. Bilateral hematomas are the least common manifestation of adrenal 

trauma. If an adrenal hematoma is identified in a patient history of minimal or no trauma, or if there are bilateral hematomas, 

spontaneous hemorrhage should be considered, which can be due to coagulopathy or bleeding in an underlying pathology 

such as metastases and primary tumors. It is important to keep in mind that a mass in the adrenal gland of a trauma 

patient may be a preexisting incidental lesion and not necessarily represent an adrenal injury. 

Renal Trauma 

Solid organ injuries (Liver, Spleen, Kidneys, Pancreas) are classified into grades of severity by the American Association for the 

Surgery of Trauma (AAST); CT grading systems are adapted from AAST classification with 95% of blunt renal trauma represent- 

72


ing minor injuries (AAST grades I-III). Optimal evaluation of renal trauma requires a high quality contrast enhanced CT examination. 

Imaging evaluation in renal trauma is directed towards answering the following key questions: determining the extent 

of parenchymal injury, presence of active arterial extravasation and other vascular injuries, and assessing for collecting 

system injury. When the trauma history is insignificant, it is important to look for underlying renal pathology such as hydronephrosis, 

renal cyst, tumor, or congenital anomalies which may have predisposed the kidney to injuries. 

Most renal injuries are minor and are managed non-operatively. These consist of renal contusion, hematoma, and lacerations. 

Deep lacerations may extend into the collecting system, and require excretory phase imaging for depiction. Most small 

urine leaks resolve spontaneously but large untreated urinary leaks may require urinary diversion with a ureteral stent. 

Arterial Extravasation may be present in 21 % of renal injuries; 18% of clinically stable trauma patients may have extravasation 

and the majority of these patients may require further therapy such as surgery or embolization. Injury to main or segmental 

renal vessels may be due to intimal injury to the renal artery in deceleration injuries, or to extension of parencymal lacerations 

into the vascular branches and result in pseudoaneurysma, arterio-venous fistulae, or segmental or total renal infarction. Isolated 

venous Injury without arterial injury is very uncommon in blunt abdominal trauma. 

Ureteral Injury 

Ureteral injuries from external blunt trauma are rare. Deceleration injuries may cause ureteropelvic junction (UPJ) injuries, and 

the same mechanism of injury can also damage the renal vascular pedicle. Typically, these injuries do not present with 

hematuria, and there is often a delay in their diagnosis. UPJ injury should be suspected when there is good excretion of contrast 

from the collecting system with massive urinary extravasation in the absence of parenchymal injury. 

Penetrating trauma and iatrogenic injuries are more often associated with ureteral injuries than blunt trauma. Gynecologic 

surgery accounts for >1/2 of iatrogenic ureteral injuries which occur predominantly in the distal 1/3 of ureter. Preoperative 

prophylactic imaging to delineate ureteral anatomy, and even the presence of ureteral stents do not prevent intraoperative 

damage. Common types of injury are ureteral ligation, kinking by suture, or transection, which can cause devascularization 

and lead to delayed necrosis and stricture. Over 65% of iatrogenic ureteral injuries are recognized only after a delay of several 

days to weeks after the surgery. 

References: 

Paparel P, N’Diaye A , Laumon B, Caillot J-L, Perrin P, Ruffion A. The epidemiology of trauma of the genitourinary system 

after traffic accidents : analysis of a register of over 43 000 victims. BJU Int ; 2006: 97: 338-341 

Rana AI, Kenney PJ, Lockhart ME, et al. Adrenal gland hematomas in trauma patients. Radiology 2004; 230:669-675 

Yao DC, Jeffrey RB, Mirvis SE, et al. Using contrast-enhanced helical CT to visualize arterial extravasation after blunt 

abdominal trauma. AJR 2002; 178:17-20 

Kawashima A, Sandler CM, MD, Corl FM, et al. Imaging of renal trauma: A comprehensive review. Radiographics. 

2001;21:557-574.) 

Acute bladder and urethral injuries 


BLADDER INJURIES 

Injury of the bladder may occur as a result of blunt, penetrating or iatrogenic trauma. The susceptibility of the bladder to 

injury varies with its degree of filling; a collapsed or nearly empty bladder is much less vulnerable to injury than is a distended 

organ. 

Radiologic Examination 

The static or CT cystogram is the examination of choice for the diagnosis of a bladder injury. At least 300 ml of contrast 

should be used and with a conventional cystogram, a postdrainage radiograph following as complete emptying of the 

bladder as possible must be included. Studies have shown that the diagnosis of bladder injury may be established on this 

radiograph only in approximately 10% of the cases. 

Bladder Injury in Blunt Pelvic Trauma: 

Major bladder injury occurs in approximately 10% of patients suffering pelvic fracture. Such injuries are classified radiologically 

as: 

– Bladder Contusion 

– Intraperitoneal Rupture 

– Extraperitoneal Rupture 

– a) Simple 

– b) Complex 

– Combined Bladder Injury 

Intraperitoneal rupture occurs when there is a sudden rise in intravesicle pressure as a result of a blow to the lower abdomen 

in a patient with a distended bladder. The increased intravesicle pressure results in rupture of the weakest portion of the 

bladder, the dome, where the bladder is in contact with the peritoneal surface. Intraperitoneal rupture accounts for approximately 

one-third of major bladder injuries. Approximately 25% of such injuries occur in patients without pelvic fracture. On 

cystography, contrast material extravasation into the paracolic gutters and outlining loops of small bowel will be present. 

The classically described mechanism for extraperitoneal bladder rupture is laceration of the bladder by a bone spicule in 

association with an anterior pelvic arch fracture. Extraperitoneal rupture represents approximately 60% of major bladder injuries. 

With simple extraperitoneal rupture, contrast extravasation is limited to the pelvic extraperitoneal space. With complex 

extraperitoneal rupture, contrast material extravasation may extend into the anterior abdominal wall, the penis, the scrotum 

73


and the perineum. Combined bladder injury results when both intraperitoneal and extraperitoneal bladder injury is present. 

This injury represents approximately 5% of major bladder injuries. 

External Penetrating Bladder Injury: 

Penetrating injury of the bladder occurs as a result of bullet or knife wounds of the pelvis or perineum or as the result of impalement 

of the bladder by a variety of objects. Penetrating injuries are classified as intraperitoneal rupture, extraperitoneal 

rupture or combined bladder injury. 

URETHRAL INJURIES 

In 1997, Goldman proposed a modification to the well accepted Colapinto and McCallum classification to make it anatomically 

consistent and more comprehensive so that it now includes all urethral injuries which occur following blunt trauma. This 

classification is as follows: 

Type I Posterior urethra is stretched but intact. No contrast extravasation is present on urethrography. A hematoma collects 

in the prostatic fossa, resulting in dislocation of the bladder base from the pelvis. 

Type II Partial or complete pure posterior injury with tear of the membranous urethra above the urogenital diaphragm. 

Urethrography demonstrates contrast extravasation into the pelvic extraperitoneal space above an intact urogenital 

diaphragm. 

Type III Partial or complete combined anterior/posterior urethral injury with disruption of the urogenital diaphragm. With this 

injury, contrast extravasation on urethrography is present below the urogenital diaphragm into the perineum. 

Type IV Bladder neck injury with extension into the urethra. 

Type IV (A) Injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury. 

Type V Partial or complete pure anterior urethral injury. 

Types I, II and III injuries collectively occur in approximately 5% of male patients with pelvic fracture. The prostate is sheared 

from its connection to the urogenital diaphragm as the puboprostatic ligaments are ruptured. The urethral injury is attributable 

to a violent force which disrupts the soft tissues rather than to a laceration of the urethra by a bony spicule. A hematoma 

collects in the retropubic and perivesicle spaces. Urine, however does not escape from the bladder unless it too is injured or 

the bladder neck sphincter mechanism has been disrupted by prior surgery. Type III injuries are the most common; both Type 

I and II are relatively uncommon since the integrity of the urogenital diaphragm is frequently compromised by the force of 

the injury. 

Type IV injuries are also relatively uncommon injuries that extend from the base of the bladder into the bladder neck. Such 

injuries have been estimated to occur in approximately 5% of women with pelvic fracture but may also occur in males. Since 

the bladder neck is the site of the internal urethral sphincter, such injuries must be carefully evaluated to be certain that the 

sphincter is not compromised. Type IV (a) injuries have a similar radiographic pattern of extravasation but do not involve the 

urethra; the injury is limited to the base of the bladder only, and as such, actually constitute an extraperitoneal bladder rupture. 

Straddle injuries (Type V) occur as a result of a blow to the perineum. This occurs commonly when the male patient falls astride 

a hard object such as the crossbar of a bicycle. Complete anterior urethral disruption is uncommon, but is suggested on 

urethrography when there is extensive extravasation without filling of the posterior urethra. Partial urethral injury demonstrates 

some filling of the posterior urethra. If Buck’s fascia remains intact the extravasation is limited to the space between Buck’s 

fascia and the tunica albuginea of the corpus spongiosum. 

Imaging in trauma of the pediatric genital and lower urinary tract 

L. Lobo (Portugal) 


1. To present the current concepts of imaging evaluation in pediatric lower urinary tract and genital trauma. 

2. To point out pediatric specificities regarding physiopathology, clinical issues, patterns of injury and risks, and 

their implications on imaging strategies. 

3. To describe imaging findings of lower urinary tract and genital trauma in children. 

4. To emphasize the role of various imaging modalities, their rational use, pitfalls and limitations. 

Trauma is a major cause of morbidity and mortality in children, especially after one year of age. Among all pediatric trauma, 

the urogenital tract is affected in about 10% of cases, with renal trauma accounting for the majority of those. It is usually a 

result of blunt abdominal injury. Penetrating and iatrogenic injuries are less common. Non-accidental injury, including sexual 

abuse, should also be considered. 

Imaging strategies in pediatric lower urinary tract and genital trauma are not so much different from those commonly 

applied for adults. However, there are some anatomic and physiologic particularities in children that are important to recognize, 

as they can have an impact on imaging evaluation and management. 

Children can stay clinically stable for a long time after blunt trauma, even in the presence of severe injuries. In children, the 

urinary bladder has a higher position than in adults, with a larger peritoneal surface increasing the risk of intraperitoneal 

bladder rupture. In boys, the posterior urethra is less protected by the prostate gland, and it can be injured elsewhere. 

Likewise, bladder neck disruption is more common in children than in adults. In girls, urethral trauma is very rare, usually 

associated with vaginal and perineal injuries. Testicular trauma is uncommon in children, being more frequent in adolescents 

and often related to sport injuries. 

Hematuria, seat-belt ecchymosis and pelvic fractures can be associated with lower urinary tract trauma in children. Seat-belt 

ecchymosis on a child abdominal wall is a strong predictor of bladder injury. 

74


Imaging modalities for the evaluation of genital and lower urinary tract trauma in children include urinary tract 

and genital ultrasound, retrograde urethrography and cystography, CT cystography and/or contrast-enhanced CT with 

delayed acquisition. Fluoroscopic and CT parameters should be adapted to the pediatric age group, as well as contrast 

medium dose and time of image acquisition. In the emergency setting, MRI has no definite role. In cases of perineal injuries 

with extensive muscle disruption, MRI can be helpful prior to delayed surgical reconstruction. Imaging evaluation has also 

an important role in the follow-up of children after lower urogenital trauma, for detection and characterization of 

complications such as urethral stenosis. 

16:30 – 18:00 Lecture Session V: Contrast media and beyond 


ESUR 2008 update on contrast media safety 

H. Thomsen (Denmark) 

Since its establishment in 1996 the Contrast Media Safety Committee has released several guidelines on various 

safety aspects of the use of contrast media. Version 6.0 of the booklet with guidelines was released at ECR´06. 

Thanks to the evolution the Contrast Media Safety Committee plans to introduce some minor changes in version 7 

compared to version 6. The topics are following: 

Metformin and nomal renal function 

The risk of contrast induced nephropathy is very low in patients with diabetes but without nephropathy. Until now 

it has been recommended that metformin intake was stopped before and 48 hours after contrast medium 

administration. Serum creatinine should be measured and be within normal range before intake was resumed. It 

is proposed that intake of metformin can be continued in patients with diabetes but without nephropathy defined 

as eGFR above 60 ml/min. There is no reason for control of renal function or a pause in metformin intake. For 

patients with diabetic nephropathy guideline is unchanged. 

Gadolinium based contrast agents and pregnancy/lactation 

As there is a risk of small amount of gadolinium may be left in the body after exposure to gadolinium based 

contrast agents and they enter foetal circulation these agents should not be given to pregnant women except 

when it is clinically justified. In such cases agents, which leaves the smallest amount of gadolinium should be 

used. The same applies to lactating women. If administered lactation should be stopped for 24 hours. Milk 

produced during those 24 hours should be thrown away. 

NSF and Gadolinium based contrast agents 

The ESUR guideline on NSF should be introduced in version 7 of the booklet. After EMEA contraindicated the use 

of the least stable agents in patients with CKD 4 & 5 and cautioned their used in patients with CKD 3, no new 

cases of NSF has been reported. The ESUR guideline is in accordance with the European regulations. The new 

European classification of the various agents (high, intermediate or low risk of NSF) will be used. Optimark, 

Omniscan and Magnavist belong to the high risk group. Multihance, Primovist and Vasovist are in the 

intermediate group. Dotarem, Prohance and Gadovist (all macrocyclic agents) belong to the low risk group. 

Release 

It is expected that version 7.0 will be available at ECR’09 and in the 2nd edition of the book Contrast Media: 

Safety issues and ESUR guidelines. 

ESUR 2008 update on molecular imaging and new contrast media 

N. Grenier (France) 

Specific diagnosis of most renal diseases still requires pathological examination after percutaneous biopsy. 

Molecular imaging techniques aim to identify and to characterize cellular and molecular processes in vivo. New 

developments of MR systems, providing higher signal-to-noise ratio and higher spatial and/or temporal resolution, 

and specific MR contrast agents, offer the opportunity to drive new challenges for obtaining functional and 

biological information on tissue characteristics relevant for diagnosis, prognosis and treatment follow-up. 

MR imaging of intrarenal macrophage activity 

Intravenous injection of ultrasmall superparamagnetic particles of iron oxide (USPIO) has been proposed for 

targeting phagocytic cells in inflammatory renal diseases. Such targeting was performed in several models in rats. 

These studies showed that the degree of signal intensity (SI) decrease, 24h after IV injection of USPIO, was 

correlated with the number of macrophages within each renal compartment. Location of signal decrease 

depended on the type of disease : global when infiltration was interstitial (hydronephrosis (1, 2), intoxication with 

puromycin amino-nucleoside (1), acute and chronic rejection (3)), cortical when intraglomerular (autoimmune 

glomerulonephritis (4)) and medullary only in acute tubular necrosis (5). 

In humans, MR imaging was performed 3 days after USPIO injection (6). According to biopsy, significant SI 

decrease was noted diffusely in patients with an inflammatory component, and within the medulla only in those 

with ATN. Patients with chronic fibrotic disease did not show any change. 

MR imaging and intrarenal stem cell therapy 

Mesenchymal stem cells (MSC) are able to repair damaged tissues, whether genetically modified or not (7, 8). 

After intravascular administration, renal distribution of SPIO-labeled MSC has been investigated. When 

75


administered into the renal artery of normal kidneys, labeled MSC could be detected in vivo within cortex as long 

as 7 days after injection and iron-loaded cells were identified in renal glomeruli using histology (9). When 

administered intravenously, a homing effect could be detected ex vivo within diseased kidneys (10). 

MR imaging and monitoring of gene therapy 

Up to now, MR imaging of transgene expression has been limited to demonstration of proof-of-principle 

experiments, using changes of SI under control of expression of a reporter gene (11),(12, 13). MR imaging could 

also help in controlling gene expression in space and time, using heat-sensitive promoters (HSP70) (14). Heating 

can be achieved with high intensity focused ultrasound. This approach has been experimented in vivo within rat 

kidney using modified MSCs expressing luciferase reporter gene under control of hsp70B promoter, administered 

through left renal artery (15). Expression was controlled ex vivo (15) and in vivo (16). 

MR-targeting of PSMA 

PSMA, type II transmembrane glycoprotein, is a potential cell surface antigen overexpressed in prostatic 

carcinomas (17). PSMA content has been shown to be correlated with tumor grade and progression. This antigen 

has been targeted with radioactive antibodies (Prostascint®) (18) but images are lacking spatial resolution for 

intraprostatic localization. Recently, anti-PSMA antibodies conjugated with iron oxide nanoparticles were used ex 

vivo to specifically image prostate cancer cells (19). 

MR imaging of apoptosis 

Targeting apoptosis within kidney would play a major role for a pathophysiological point-of-view and for follow-up 

of acute ischemic disease under treatment (20). This approach requires labeling of apoptotic cells using USPIOs 

as marker and phosphatidylserine (present on outer leaflet of plasma membrane of apoptotic cells) as target (21). 

This approach has never been applied to ischemic kidney model. 

MR imaging of enzyme synthesis or activity 

* Metalloproteases (MMP) are zinc-containing endopeptidases, involved in degradation and remodeling 

extracellular matrix, crucial for tissue development and homeostasis (22). Within kidney, aberrant MMP 

expression is related to number of acute and chronic renal pathologies. A Gd-chelate coupled with a MMPinhibitor 

was recently developed and applied on atherosclerotic plaques (23). 

* Myeloperoxidase (MPO) is one of most abundant enzymes secreted by inflammatory mononuclear cells 

(neutrophils and macrophages), able to generate reactive oxygen species. Within kidney, this reaction leads to a 

variety of compounds that in turn may cause dysfunction of cells in different compartments of renal parenchyma 

(24). A MPO-sensitive Gd-based MR contrast agent has been developed recently targeting in vivo reperfused 

ischemic myocardium (26) and inflammatory demyelinating plaques in brain (25). 

Applications of these techniques within the kidney should be numerous in the future. 

References 

1. Hauger O, Delalande C, Trillaud H, et al. MR imaging of intrarenal macrophage infiltration in an experimental model of 

nephrotic syndrome. Magn Reson Med 1999; 41:156-162. 

2. Schreiner GF, Harris KP, Purkerson ML, Klahr S. Immunological aspects of acute ureteral obstruction: immune cell infiltrate 

in the kidney. Kidney Int 1988; 34:487-493. 

3. Ye Q, Yang D, Williams M, et al. In vivo detection of acute rat renal allograft rejection by MRI with USPIO particles. Kidney 

Int 2002; 61:1124-1135. 

4. Cattell V. Macrophages in acute glomerular inflammation. Kidney Int 1994; 45:945-952. 

5. Jo SK, Hu X, Kobayashi H, et al. Detection of inflammation following renal ischemia by magnetic resonance imaging. 

Kidney Int 2003; 64:43-51. 

6. Hauger O, Grenier N, Deminere C, et al. USPIO-enhanced MR imaging of macrophage infiltration in native and transplanted 

kidneys: initial results in humans. Eur Radiol 2007; 17:2898-2907. 

7. Baksh D, Song L, Tuan RS. Adult mesenchymal stem cells: characterization, differentiation, and application in cell and 

gene therapy. J Cell Mol Med 2004; 8:301-316. 

8. Pittenger MF, Martin BJ. Mesenchymal stem cells and their potential as cardiac therapeutics. Circ Res 2004; 95:9-20. 

9. Bos C, Delmas Y, Desmouliere A, et al. In vivo MR imaging of intravascularly injected magnetically labeled mesenchymal 

stem cells in rat kidney and liver. Radiology 2004; 233:781-789. 

10. Hauger O, Frost EE, Deminière C, et al. MR evaluation of the glomerular homing of magnetically labeled mesenchymal 

stem cells in a rat model of nephropathy. Radiology 2006; 238:200-210. 

11. Louie AY, Huber MM, Ahrens ET, et al. In vivo visualization of gene expression using magnetic resonance imaging. Nat 

Biotechnol 2000; 18:321-325. 

12. Moore A, Josephson L, Bhorade RM, Basilion JP, Weissleder R. Human transferrin receptor gene as a marker gene for MR 

imaging. Radiology 2001; 221:244-250. 

13. Weissleder R, Mahmood U. Molecular imaging. Radiology 2001; 219:316-333. 

14. Rome C, Couillaud F, Moonen CT. Spatial and temporal control of expression of therapeutic genes using heat shock 

protein promoters. Methods 2005; 35:188-198. 

15. Letavernier B, Salomir R, Delmas Y, et al. Ultrasound induced expression of a heat-shock promoter-driven transgene 

delivered in the kidney by genetically modified mesenchymal stem cells. A feasibility study. In: Hynynen K, Jolesz F, eds. 

MR-guided focused ultrasound surgery. New-York: Taylor & Francis, 2007. 

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16. Eker O, Quesson B, Frulio N, et al. In vivo visualization of an optical reporter gene expression transported by a cellular 

vector and locally activated by MRI-guided HIFU in rat kidney. In: Medicine ISoMRi, ed. International Society of Magnetic 

Resonance in Medicine. Toronto, 2008. 

17. Chang SS. Overview of prostate-specific membrane antigen. Rev Urol 2004; 6 Suppl 10:S13-18. 

18. Hinkle GH, Burgers JK, Neal CE, et al. Multicenter radioimmunoscintigraphic evaluation of patients with prostate carcinoma 

using indium-111 capromab pendetide. Cancer 1998; 83:739-747. 

19. Serda RE, Adolphi NL, Bisoffi M, Sillerud LO. Targeting and cellular trafficking of magnetic nanoparticles for prostate cancer 

imaging. Mol Imaging 2007; 6:277-288. 

20. Ortiz A, Justo P, Sanz A, Lorz C, Egido J. Targeting apoptosis in acute tubular injury. Biochem Pharmacol 2003; 66:1589-1594. 

21. Hakumaki JM, Brindle KM. Techniques: Visualizing apoptosis using nuclear magnetic resonance. Trends Pharmacol Sci 

2003; 24:146-149. 

22. Catania JM, Chen G, Parrish AR. Role of matrix metalloproteinases in renal pathophysiologies. Am J Physiol Renal Physiol 

2007; 292:F905-911. 

23. Lancelot E, Amirbekian V, Brigger I, et al. Evaluation of matrix metalloproteinases in atherosclerosis using a novel noninvasive 

imaging approach. Arterioscler Thromb Vasc Biol 2008; 28:425-432. 

24. Malle E, Buch T, Grone HJ. Myeloperoxidase in kidney disease. Kidney Int 2003; 64:1956-1967. 

25. Chen JW, Querol Sans M, Bogdanov A, Jr., Weissleder R. Imaging of myeloperoxidase in mice by using novel amplifiable 

paramagnetic substrates. Radiology 2006; 240:473-481. 

26. Nahrendorf M, Sosnovik D, Chen JW, et al. Activatable magnetic resonance imaging agent reports myeloperoxidase 

activity in healing infarcts and noninvasively detects the antiinflammatory effects of atorvastatin on ischemia-reperfusion 

injury. Circulation 2008; 117:1153-1160. 

Use of Ultrasmall Superparamagnetic Iron Oxide in Lymph Node MR Imaging 

J. Barentsz, Jurgen J. Fütterer (The Netherlands) 


To show the technique, lymph node anatomy, appearance of normal and abnormal nodes, and pitfalls of MR using a 

macrophage-specific magnetic resonance (MR) contrast agent. 

A macrophage-specific magnetic resonance (MR) contrast agent allows the detection of small and otherwise undetectable 

lymph node metastases in patients with prostate cancer. This has an important clinical impact, as the diagnosis will be more 

precise and less invasive to obtain. Subsequently, this will reduce morbidity and health care costs. However, thorough 

knowledge of sequence parameters and planes, lymph node anatomy, appearance of normal and abnormal nodes, and 

pitfalls is essential when using this technique. This will be elaborated in this presentation. 

Sunday, September 14, 2008 

09:00 – 10:30 Lecture Session VI: Female pelvic cancers and guidelines forimaging 


ESUR 2008 update on Endometrial Cancer 


Endometrial cancer is the fourth most frequent cancer in women. Surgical treatment options depend on the local extent of 

disease. In low risk patients only hysterectomy with bilateral oophorectomy is performed whereas in selected high risk 

patients lymphadenectomy, omental and peritoneal biopsies are included in the surgical treatment. Patient selection for 

primary lymphadenectomy at the time of hysterectomy is therefore a current debate in oncologic gynecology. 

In patients with endometrial cancer, histological tumor grade and depth of myometrial invasion strongly correlate with lymph 

node metastases and patient survival. Therefore patients are considered at high risk when high tumor grade is diagnosed at 

endometrial biopsy or when deep myometrial invasion is identified before surgery. Preoperative identification of deep myometrial 

invasion in patients with endometrial cancer is best performed with contrast-enhanced MRI of the pelvis with an 

accuracy of about 91%. However pitfalls in diagnosing the extent of endometrial cancer have been reported with MRI when 

associated adenomyosis or large leiomyomas impair exact assessment of depth of myometrial invasion. To reduce potential 

pitfalls or misinterpretation of false negative or false positive findings of myometrial or cervical invasion, MRI images should be 

acquired with enough technical quality to allow adequate image interpretation. 

Oblique coronal and axial slice orientation according to the long and short axis of the endometrial cavity should be applied 

under medical supervision. For optimal image quality T2W images covering the pelvis should be acquired with a small FOV 

(20-25cm) and a 512x512 matrix. Slice section of 4mm in T2W imaging should avoid difficulties in analyzing small postmenopausal 

uteri or underestimation of myometrial depths invasion due to thin overstretched myometrial walls by large tumors. 

Disruption on early subendometrial contrast enhancement on dynamic imaging is a landmark for the diagnosis of myometrial 

invasion. In postmenopausal woman such an enhancement may be impaired by the low spatial resolution of dynamic contrast 

enhanced images. Slice section of 2mm with enough spatial resolution is only possible in 3D gradient echo sequences. 

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The time point after intravenous injection of contrast media in 3D gradient echo images to obtain highest contrast to noise 

ratio between the endometrial tumor and the myometrium has been demonstrated at 2min30. A single high spatial resolution 

3D gradient echo sequence is suggested as the optimal post-contrast sequence for the diagnosis of myometrial invasion by 

endometrial cancer. The increased length of those sequences usually allows fat suppression during image acquisition and a 

matrix of 512x512 that should increase detection of deep myometrial invasion and allow the diagnosis of transmyometrial 

invasion with higher confidence. 

Indications for MRI with proven endometrial cancer include: high grade, serous or papillary subtypes at biopsy; differentiation 

stage IB from IC as a basis for performing lymphadenectomy, suspicion of advanced disease (IIA) and confirmation of stage 

III and IV disease; screening for lymph node enlargement as a roadmap for lymph node sampling; medical contraindication 

for surgical staging, and suspected endometrial cancer inability of curettage (e.g. cervical stenosis). 


1. Understand what staging information changes treatment options in endometrial cancer 

2. How to obtain high quality images of the uterus at MRI of the pelvis and particularly for the diagnosis of deep myometrial 

invasion 

3. Learn more about optimal reading conditions and interpretation criteria for the endometrial cancer TNM classification 

in MRI 

4. How to improve your MRI report for endometrial cancer staging 

ESUR 2008 update on Cervical Cancer 

C. Balleyguier (France), T.M. Cunha (Portugal) 

The learning objectives are the following: 

1. To understand the role of MRI in cervical cancer staging 

2. To know which sequences are required in cervical cancer staging 

3. To know how writing the MRI report in cervical cancer staging 

4. To know the new European guidelines for cervical cancer staging 

Indications 

MRI is in 2008 the best imaging method for uterine cervical cancer staging, especially for large tumors > 2 cm. Final staging is 

still based on physical examination, on FIGO classification, but more and more additional informations such as the 3D size of 

the tumor, the presence of pelvic or abdominal lymph node are mandatory to decide which treatment should be done. MRI 

evaluation should be performed in any cases of cervical cancer, superior to FIGO IB. 

MRI is useful to evaluate the response after radiochemotherapy. There is a debate on the delay to realize the examination, 

between 4 to 12 weeks after the end of the treatment. A late delay (after 6 weeks) may reduce the uptake of inflammatory 

changes and facilitate the reading of the images. 

The risk of recurrence after uterine cervical carcinoma is about to 3-4 % /year in case of conservative treatment. There is still 

no consensus for a systematic MR follow-up after cervical carcinoma. 

MRI should be performed in case of suspicion of local recurrence: recent ureteral dilatation, clinical suspicion on vaginal 

examination, abnormal papsmear evaluation etc…MRI can detect a local recurrence and locate if it’s central or lateral. 

A central recurrence can be surgically treated (pelvectomy) as a lateral recurrence is not treatable surgically. 

Technique 

At least two orthogonal planes on T2w sequences are necessary to visualize the tumor, which appears as a hyperintense cervical 

mass in comparison with the myometrium. T2w sequences must be acquired without a fat suppression, because a fatty 

contrast is needed to clearly establish the tumor limits. T2w oblique sequences, with thin slices (4mm/0.4 mm) in a perpendicular 

plan to cervical axis, are useful to detect a parametrium infiltration. Axial T2w sequences must cover pelvis and abdomen 

to the left renal veine. Thus, T1w sequences are nearly useless, and can be avoided in cervical cancer staging. Contrast 

ratio in T1w sequences is poor on the pelvis. These sequences are mostly useful to evaluate the contrast uptake after IV injection, 

and might be not performed if the injection is not required. So, we don’t recommend systematic acquisition of T1w 

images, when no injection is performed. 

Bowel preparation or vaginal opacification are optional. Gadolinium chelate injection can be useful in small lesions or after 

chemoradiotherapy, but are not so helpful in large tumors. In case of dynamic acquisition, contrast enhancement of the 

tumor is lower than the myometrium in the early phase, as on the late phases, tumor signal is higher than the myometrium. 

Thus, the reading of the images is easier on the earlier phases. But as the analysis of the images is largely based on T2w 

sequences, contrast injection might be not so accurate. 

After treatment, most of the authors in the literature are performing an IV injection, to differentiate the residual tumor or a 

recurrence from fibrosis. Dynamic injection must be preferred to detect subtle lesions, no more visible on the late phases. 

Diffusion weighted imaging (DWI) 

DWI seems to be very promising in the evaluation of uterine cervical cancer in MRI; even there is only few published data. 

Apparent Diffusion Coefficient (ADC) decreases in case of cervical carcinoma compared to the normal cervix and increases 

after radiochemotherapy. DWI can help to detect residual tumor or suspicious lymph node, and might be competitive 

with PET-imaging. We recommend to perform optional DWI sequences on the pelvis and the abdomen, in controlled studies, 

to allow a better standardization of the technique. 

Report 

The following check list is helpful for a comprehensive and easy to read report. 

- Description of the lesions 

tumor size must be evaluated in at least two orthogonal views; it is necessary to precise if the lesion size is superior to 4 cm 

or not, because treatment might be different for larger tumors. 

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- Local staging 

Vaginal extension: precise if the extension is anterior, posterior. If the lesion reaches the 2/3 superior of the vagina, it’s a 

FIGO IIA; if the lesion invades the 1/3 inferior of the vagina, it is a FIGO IIIA. 

- Parametrial extension 

The best sign to assess a parametrial extension is the interruption of the hypointense line circumscribing the cervix on 

coronal T2w sequence with a mass effect of the lesion within the parametrium. A parametrial extension is certain if there 

is a ureteral dilatation. The side of the dilatation must be noted. 

- Isthmic extension: as it is not possible to evaluate the extent to isthmus clinically, it should be precised in the report. 

- Lymph node staging 

The FIGO classification does not include the nodal status, as it is a clinical classification. Yet, lymph node spreading is one 

of the most important prognostic factor in cervical carcinoma. Accuracy of MRI is quite low for lymph node staging, with 

a sensitivity varying from 38 to 89 %, and a specificity from 78 to 99 % according to the studies. That’s why PET-CT must be 

done in case of locally advanced cervical carcinoma with no abnormal lymph node depicted in the pelvis or the abdomen. 

Size criterion for a supicious lymph node is a short axis superior to 1 cm, in the pelvis or the abdomen. As we know 

that smaller lymph nodes may be malignant, especially in the pelvis, it’s important to describe other round, hyperintense 

lymph nodes even they are smaller than 1 cm. 

MR imaging of the US indeterminate adnexal mass: an algorithmic approach 

J. Spencer (United Kingdom) 

For the majority of women with suspected adnexal masses US is able to provide all the information required to plan further 

investigation and treatment but a small proportion cannot be designated as benign or malignant by US. MR imaging has 

been shown to correctly diagnose the great majority these lesions, most of which are infact complex benign masses [1]. 

These US indeterminate masses are not rare and exotic lesions but common adnexal pathologies such as mature teratomas 

(dermoids), haemorrhagic lesions and solid fibrous masses (ovarian fibroma and uterine fibroids). 

The ESUR Female Imaging Sub-Committee has discussed the use of an algorithmic approach to the MR imaging assessment 

of the US indeterminate mass based on a decision tree which divides masses into three groups on the basis of their dominant 

characteristic on basic T1W and T2W sequences: 

T1 ‘bright’ masses containing T1 high signal intensity. These masses require fat suppressed T1W imaging to distinguish fat from 

blood. 

T2 ‘dark’ solid masses containing solid tissue which has T2 signal intensity lower than skeletal muscle. Solid adnexal masses 

which are very dark usually contain fibrous tissue and require oblique T2W imaging to see if they are an ovarian fibroma or a 

uterine fibroid. T2 intermediate solid masses are usually malignancies. After IV gadolinium injection these show significant 

enhancement. Rarer endocrine tumours also enhance. Fibromas show little or no enhancement. 

Complex cystic or cystic-solid masses. US diagnoses the majority of these but problems may arise in distinction of blood clot 

from solid material. The former produces a T1 bright mass. The latter can be diagnosed by demonstrating enhancing components 

after IV gadolinium administration. 

This tailored approach should allow distinction of benign masses which can be either followed up or resected depending on 

symptoms from potentially malignant masses which require referral for staging and surgical assessment by a specialist gynaecological 

oncologist. 

For the examination there is minimal patient preparation. Opinions regarding the need for patient fasting are divided but 

there are data showing the value of IV smooth muscle relaxants [2]. The IV cannula should be left in place in case IV gadolinium 

is indicated. 

Imaging should comprise as a minimum a T2W sagittal sequence and a pair of T1W and T2W sequences covering the mass in 

the same plane with similar slice thickness. These allow precise comparison of the tissue characteristics. There are ‘signature’ 

appearances of fat and blood on these sequences. Blood and iron products of haemorrhage produce T2* effects with 

dependent shading in cysts and T2 dark rings in the walls of haemorrhagic cysts. Small fat deposits in dermoids result in the 

chemical shift artefact along the frequency encoding axis. 

Adnexal masses are supplied from the gonadal pedicle but pedunculated uterine fibroids are connected by a stalk which 

contains bridging vessels. 

For most cases simple pre- and post-gadolinium fast spin echo T1W imaging suffices to assess enhancement. Another option 

is the use of dynamic contrast enhanced MR imaging which can be bracketed between these two sequences. Early data 

suggest that enhancement profiles can help in identifying lesions which require cancer surgery [3]. 

Key references 

1. Sohaib SA et al. Clin Radiol 2005; 60: 340-348. 

Description of use of MR imaging for ‘problem solving’ US indeterminate masses 

2. Johnson W et al. Clin Radiol 2007; 62: 1087-1093. Use of hyoscine butyl bromide improves image quality and diagnosis in 

pelvic MR imaging. 

3. Thomassin-Naggara I et al. Radiology 2008; 248: 148-159. Use of DCEMR, correlation with tumour angiogenesis. 

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ESUR 2008 update on Ovarian Cancer Staging 



1. To make familiar with imaging features of ovarian cancer 

2. To understand the role of Radiology in treatment decision in ovarian cancer 

3. To introduce the guidelines for staging ovarian cancer suggested by the ovarian cancer staging workgroup 

Ovarian cancer continues to be a major challenge for oncologists and radiologists, and is still one of the most lethal cancers 

in females. However, recent advents have been noted. In ovarian cancer comprehensive pretherapeutic imaging is gaining 

acceptance as an integral part of initial patient management in patients with gynecologic neoplasm. Thus, the findings 

assessed by Radiology are becoming pivotal in a more individualized patient care. Central to this is a multidisciplinary team 

approach in the management of ovarian cancer (1). 

However, for radiologists this requires profound knowledge of staging ovarian cancer including imaging findings, of pathways 

of tumor spread and knowledge of treatment options. 

The goals of preoperative staging of ovarian cancer are: 

a) Confirmation of a sonographically malignant adnexal mass 

b) Assessment of tumor burden, mapping of the distribution of metastatic disease and diagnosis of possible complications 

e.g. bowel obstruction, hydronephrosis, venous thrombosis 

c) Exclusion of a primary site in the breast, GI tract or pancreas whose metastatic spread might mimic primary ovarian cancer. 

Thus radiology can substantially contribute to the management in a patient with a newly diagnosed ovarian cancer in 

surgery planning, in selection of candidates for neoadjuvant chemotherapy, and in pretherapeutic tissue sampling (2). 

CA-125 provides only limited information for staging, but is the mainstay in tumor surveillance. 

Guidelines for staging ovarian cancer have been developed by the Ovary working group of the ESUR and were completed 

by the input of 11 European experts of the female genitourinary subgroup. Based upon the literature and personal preferences 

there was uniform consensus that CE-multidetector CT is the modality of choice for staging ovarian cancer, as it 

provides all relevant information in a short examination time (3). MRI continues to be an alternative modality, particularily in 

contraindications for CT and in young females. Sonography does not provide sufficient information for staging, but is useful in 

image guided biopsy. The value of PET/CT has yet to be assessed, however it may be useful in suspected distant spread. 

These guidelines including the indications for staging ovarian cancer, technical details for CT and MRI, key imaging features, 

and criteria for non- optimally respectable disease will be summarized. Furthermore, a structured report including all relevant 

findings in a patient preoperatively assessed for ovarian cancer will presented in detail in this presentation. 

References: 

1. Spencer JA (2005) A multidisciplinary approach to ovarian cancer at diagnosis. BJR 78:S94-S10). 

2. Forstner R (2007) Radiological staging of ovarian cancer: imaging findings and contribution of CT and MR. Eur Radiol 

17:3223-3246.I 

3. Tempany CM, Zou KH, Silverman, et al. (2000) Staging of advanced ovarian cancer: comparison of imaging modalitiesreport 

from the Radiology Oncology Group. Radiology 215:761-767 

11:00 – 12:30 Lecture Session VII: Pelvic Floor and Functional Imaging 


Functional imaging of the urinary tract in children: morphology of the urinary bladder, bladder neck and the urethra 


Introduction 

Normal children learn bladder control and uninhibited voiding at relatively low pressures in the first five years of life. Patients 

with neurogenic bladder, developmental anomalies of the lower urinary tract, behavioural voiding disturbances and 

recurrent lower urinary infection are predisposed to show abnormal voiding patterns. 

Discussion 

The evaluation of the voiding phase during micturition cysturethrography (MCU) allows the demonstration of normal opening 

of the bladder neck, visualisation of the shape of the urethra and the effectiveness of bladder control. The normal landmarks 

of the urethra during peak of voiding are explained and some pathological cases discussed. 

Correlation of morphological criteria of the bladder base and bladder neck diseases diagnosed with a MCU with bladder 

manometric studies are presented and the most frequent abnormal voiding patterns in children shown. 


1. Demonstration of the normal functional anatomy of the bladder base and the urethra 

2. Demonstration of bladder base and some urethral abnormalities 

Functional Anatomy of the Pelvic Floor 


The term “Pelvic Floor” refers to the pelvic diaphragm, the sphincter mechanism of the lower urinary tract, the 

upper and lower vaginal support, and the internal and external anal sphincter. Pelvic Floor dysfunction (PFD) is a 

80


general term that has come to describe genital prolapse and conditions that adversely affect the female continence 

mechanisms (urinary and fecal). Although, multiple factors predispose for PFD, the precise pathological mechanism is poorly 

understood, and treatment is often started regardless of the specific anatomic lesion involved possibly due to a lack of 

understanding of normal anatomy and physiology of the pelvic floor. A report from Olsen et al [1] indicated that 29% of 

the procedures performed for incontinence and prolapse are repeat surgeries, suggesting the need for advances in both 

diagnosis and management of these disorders. DeLancey [2] emphasized the need for specific tests to pinpoint the specific 

anatomic defect responsible for PFD in each patient. Static and dynamic Magnetic Resonance (MR) imaging has revolutionized 

the ability to demonstrate muscular anatomy and movement of visceral organs of pelvic floor. Rather than the classic 

passive and active supporting elements and based on MR imaging findings the pelvic organ support system was divided into 

the urethral supporting structures, the vaginal supporting structures and the anal sphincter complex [3]. 

The learning objectives of this lecture are: 

1. To give a comprehensive illustration how to asses the anatomy of the pelvic floor from a specific functional point of view. 

2. To recognise and classify the types of defects in each supporting structures. 

3. To understand how combined analysis of both static and dynamic MR images of patients reporting stress urinary incontinence, 

pelvic organ prolpase and anal incontinence revealed a noteworthy relationship between precise anatomic 

defects in the pelvic organ support system and specific pelvic floor dysfunction [3]. 

4. To explain how this relationship was able to pinpoint the underlying structural defects and can allows for a defect-specific 

approach to pelvic floor dysfunction for each patient [3]. 

5. How to report the MRI findings in a systematic way in respect to the urologist, gynecologist and proctologist clinical point 

of view and requirements [3]. 

References: 

1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and 

urinary incontinence. Obstet Gynecol 1997; 89: 501–506 

2. DeLancey JO. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. 

Am J Obstet Gynecol 2005; 192:1488–1495. 

3. El Sayed RF, El Mashed S, Farag A, Morsy MM, Abel Azim MS. Pelvic floor dysfunction: assessment with combined 

analysis of static and dynamic MR imaging findings. Radiology, August 2008 [in press] 

Functional Imaging of the Pelvic Floor: MRI and its alternatives: 

A. Lienemann (Germany) 

Pelvic floor dysfunction and associated pelvic organ prolapse represent a major problem in our present-day society, mostly 

afflicting parous women. Cine Magnetic resonance imaging (cine MRI) is assuming an increasingly important role in the more 

accurate delineation of the extent of the problem. It is superior to other radiological modalities such as viscerography or 

defecography when assessing the movement of the pelvic floor. As a more general definition cine MRI of the pelvic floor 

is a synthesis of an imaging modality (MRI with its distinct features) and an adequate method of examination (captation of 

movements). 

At present imaging sequences do not allow a sufficient depiction of movement using true 3D- techniques. 

Therefore two different approaches are used: multiple single slices at the same slice position or one stack of 

slices covering a whole anatomical region. Out of the literature the smallest common denominator for functional cine MRI 

can be defined as follows: High field system; patient either in supine or sitting position; fast gradient echo sequence; midsagittal 

slice orientation; patient at rest or straining. 

The examination can be divided into 6 parts: [1] No preparation. [2] The patient should be familiarized with the intention and 

course of the examination. [3] Adequate opacification of pelvic organs is mandatory. We recommend opacification of the 

vagina and the rectum. [4] MRI is performed on a 1.5 T system using a body-array-surface coil with the patient supine. [5] We 

combine static (T2-weighted turbo spin-echo sequences axial and sagittal) and dynamic (single-slice True-FISP sequence (TR 

5.8 ms, TE 2.5 ms, flip angle 70 degrees, matrix 220 x 256, FOV field of view 270 mm, a total of 30 measurements, in-plane resolution 

1.02 mm)) pulse sequences. The patient is asked to increase the intraabdominal pressure by straining and to defecate. 

[6] Image analysis using two different reference lines and looking at the bony-, muscular pelvis as well as ligaments. 

A summary of important findings within the different compartments are visualized. Clinical applications, strengths and limitations 

of this imaging technique are mentioned. 

All except two publications stress the usefulness of functional cine MRI in the evaluation of patients with organ descent 

and prolapse. This well accepted method allows for the visualization of all relevant structures. It is especially useful in the 

detection of enteroceles, and provides a reliable postoperative follow-up tool. It is the modality of choise in depicting 

pelvic floor disorders. 


1. What is Functional cine MRI of the pelvic floor? 

2. Image analysis: what is necessary? 

3. Case studies: What are the most important findings? 

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P1-P17: Female Imaging 

P1 Magnetic Resonance Imaging versus Double Contrast Barium Enema for the assessment of rectal or colonic 

localization of endometriosis 

G. Restaino, M. Occhionero, M. Missere, E. Cucci, M. Ciuffreda, G. Sallustio (Campobasso, Italy) 

Purpose: 

To assess the accuracy of magnetic resonance imaging (MRI) for the identification of rectal or colonic localization 

of pelvic endometriosis in comparison with double contrast barium enema (DCBE) and laparoscopic or surgical findings. 


15 patients with clinical and US suspicion of rectal or colonic localization of pelvic endometriosis were prospectively evaluated 

with MRI and DCBE. 

MRI was performed with 1.5 T magnet and phased-array surface coil; high resolution T2-weighted and T1-weighted 

fat-suppressed images were acquired after administration of a spasmolytic agent. DCBE was performed according to the 

classical technique with air and barium. 

MRI and DCBE were independently evaluated by two radiologists: quality of examination, visibility of colonic wall, presence, 

number, location and extent of rectal/colonic endometriosis localization were recorded. Results of the two procedures were 

compared with laparoscopic or surgical findings. 

Results: 

MRI and DCBE correctly identified colonic and/or rectal localizations of endometriosis in 6/15 patients with 100% sensitivity. 

In 2 patients with false positive results at DCBE, MRI correctly excluded endometriosis infiltration, showing better specificity 

than DCBE (100% vs 81%). Moreover, MRI identified multiple localization of deep pelvic endometriosis that were missed 

by DCBE. 

Conclusions: 

MRI is more accurate than DCBE for the diagnosis of rectal/colonic localization of endometriosis, can identify foci of deep 

endometriosis and has no radiation burden, which is crucial in childbearing age endometriosis patients. 

P2 MR images of endometriosis: 8 years experience 

L. Buñesch, M. C. Sebastià, S. Rafael, F. Carmona, C. Nicolau (Barcelona, Spain) 

Purpose: 

To describe the common and uncommon MR features of endometriomas and deep endometriosis. 


We reviewed the MR studies (1.5 – 3 T; T2, T1 and fat sat sequences) and surgical results of 37 patients with clinical suspicion 

of deep endometriosis. 

For the analysis of our findings, we classified endometriosis into ENDOMETRIOMAS (ovarian cysts) and DEEP ENDOMETRIOSIS 

(fibrotic lesions). We subclassified deep lesions according to their location (torus uterinus, anterior cul-de-sac, posterior 

cul-de-sac (rectovaginal septum)). 

Results: 

ENDOMETRIOMAS were present in 17 patients (46%). DEEP ENDOMETRIOSIS was the most common finding: 

84% (torus uterinus: 17p (46%), anterior: 3p (1%), posterior: 18p (48%)). 

We observed a significative association between endometriomas and torus uterinus fibrosis: 88% of the patients with torus 

uterinus fibrosis also presented endometriomas while only 38% of the women with posterior and anterior lesions did. 

Torus uterinus lesions had the appearance of fibrotic plaques while posterior and anterior fibrosis were nodular. 

Fibrotic plaques caused distortion of adjacent structures (sigma (65%), ovaries (53%) and uterus (35%)) while 

nodules were infiltrative: rectum (28%) and bladder (67%). 

Fibrosis T2 hypointensity provided the diagnosis in 36 patients. In the remaining patient, the characteristic T1-hyperintense 

dots led to the diagnosis. T1-hyperintense dots were absent in 44% of posterior lesions and in 47% of torus uterinus lesions. 

Surprisingly, the anterior nodules showed T2 hyperintense dots with a frequency significantly superior to that of the posterior 

nodules (100% vs 28%). 

Conclusions: 

Knowledge of the various MR features of endometriosis is helpful in reaching a correct diagnosis and staging of 

the process. 

P3 MR imaging of non-squamous cervical cancer: discriminant features 

R.E. Hyland, S.E. Swift, N. Wilkinson, J.A. Spencer (Leeds, United Kingdom) 

Purpose: 

Squamous carcinoma is the most common type of cervical cancer and is routinely staged using MR imaging. 

We describe the MR imaging features of non-squamous cancer of the cervix accrued from cases managed in the largest 

gynaecological cancer centre in the UK. Our aim is to emphasise problems, pitfalls and solutions to assessment of the 

undiagnosed cervical mass. 

82 

Posters



This comprises women referred from a population of 4 million for treatment within their regional Cancer Centre with histologically 

diagnosed non-squamous cancer of the cervix. 

Results: 

The commonest non-squamous epithelial cancers involving the cervix were adenocarcinoma, mucinous carcinoma and 

downward spread of endometrial cancer. Rarer intrinsic pathologies included small cell carcinoma, carcinoid tumour, 

sarcoma, lymphoma. Metastatic disease, both haematogenous spread from sites such as the breast and direct invasion 

from adjacent structures such as the rectum, may occasionally present as a cervical mass or with cervical stenosis. These 

tumours may predominantly affect the endocervix or the cervical stroma and thus present with different clinical symptoms 

and signs. There may be difficulty in achieving a histological diagnosis from cervical smear and colposcopic biopsy and MR 

imaging may be valuable in guiding clinical approaches to biopsy and in suggesting alternative diagnoses. 

Conclusions: 

Whilst the majority of cancer of the cervix is squamous and women present for MR imaging with a clear histological diagnosis, 

a minority have different histological types and presentations and MR imaging can be most valuable in guiding diagnosis 

and management. 

P4 Multidetector CT features of benign adnexal masses 

A.C. Tsili, A. Charisiadi, O. Papanikolaou, I. Ntova, Ev. Paraskevaidis, K. Tsampoulas (Ioannina, Greece) 

Purpose: 

Multidetector CT greatly improved the accuracy of CT in detecting and characterizing adnexal masses. 

The purpose of this study was to present the MDCT features of benign adnexal masses. 


We report the MDCT imaging features of 67 histologically proven benign adnexal masses. Pathologic diagnoses 

were nonneoplastic adnexal cyst (n=16), endometrioma (n=12), teratoma (n=7), serous cystadenoma (n=13), mucinous 

cystadenoma (n=3), fibroma or fibrothecoma (n=8), and a variety of benign adnexal lesions, including mixed benign 

ovarian tumor, pelvic inflammatory disease and ovarian torsion (n=8). MDCT protocol included scanning of the abdomen 

after the iv administration of iodinated contrast material (portal phase) using a detector collimation of 16 X 0.75 mm and 

a pitch of 1.2. 

Results: 

Ovarian cysts had a characteristic CT appearance of a circumscribed cystic lesion, with homogeneous water density, 

smooth, thin wall and occasionally a few septa. Serous and mucinous cystadenomas were detected as unilocular or multilocular 

cystic tumors, with thin wall or septa, containing serous fluid or liquids of higher than water CT density, respectively. 

Dilated fallopian tube was seen as an oblong, tubular, fluid-filled structure. MDCT was accurate to characterize mature cystic 

teratomas. Endometriomas had a variable CT appearance, including a unilocular or multilocular cystic mass and a homogeneous 

hyperdense mass lesion. Fibrous tissue had a 50 HU CT density in patients with fibromas or fibrothecomas. 

Conclusions: 

Multidetector CT enables a reliable preoperative characterization of benign adnexal masses. 

P5 Adnexal Masses In Women with Acute Abdomen: Differential Diagnosis and Diagnostic Pitfalls On CT Imaging 

Y. Lee, H.P. Hong, H.W. Park (Seoul, South Korea) 

Clinical diagnosis of adnexal masses with acute abdomen in women is often difficult to assess and can occur due to a 

variety of causes. We discuss and illustrate the spectrum of MDCT findings emphasis on differential diagnosis and diagnostic 

pitfalls in variable gynecological and nongynecological etiologies ; pelvic inflammatory disease including tubo-ovarian 

abscess, ectopic pregnancy, ruptured or hemorrhagic ovarian cyst, ovarian hyperstimulation syndrome, endometriosis, 

ovarian torsion, perforated appendicitis, and diverticulitis et al. 

CT plays a very important role in the diagnosis and management of adnexal masses in patients with acute abdomen. 

Tuboovarian abscess is recognized as a cystic mass having a thick wall that is strongly enhanced. Hemoperitoneum 

associated with hemorrhagic cyst strongly indicates rupture of the cyst. Torsion of the adnexa can be diagnosed by 

the pedicle between the ovary and uterus. Rupture of endometrial cysts and cystic teratomas can cause acute chemical 

peritonitis. In ectopic pregnancy, findings of adnexal cyst associated with strong enhancement of the tubal wall frequently 

contribute to the diagnosis. 

P6 Problem solving MR imaging pathway: an algorithmic approach to the sonographically ‘indeterminate’ 

adnexal mass 

S. Ghattamaneni , N. Bhuskute, F. Lang, J.A. Spencer (Leeds, United Kingdom) 

Purpose: 

1. To illustrate a problem solving pathway of MR imaging for dealing with complex and ‘indeterminate’ adnexal masses 

detected on ultrasound scan. 

2. To recognise the role of particular MR sequences to achieve a tissue specific diagnosis 

83



1. Ultrasound (US) is the first line investigation for suspected adnexal pathology. However, a troublesome proportion of these 

remain ‘indeterminate’ and MR imaging is the preferred next modality for further evaluation. 

2. We describe a simple algorithmic approach to MR imaging of an US indeterminate adnexal mass. This has been developed 

in the largest gynaecological network in the UK based on an experience of over 500 examinations in the last 5 years. 

3. Initial T1 and T2-weighted images allow identification of the organ of origin and le 

sions can be categorised into one of the following based on signal characteristics: 

a) T1 ’bright’ 

b) T2 ‘dark’ or 

c) Cystic / cystic-solid 

4. Subsequent application of fat-suppression and /or contrast enhanced sequences are pivotal for evaluation of contents 

and nature of the mass and permit a tissue specific diagnosis. 

5. This exhibit will illustrate the pathway described with pictorial examples to aid better understanding of this common 

problem. Key MR features of common US ‘indeter-minate’ adnexal lesions are emphasised. 

Conclusions: 

1. MR imaging is highly accurate for characterization of US ‘indeterminate’ adnexal mass and allows tissue specific diagnosis. 

2. Confident distinction of benign from malignant adnexal disease may define management strategy towards conservative, 

limited or radical surgical options. 

P7 Fallopian tubal diseases: discriminant morphologic characteristics and manifestations on MR imaging 

S. Ghattamaneni, N. Bhuskute, J.A. Spencer (Leeds, United Kingdom) 

Purpose: 

1. To review and emphasise the cardinal signs of Fallopian tube masses on MR imaging with illustrative examples 

2. To correlate these signs on the basis of anatomy and histopathology 

3. To describe two new MR signs of tubal diseases; ‘synechiae’ and ‘amorphous shading’ 


Review: 

1. Characteristic features of hydrosalpinx on ultrasound 

2. MR imaging sequences for discriminating an adnexal mass as tubal reflecting specific inflammatory processes 

Describe: 

• Key morphological MR imaging features of dilated Fallopian tube: tubular/ convoluted shape; incomplete mucosal 

folds (plicae); mural nodules; ‘waist’ and ‘beak’ signs; and ‘synechiae’ 

• Patterns of shading with illustrative examples: ‘amorphous’ pattern represents pus and ‘gravitational’ shading is 

characteristic of endometriosis 

• Differential diagnoses and pitfalls 

Conclusions: 

1. By recognizing key MR imaging signs, masses of tubal origin can be reliably discriminated from other complex adnexal 

diseases. 

• A tubular or cystic mass with any of the findings of plicae, synechiae, T2- dark mural nodules, waist sign and beak signs is 

highly suggestive of tubal origin. 

• The etiology of a lesion is suggested by the pattern of shading within the mass; ‘amorphous’ in pyosalpinx and ‘gravitational’ 

in endometriosis. 

2. A confident diagnosis of Fallopian tubal disease impacts on management as the great majority are benign and may be 

treated conservatively or with limited surgery. 

P8 CT Findings of Tuboovarian Abscess 

J. Kim (Daejeon, South Korea) 

Purpose: 

To present various CT findings of tuboovarian abscess (TOA). 


Among the patients of pathologically proven TOA at our hospital, a review of available CT scans was performed. A retrospective 

analysis of the CT findings was done without knowledge of the pathologic diagnosis, in terms of site, size, nature 

and shape of the fluid density mass, the thickness and enhancement pattern of the cyst wall, reactive lymphadenopathy, 

adjacent organ involvement, etc. 

Results: 

TOA revealed various CT findings such as fluid density mass, especially multilocular ; thick, uniform, enhancing wall, especially 

of multi-layered appearance ; complex cystic mass with enhancing thickened septa ; pyosalpinx ; internal gas bubbles ; 

thickening of uterosacral and/or broad ligaments ; loss of definition of the uterine border ; reactive paraaortic lymphadenopathy 

; adjacent involvement such as rectum, sigmoid, ureter, etc. 

Conclusions: 

CT is a helpful imaging modality in the diagnosis and differential diagnosis of TOA. 

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P9 Management impact of CT in women undergoing neoadjuvant chemotherapy and interval debulking 

surgery for ovarian cancer 

N. Bhuskute, S. Ghattamaneni , J.A. Spencer (Leeds, United Kingdom) 

Purpose: 

To illustrate: 

• The role of CT in patient selection for management of advanced ovarian cancer at initial diagnosis. 

• The imaging features of ovarian cancer unlikely to be successfully debulked by surgery and therefore better treated by 

neoadjuvant chemotherapy (NCTx) and interval debulking surgery (IDS). 

• The role of CT imaging in providing a histological diagnosis, monitoring disease response and planning for IDS. 

Abstract: 

• Patients with newly diagnosed ovarian cancer should be treated by radical debulking (cytoreductive) surgery, aiming for 

complete tumor resection, followed by adjuvant chemotherapy. 

• Some 70% patients present with advanced disease and for some optimal debulking cannot be obtained or they have a 

performance status which precludes radical surgery. These patients have been shown to benefit from NCTx followed by 

IDS. 

• CT at initial diagnosis not only provides alerts to ‘unresectable disease’ but also provides a method of core biopsy to 

achieve a firm histological diagnosis when surgery will not occur, a technique described, validated and audited in extensive 

experience in our institution. 

• CT thus avoids non-therapeutic surgery with potential morbidity and mortality and monitors response to neoadjuvant 

chemotherapy. 

• In this exhibit we illustrate the areas of disease spread likely to prevent adequate cytoreductive surgery, describe CT 

guided biopsy, monitoring of disease response and planning of IDS. 

Conclusions: 

1. CT is useful to identify patients who might benefit from NCTx. 

2. CT has an important role in providing a tissue diagnosis, monitoring disease 

response and identifying cases for IDS. 

P10 Role of a Computed Tomography derived score (PIrad) for the prediction of optimal cytoreduction at 

primary surgery in patients with ovarian cancer 

E. Cucci, L. Aquilani, M. Missere, G. Restaino, M. Ciuffreda, G. Sallustio (Campobasso, Italy) 

Purpose: 

Residual disease after primary surgery is one of the crucial prognostic factors in advanced ovarian cancer. We designed 

this prospective study to assess the role of a CT derived score (PIrad) in the preoperative prediction of ovarian cancer 

optimal cytoreduction (residual tumor ≤1 cm). 


109 pts underwent abdominal helical contrast enhanced CT scan before exploratory laparotomy and were evaluated for 

potential cytoreduction. CT images evaluation was performed without knowledge of the operative findings, and included 

9 parameters: peritoneal and diaphragmatic carcinosis, bowel mesentery involvement (≥2 cm), supra- or infrarenal 

paraaortic lymphnodes (≥2 cm), liver involvement, spleen, stomach, or lesser sac localization, frozen pelvis, and ascites. The 

presence/absence of each sign was assigned a score which produced an overall radiologic resectability predictive index 

(PIrad) for each patient. 

Results: 

Median value of PIrad was 6 (0-15). After laparotomy, 56 patients out of 109 (49.6%) were optimally cytoreduced, 

while 54 patients (47.8%) were considered to have a non-resectable disease. At a PIrad cut-off value ≥ 12 corresponded 

a PPV = 87.5% and a NPV = 51.5%. 

Conclusions: 

A PIrad ≥ 12 showed high PPV, acceptable NPV, and high accurateness in identifying pts with advanced ovarian carcinoma 

unlikely to undergo optimal primary cytoreduction. Moreover, since it’s based on progressive cut-off values, PIrad allows to 

adjust for acceptable rates of unnecessary exploration and inappropriate lack of exploration according to patients’ age, 

performance status, and co-morbidities. 

P11 Ovarian metastasis in endometrial carcinoma: incidence and imaging findings with Computed Tomography 

and Magnetic Resonance in a referral center for Gynaecological Oncology 

G. Restaino, M. Occhionero, S. Giambersio, E. Cucci, M. Guerriero, G. Sallustio (Campobasso, Italy) 

Purpose: 

Ovarian metastases (OM) are an independent prognostic factor in stage I endometrial carcinoma (EC). Purpose of our study 

was to retrospectively evaluate incidence of OM from primitive EC in a referral center for Gynaecological Oncology and to 

illustrate their CT and/or MRI appearance 


We conducted a retrospective study on 212 patients with EC treated at Catholic University of Campobasso from 2004 

to 2007 by total abdominal hysterectomy. In the electronic database of Pathology Department we sought for patients 

with postoperative histological diagnoses of OM, thereafter we restored and evaluated the preoperative CT and/or 

MRI studies. 

85


Results: 

Examination of Pathology database revealed OM in 10 patients (4.7%). Imaging studies were found in 7/10 patients, 

specifically 4 MR and 3 CT examinations. Involved adnexa mostly appeared adhered to uterus, with normal or mildly-moderately 

enlarged volume, solid appearance and slightly inhomogeneous density or signal intensity and inhomogeneous 

enhancement after contrast agent i.v. administration. In one MR case the OM presented as a solid round capsulated mass, 

3.7 cm wide, isointense to primary tumor. 

Conclusions: 

Incidence of OM in EC in our referral center for Gynaecological Oncology resulted 4.7%, consistently with previous reported 

papers. Imaging findings in OM are aspecific and may be subtle. Knowledge of CT and MR appearance of OM in EC may 

help the radiologists to correctly achieve the diagnosis. 

P12 Comparison of 18F-FDG PET/CT and CT or MRI for the preoperative staging of ovarian cancer 

J.Y. Byun, Y.J. Lee, G.W. Jung, S.N. Oh, S.E. Rha, I.R. Yoo, S.H. Kim, S.K. Chung (Seoul, South Korea) 

Purpose: 

To compare the diagnostic performance of 18F-FDG PET/CT with CT or MRI for the preoperative staging of ovarian cancer. 


28 patients (mean age, 45 years; range, 15-67years) with surgically confirmed to malignant ovarian carcinoma (mean size, 

11.2cm; range 4-30cm) underwent both preoperative 18F-FDG PET/CT and CT or MRI (CT on 20 patient, and MR on 10 

patient). 18F-PET/CT and CT or MR images were evaluated separately and imaging results were compared with pathologic 

and operative findings. We analyzed the image findings focused on the following characteristics: 18F-FDG uptake or 

enhancing solid portion, pelvic lymph node metastasis, paraaortic lymph node metastasis, distant metastasis, peritoneal 

carcinomatosis and staging which was based on FIGO criteria. 

Results: 

6 tumors (21%) show no abnormal uptake on 18F-FDG PET/CT and one tumor (4%) shows no evidence of enhancing solid 

portion on CT or MRI. Staging reveled stage I disease in eleven patients (IA, n=8; IC, n=3), stage III in twelve (IIIA, n=2, IIIC, 

n=11), stage IV in five, according to the FIGO criteria. 18-FDG PET/CT staging correlated with post-operative staging in 19 

of 28 patients (68%), while CT or MRI in 17 of 28 patients (61%). 

Conclusions: 

In patients of malignant ovarian cancer, 18F-FDG PET/CT has no additional benefit to accurate diagnosis of preoperative 

staging, compared to the CT or MRI. 

P13 Review of imaging in cases of pelvic actinomycosis masquerading as gynenocological malignancy 

N. Bhuskute, S. Ghattamaneni, S. Munot, S. Osborn, J.A. Spencer (Leeds, United Kingdom) 

Introduction: 

Actinomycosis in the pelvic region is an uncommon diagnosis often related to the use of intra uterine device (IUD). 

The clinical presentation is, however, non-specific and often these cases present as complex pelvic masses which may mimic 

malignant disease. We illustrate the imaging appearances of such cases presenting to our regional multidisciplinary team 

which provides treatment for over 600 new cases of gynecological cancer each year. 

Abstract: 

Between Jan2004 and Nov 2007, 6 cases of pelvic actinomycosis which presented to the gynecological oncology multidisciplinary 

team were identified. We present a pictorial review of these cases with emphasis of the different appearances 

mimicking malignancy. Only two cases were associated with recent use of an IUD. Diagnosis was established by histological 

examination of removed tissue in all cases and Actinomycoses was demonstrated. 

Various presentations masquerading as gynenocological malignancy included cystic, solid and cavitating enhancing 

masses similar to primary ovarian cancer. Spread across the tissue planes, enhanced by the proteolytic enzymes produced 

by the organism, may reach the pelvic sidewall as may be seen with cervical cancer or spread to peritoneal cavity. 

One case involved a solid mass over the surface of the liver simulating a metastatic deposit from an ovarian primary tumour. 

Conclusion: 

Actinomycosis remains an uncommon but important differential diagnosis of the complex pelvic mass and may be seen 

without IUD use. This exhibit illustrates the varied imaging appearances of this condition illustrating pitfalls encountered by an 

experienced multidisciplinary team. 

P14 Radiological Findings of Gynecologic Conditions that Cause Chronic Pelvic Pain 

H.C. Henriques, M. Duarte, T.M. Cunha (Lisboa, Portugal) 

Purpose: 

To describe transvaginal ultrasound (US), computed tomography (CT) and magnetic resonance (MR) imaging 

appearances of gynecologic conditions that can cause chronic pelvic pain. 


Chronic pelvic pain is a common and disabling problem among female patients caused by numerous organic pathologies. 

It is defined as nonmenstrual pain of at least 6 months duration. The gynecologic causes are frequently overlooked and 

under diagnosed, resulting in inappropriate referral and inadequate treatment. 

US is generally accepted as the first imaging modality for the evaluation of chronic pelvic pain in the female patient, but 

sometimes US is not completely reliable for diagnosis.MR imaging have proved to be valuable, is objective, highly accurate, 

and not operator dependent. CT also has a role in the evaluation of chronic pelvic pain. 

86


Results: 

The authors make a comprehensive review on the imaging appearances of gynecologic conditions that can cause chronic 

pelvic pain. US, CT and MR images illustrate these pathologies, including endometriosis, adenomyosis, pelvic congestion 

syndrome, chronic pelvic inflammatory disease, ovarian remnant, pelvic relaxation, retained ovary syndrome, uterine 

leiomyomas and adhesions. 

Conclusions: 

Familiarity with the spectrum of radiologic imaging findings allows the radiologist to diagnose accurately the conditions 

producing chronic pelvic pain in most cases and to guide appropriate treatment. 

P15 Imagiological features of gynecologic pathology in women with acute pelvic pain 

M. Duarte, H.C. Henriques, T.M. Cunha (Lisboa, Portugal) 

Purpose: 

To describe and illustrate the ultrasonographic (US), computed tomography (CT) and magnetic resonance (MR) 

features of gynecologic conditions in women presenting with acute pelvic pain. 


Acute pelvic pain in women is a frequent cause of emergency hospital admission. 

Imaging techniques have enabled diagnosis of acute gynecologic conditions, which are characterized by sudden 

onset of lower abdominal pain, fever, genital bleeding, intraperitoneal bleeding or symptoms of shock. 

US is the first imaging tool in the assessment of acute pelvic pain in female patient, however usually is not conclusive. 

CT and MR are performed if US findings are equivocal, if the abnormality extends beyond the field of view 

achievable with the transvaginal probe or if further characterization of pelvic disease is required. MRI is also a 

complement to US when iodinated contrast media or radiation is not desirable. 

Results: 

The authors make a review of the characteristic imaging appearances of many gynecologic conditions that cause acute 

pelvic pain. US, CT and MR images illustrate these pathologies, including uterine disorders, ovarian disorders, endometriosis, 

pelvic inflammatory disease, pregnancy related conditions, postoperative or postpartum complications. 

Conclusions: 

Rapid and accurate diagnosis is essential for the appropriate management of acute pelvic conditions. It is important to 

differentiate diseases that require an immediate surgical or interventional approach, from conditions that can be treated 

with conservative therapy. 

Radiologists familiar with the clinical and radiologic characteristics of the underlying causes of acute pelvic pain will be able 

to diagnose accurately, guide appropriate treatment and may eliminate the need for further evaluation. 

P16 A Case Report of Angiomyofibroblastoma Arising from the Posterior Perivesical Space: MR Findings 

K.J. Lim, J.H. Moon, D.Y. Yoon, J.H. Cha (Seoul, South Korea) 

Purpose: 

We present a case of AMFB arising from the posterior perivesical space and emphasize the magnetic resonance (MR) 

imaging features. 


A 48 year-old woman presented with a vaginal mass, which was incidentally detected lesion for gynecological cancer 

screening. 

Results: 

The tumor was characterized by numerous, small to medium sized, and thin walled intratumoral blood vessels. A variable 

number of inflammatory cells and myxoid fibrous stroma were also detected through the lesion. At immunohistochemical 

analysis, the tumor cells were positive for actin (Figure 3). These distinctive histological features were compatible with the 

diagnosis of AMFB. 

Conclusions: 

A well-marginated mass involving the external genitalia in women shows hetero-geneous hypointensity on T2-weighted 

MR images and intense and delayed contrast enhancement, AMFB should be included in the differential diagnosis. 

P17 Magnetic Resonance Imaging in the diagnosis of suspected placental invasion: correlation with 

color Doppler ultrasound 


Purpose: 

The purpose of this study was to compare the value of pelvic ultrasound with color Doppler and MRI in: 1) the diagnosis of 

placental adhesive disorders (PAD) 2 ) the definition of the degree of placenta invasiveness 3 ) determining the topographic 

correlation between the diagnostic images and the surgical results. 


56 pts in the third trimester of pregnancy (mean age 31 years; range 22-38 years) with a diagnosis of placenta previa and 

at least one previous caesarean section underwent color Doppler US and MR. The sonographic and MRI diagnoses were 

compared with the final pathologic or operative findings. 

Outcomes at delivery were as follows: normal placenta (n = 43) and PAD (n = 13). 

87


Results: 

MR and US-doppler showed no statistically difference in identiyfing patients with PAD (p=0.74), while MR was statistically better 

of US-doppler in evaluating the depth of placenta infiltration (P


Purpose: 

To present the sonographic findings of the above two entities and to highlight the role of sonography in the correct preoperative 

diagnosis, essential for the management decisions. 


The sonograms of 4 boys with testicular epidermoid cysts and 9 boys with testicular teratoma were reviewed. Patient age 

ranged from 47 days to 9 years, with a painless scrotal mass as the most common presentation (n=11). Two boys presented 

with acute scrotum due to testicular ap-pendiceal torsion and scrotal trauma, respectively and testicular mass was an 

incidental finding. 

Results: 

Epidermoid cysts were demonstrated as sharply demarcated by an echolucent or echogenic rim, solid-appearing masses 

with a target or onion ring configuration with alternating layers of hyper- and hypoechogenicity, avascular at Doppler 

examination. Intraoperative US-guided localization of the epidermoid cyst and excisional biopsy permitted a testis-sparing 

surgery in the most recent two cases. 

Teratomas appeared as wellcircumscribed predominantly cystic lesions with peripheral solid components, or complex 

masses with calcifications, echogenic fat and cystic areas, with internal blood flow at Doppler examination. 

All cases were histopathologically confirmed. 

Conclusions: 

Despite sonographic similarities, knowledge and recognition of the characteristic features of teratomas and epidermoid 

cysts is essential, and facilitates accurate diagnosis and patient treatment. The latter are candidates for a testis-sparing 

approach instead of an orchiectomy. 

P21 Bilateral nephroblastoma - case report 


Introduction: 

Wilms Tumor is the most common renal tumor in children. Synchronous bilateral Wilms tumor ( BWT) accounts for 5% of all 

patients registered to the National Wilms Tumor Study Group ( NWSTG). 

Case study: 

A 28-year-old female patient was presented to Oncology Institute with right kidney tumor. Her left kidney was resected due 

to Wilms tumor in the second month of her life. Abdominal ultrasound was performed and demonstrated a massive 

right kidney tumor. Than abdominal CT was performed with the use of 16-slice CT scanner. 

The examination revealed: 

Right kidney showing signs of compensative overgrowth was rotated and moved to the top. In the lower and peripheral 

part of the kidney a nodular mass 7x10x9 cm in size was visible. The tumor was well-demarkated, showing mixed attenuation, 

extends from the inferio-lateral kidney pole. The tumor was adjacent to psoas muscle and abdominal cavity walls; no infiltration 

of those structures was noted. Described lesion surrounds inferiomedial part of the kidney and approaches kidney pelvis 

without infiltrating them. Supero-anterior and medial part of the kidney shows normal structure. Lymph nodes enlargement 

within periaortal area was not detected. 

Surgical procedure was performed resulting in excision of the tumor and saving the kidney. Histopathology examination 

revealed nephroblastoma. The tumor was surrounded by a thick, fibrous capsule. Surrounding parenchyma and fat tissue 

was not involved. 

CT examination performed 4 months after nephron sparing surgery revealed: right kidney of 137x51 mm in size, 

normal location, normal structure and correct function. 

P22 All types of congenital hydrocele, from testicular to abdomino-scrotal: embryology, state of the art US 

imaging and differential diagnosis 

M. Vakaki, G. Pitsoulakis, C. Koumanidou (Athens, Greece) 

Purpose: 

Failure of complete closure of the processus vaginalis in males during fetal life results in a spectrum of abnormalities. 

The purpose of this study was to evaluate the role of state of the art sonography in the diagnosis and differentiation of the 

various types of congenital hydrocele, to highlight the clinical significance of the prompt and proper sonographic diagnosis 

and to correlate the sonographic findings with embryology. 


The sonograms of 220 boys, 10-d to 10-y old, with ipsilateral ( =105) or bilateral ( =25) hydrocele, were retrospectively studied. 

Sonographic examination of the inguinal and scrotal areas was performed with high-frequency 5-12 MHz broad band transducer, 

supplemented by dynamic examination, color Doppler and abdominal sonogram, when necessary. 

Results: 

The sonographic examination revealed 70 cases of communicating hydrocele, 29 cases of non-carcerated inguinal/scrotal 

hernia, 14 cases of incarcerated inguinal/scrotal hernia, 22 cases of funicular spermatic cord hydrocele, 41 cases of encysted 

hydrocele of the spermatic cord, 67 cases of testicular hydrocele and one case of bilateral abdominoscrotal hydrocele. 

The various sonographic findings with anatomic and embryologic correlation and the sonographic differential diagnosis are 

presented. 

Conclusions: 

The spectrum of congenital hydrocele in males is wide, with very common, as well as very rare types. Sonography with the 

use of state of the art equipments is the imaging method of choice for the diagnosis of all of them. Pediatric radiologist’s 

awareness is the first and most essential step for an accurate sonographic diagnosis, which is fundamental for the determination 

of the appropriate management on time. 

89


P23 High-resolution US and multicystic dysplastic kidney: what is the pediatric radiologist looking for? 

M. Vakaki, G. Pitsoulakis, E. Dagiakidi, C. Karanikas, N. Evlogias, C. Koumanidou (Athens, Greece) 

Purpose: 

To present the various sonographic appearances of multicystic dysplastic kidney (MCDK) and their changes over time, and 

to highlight the associated congenital urogenital abnormalities. 


This retrospective 8-year study included 30 children, 3-day to 11-year old, with MCDK. The abdominal sonograms were performed 

on high definition sonographic equipments with high frequency transducers, depending on the patient’s age. 

Results: 

The sonographic examination demonstrated: multiple non-communicating cysts of varying size and shape, no identifiable 

renal pelvis and absent/ dysplastic renal tissue in the renal fossa (n=22), a solitary cystic mass (n=3), small cysts surrounding a 

large central cyst (hydronephrotic form) (n=1), or one of the above appearances in the upper pole of a duplicated kidney 

(segmental MCDK) (n=4). Of the contralateral kidneys, 16 kidneys showed compensatory hypertrophy. Associated ipsilateral 

genital malformations included: uterus didelphys (one girl), uterus didelphys with hydrocolpos ipsilateral to MCDK (one girl) 

and Müllerian duct remnant (three boys). Associated contralateral renal abnormalities that were sonographically detected 

were: ureteropelvic junction obstruction (n=2), duplicated kidney (n=3), and findings suggestive of vesicoureteral reflux, established 

by voiding cysteourethrography (n=8). At 1-year sonographic follow-up, 9 infantile MCDKs disappeared and 11 were 

involuting. Within 3 years 27 MCDKs disappeared. One growing MCDK was surgically removed and two children were lost to 

follow-up. 

Conclusions: 

High-resolution sonography can provide an accurate diagnosis of MCDK, can reliably suggest the possible associated congenital 

urogenital malformations, and can be used for the long-term follow-up. For obtaining detailed information, the Pediatric 

Radiologist’s awareness is an essential prerequisite. 

P24 Unsual pelvic mass in a adolescent girl 

S.M P. Palma, J. Leitão, L. Lobo, M. Abecasis, I. Távora, A. Melo, D. Nogueira (Lisboa, Portugal) 

The authors present a case of uterus didelphys in a previously healthy 13 years-old girl associated with a longitudinal 

vaginal septum and left renal agenesis. 

The initial clinical presentation was abdominal pain and a volumous pelvic mass . Abdominal and pelvic Ultrasound and pelvic 

Magnetic Resonance (MRI) were performed, allowing for the diagnosis. MRI revealed a pelvic mass with regular borders, 

filled with blood and related to three tubular structures, two directed to the left side and one to the right. Only one kidney 

was visible on the right side. Findings were consistent with hematometracolpos in a uterus didelphys associated with a longitudinal 

vaginal septum, and unilateral renal agenesis. 

Uterus didelphys represents 5% of the Müllerian duct anomalies (MDA’s) and is defined as two widely separated endometrial 

cavities. A longitudinal vaginal septum occurs in 75% of cases. Due to close embryologic relationship of the Müllerian and 

Wolffian systems, MDA’s may be associated with renal anomalies. 

MRI is the most accurate non-invasive modality available for detection and characterization of a MDA, providing information 

about the external fundal contour, shape of the uterine cavity and septa constitution. 

This case represents a rare congenital anomaly of the female genital tract associated with left kidney agenesis illustrated 

by interesting and relevant MR images. MRI allowed the characterization of this uterine anomaly which was matched with 

physical examination findings. 

P25-P40: Imaging of the Urinary Tract 

P25 An approximation algorithm is useful for evaluating split renal function from CT 

H. Björkman, P. Dahlman, A. Magnusson (Uppsala, Sweden) 

Purpose: 

The purpose of this study was to evaluate the accuracy of a simplified model for approximation of split renal function (the 

ratio of the kidneys’ function) from single phase contrast enhanced CT. A secondary aim was to evaluate the agreement 

between different contrast phases for the measurement. 


Sixty-four patients undergoing CT of the kidneys were studied retrospectively. As reference method for assessment of split 

renal function, the volume and mean contrast attenuation of each kidney was obtained with a volumetric tool. An approximation 

based on renal length, maximum cross sectional area and contrast attenuation in a single slice was applied and 

compared with the reference method. Intra- and inter-observer repeatability and comparison between corticomedullary 

and nephrographic contrast phase was made. For assessing agreements, 95 % limits of agreement (95% LA) were calculated. 

Results: 

Repeated measurements by the same observer with the approximation method differed acceptably, with 95% LA of -1.7 and 

2.3 percentage points. The inter-observer agreement was similarly close, with 95% LA of -2.4 and 3.2 percentage points. The 

approximation method differed from the reference method with 95% LA of -3.9 and 2.4 percentage points. The agreement 

between contrast phases had 95% LA of -1.4 and 2.0 percentage points. 

90


Conclusions: 

For routine purposes, split renal function can be estimated from contrast enhanced CT by means of an approximation formula. 

When high accuracy is needed, an exact volumetric method is recommended. The method gives comparable results 

when applied in either corticomedullary or nephrographic contrast phase. 

P26 Renal malignancies with sarcomatous elements: MDCT features 

A.C. Tsili, K. Christakis, D. Giannakis, A. Zioga, N. Sofikitis, K. Tsampoulas (Ioannina, Greece) 

Purpose: 

Sarcomatoid renal cell carcinoma (SRCC) represents a high-grade transformation of an epithelial neoplasm of the kidney. 

Transitional cell carcinoma of the renal pelvis may also coexist with a sarcomatous component. These are rare, highly-aggressive 

neoplasms that are associated with a poor prognosis. We describe one case of a sarcomatoid renal cell carcinoma 

and a case of sarcomatoid carcinoma of the renal pelvis. The role of multidetector CT (MDCT) and its contribution to the 

diagnosis are discussed. 


A 64-year old woman, with a pathologically proven early-stage SRRC, was referred for multidetector CT examination of the 

abdomen, due to an incidental right renal mass. We present also a case of 68-year old man with gross painless hematuria 

and a sarcomatoid carcinoma of transitional cell origin of the renal pelvis, evaluated also by MDCT. 

Results: 

MDCT examination in the first case revealed a lower pole renal mass, sharply demarcated and heterogeneously enhancing, 

the last finding suggestive of malignancy. A heterogeneously enhancing left pelvic mass, infiltrating the renal parenchyma 

was detected in the second patient. 

Conclusions: 

Based on the MDCT findings, the presence of heterogeneous enhancement may suggest an aggressive nature of renal 

malignancies. 

P27 Synchronous renal tumors of different histology in the same kidney: report of seven cases 

E. Capaccio, V. Varca, A. Simonato, C. Toncini, G. Carmignani, L.E. Derchi (Genova, Italy) 

Purpose: 

To report a series of 7 patients with two parenchymal tumors of different histology involving synchronously the same kidney. 


We reviewed the pathology reports in a series of 381 consecutive patients who underwent surgery for primary renal tumors 

from January 2000 to September 2007 for presence of synchronous renal tumors of different histology within the same kidney. 

The files of these patients were reviewed for clinical history, preoperative diagnosis, postoperative course and follow-up. 

Special attention was given to the results of imaging studies. All patients had CT (a variety of single and multilayer spiral 

equipment); five had also ultrasonography. 

Results: 

Seven out of 381 patients (1.84%) had coexistence of two primary tumors of different histology within the same kidney. Both 

lesions were detected preoperatively by CT in 6/7 cases; in the remaining one, a 1 cm lesion (examined with single layer 

equipment) was not visible, even in retrospect. 

5/7 CT studies were available for review. The two lesions had different enhancement patterns in 3/5 cases only. 

Conclusions: 

Coexistence of multiple, synchronous tumors of different histology within the same kidney has been only rarely described in 

the literature. This condition, however, is not exceedingy rare. Detection of two tumors with different enhancement patterns 

in the same kidney by imaging studies may help proper management of the patient. 

P28 Diffuse Renal Involvement: Differential diagnosis based on Imaging findings 

R.G. Figueiras, C.V. Martin, S.B. Gonzalez, A.G. Figueiras, M.A. Rego, A.N. Parga, I.R. Isidro 

(Santiago de Compostela, Spain) 

Purpose: 

1. To list the diseases that may involve the kidney in a diffuse fashion 

2. To describe its imaging features on US, CT, and MRI 

3. To establish the differential diagnosis of various diffuse renal processes 


Imaging features of different entities are shown, including congenital diseases, cystic lesions, metabolic diseases, 

inflammatory processes, ischemic conditions, haematologic disorders, and neoplastic diseases. 

Characteristic Imaging findings that could help to make their differential diagnosis are reviewed. 

Results: 

Many pathologic entities could involve the kidneys in a diffuse fashion, being either infiltrative or multifocal. 

US, CT and MRI could provide some clues to make the right diagnosis. 

Conclusions: 

Diffuse renal Involvement is a usual finding in many different entities. It is important to make the right diagnosis because the 

management of the patient may be very different. Although the radiologic features are often non-specific and correlation 

with clinical findings and symptoms is necessary, familiarity with the imaging features and differential diagnoses of various 

diffuse renal processes will facilitate prompt, accurate diagnosis and treatment. 

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P29 Primary small cell carcinomas arising from the genitourinary tract: imaging features 

A.C. Tsili, V. Malamou-Mitsi, D. Giannakis, A. Charisiadi, N. Sofikitis, Ev. Paraskevaidis, K. Tsampoulas 

(Ioannina, Greece) 

Purpose: 

Primary small cell carcinomas (SCCs) arising from the genitourinary tract are uncommon. The purpose of this study was to 

analyze the multidetector CT and MR imaging features of two cases of SCCs, one of the urinary bladder and another of the 

endometrium. 


A 74-year old man with pathologically proven SCC of the urinary bladder underwent multidetector CT examination of the 

abdomen and CT virtual cystoscopy. This study includes also a case of a 63-year old woman, with a small cell neoplasm of 

uterine origin, evaluated by both multidetector CT and MR imaging. 

Results: 

Multidetector CT and virtual cystoscopy revealed a large, irregularly-surfaced, solid bladder mass, infiltrating the perivesical 

fat, the seminal vesicles and the prostate in the first case. Both multidetector CT and MR imaging in the second case showed 

a large, heterogeneously enhancing uterine mass, accompanied by bulky pelvic and retroperitoneal lymphadenopathy 

and peritoneal metastases. 

Conclusions: 

Primary SCCs of the urinary bladder and the endometrium represent rare, aggressive high-grade malignancies. Both tumors 

in this study were detected as large, inhomogeneously enhancing masses of advancedstage. Based on the cross-sectional 

imaging features, the preoperative diagnosis of SCC could not be anticipated in our cases. 

P30 Synchronous primary malignancies of the genitourinary tract: imaging features 

A.C. Tsili, A. Charisiadi, G. Koliopoulos , M. Doukas, Ev. Paraskevaidis, K. Tsampoulas (Ioannina. Greece) 

Purpose: 

Multiple primary malignant synchronous tumors in the same patient are uncommon. We present herein two cases of elderly 

women, one with an advancedstage epithelial ovarian carcinoma and a right clear cell renal cell carcinoma, and a case of 

multiple transitional cell carcinomas (TCCs) coexisting with a vaginal adenocarcinoma, evaluated by both multidetector CT 

and MR imaging. 


This study includes two women referred to the Gynecology clinic for vaginal bleeding, evaluated by both multidetector CT of 

the abdomen and MR imaging of the pelvis. 

Results: 

Imaging findings in the first case, revealed the presence of left adnexal malignancy, of FIGO stage IIIC, concomitant with a 

right lower pole renal mass, strongly and inhomogeneously enhancing, the latter finding suggestive for the presence of renal 

cell carcinoma. Multiple urothelial malignancies involving the left kidney, the ipsilateral ureter and the urinary bladder, 

coexisting with a heterogeneously enhancing mass of the anterior vaginal wall were detected in the second case. 

Conclusions: 

Synchronous multiple primary tumors involving the urinary tract and the female genital tract are extremely rare. Imaging 

evaluation permits an accurate staging of the disease and a possible preoperative histologic characterization of the 

malignancies. 

P31 Papillary Renal Cell Carcinoma: Radiologic and Clinical Spectrum 

R. Vikram, C.S. Ng, P. Tamboli, N.M. Tannir, S.F. Matin, E. Jonasch, C.G. Wood, C.M. Sandler (Houston, Tx, USA) 

Purpose: 

To describe the radiological findings that help distinguish papillary from other types of renal carcinoma and to describe the 

clinical presentation and patterns of metastatic disease. 


The exhibit is based on a review of over 130 patients with papillary renal cell carcinoma (RCC) including gross and microscopic 

pathological correlation. We describe the pathological subtypes & imaging features of the primary tumor and 

compare it to the conventional clear RCC. We also describe and illustrate the patterns of metastatic disease. 

Results: 

NA 

Conclusions: 

Papillary renal cell carcinoma has unique imaging and clinical features. Localized disease generally has a more favorable 

prognosis than conventional clear renal cell carcinoma. This exhibit will provide a systematic review of both common and 

uncommon imaging findings and will stress how an understanding of this tumor’s distinct features affect patient management. 

P32 The Treated Kidney: A Pictorial Review of Imaging Findings Following Kidney Directed Interventions, 

Short and Long Term Follow-up 

C.M. Sandler, C.A. Farinas, M. Patnana, S. Carter, J. Szklaruk (Houston, Tx, USA) 

Purpose: 

There have been recent advances in techniques and an increased utilization of kidney directed therapy for the reatment of 

renal disease. The most commonly utilized techniques for renal directed interventions include partial resection, percutaneous 

92


nephrostomy, biopsy, ureteral stent placement, nephrectomy, and radiofrequency ablation. Familiarity with the normal 

appearance of the kidney in the immediate post-treatment setting and in the short and long term follow-up is essential for 

accurate image interpretation. 

The purpose of this presentation is to present the imaging findings in computed tomography (CT) and magnetic resonance 

imaging (MRI) of the abdomen in patients who had successful renal directed therapy. The presentation will also discuss 

relevant clinical information such as indications and techniques. 


The inclusion criteria for this presentation are patients who had successful renal directed therapy and who had 

immediate, short term, and long term imaging follow-up evaluation with either computed tomography (CT) or 

magnetic resonance imaging (MRI). The CT and or MRI images for each patient were reviewed. The imaging 

findings were collaborated with reported results for each of the various kidney directed therapies. 

Results: 

See Methods 

Conclusions: 

CT and MRI are commonly used to monitor patients with renal disease. Upon competition of this presentation the 

participant will be familiar with the imaging appearance of successful renal directed therapies and will have 

obtained knowledge on the indications and techniques of such therapies. 

P33 MR urography with a new negative oral contrast agent 

T. Gokan, M. Kawahara, Y. Ohgiya, M. Hirose (Tokyo, Japan) 

Purpose: 

To show usefullness of combination of oral administration of both water and negative gastrointestinal contrast 

(Bothdel: manganese chloride tetra hydrate) in MR urography. 


The study was divided into two parts; phantom study, volunteer human study. Phantom was composed of 12 plastic tubes 

which were filled with diluted Bothdel. The imaging sequences used were RARE and HASTE technique. 

Magnetic resonance Urography (MRU) was performed in 13 healthy volunteers. The imaging sequences used was RARE 

technique. Precontrast images were obtained before oral administration, postcontrast MRU was obtained 30 minutes after 

administration at first and then again 30 minutes later. Image assessment was based on contrast effect, image effect and 

Opacification score. Statistical analysis was performed with the Wilcoxon signed rank test. 

Results: 

Signal intensity of the tube with 100%-12.5% Bothdel appeared equal to background noise on the RARE sequence. There 

were statistically significant improvements in contrast, image effect and opacification score between pre and post administration 

images but no significant difference between 30 min and 60 min post administration images. On contrast effect, 

Precontrast images were graded as poor in 7 cases. For postcontrast images, none was graded as poor. There was particularly 

significant improvement in opacification score and the distal ureter was the most difficult segment to opacify. 

Conclusions: 

A use combination of oral administration of both water and Bothdel could perform the removal of a bowel signal effectively 

and that improved the urinary tract visualization. 

P34 Virtual Pyelo-ureteroscopy: Role of 16-row MDCT 

S.D. Yarmenitis, K.G. Chlapoutakis, A. Papadakis, F. Sofras, N.C. Gourtsoyiannis (Heraklion, Greece) 

Purpose: 

To demonstrate virtual endoscopy findings of common urinary tract pathologies, utilizing a 16-row MDCT scanner. 


35 patients referred to our department for hematuria were examined with MDCT urography. The final diagnosis was made on 

the basis of surgical findings, medical treatment or imaging follow-up. Perspective 3D reconstruction views of the urogenital 

tract were obtained utilizing the virtual endoscopy software application installed in the CT system’s workstation. 3D colorcoded 

endoscopic views were created based on the volume rendering artificial surfacing method. Surface rendering display 

parameters were manually determined by appropriate thresholding the Hounsfield Unit (HU) histogram over a region of 

interest (ROI). 

Results: 

Characteristic imaging features of both benign and malignant urothelial entities are demonstrated. Irregularity of surface, 

outline and shape of a protruding lesion raise suspicion for the presence of malignancy. On the contrary, regularity of the 

outline and surface favour benignity. The major drawback of virtual endoscopy is the uncertain performance when examining 

small, flat lesions or in situ carcinomas characterized only by mucosal discoloration or minimal thickening. 

Conclusions: 

At the moment VE can only be recommended as an adjunct to cross-sectional imaging and/or as a complementary technique 

along with the various 3D re-construction techniques (MIP, MPR, and VRT), and not as a stand-alone diagnostic tool. 

As such, this technique seems to be ideal to tailor-up further diagnostic procedures by focusing at the specific sites of 

depicted pathology. In addition it can evolve to a very convenient teaching tool. 

93


P35 Benefit vs Risk in patients with acute flank pain examined with CT 

M. Lönnemark, S.A. Hamdeh, L. Jangland (Uppsala, Sweden) 

Purpose: 

IVP has during recent years been replaced by CT in the work-up of patients with acute flank pain. The drawback of CT is the 

increased radiation dose resulting in an increased risk of radiation induced cancer. The aim was to study the age panorama 

in patients with acute flank pain and the benefit and risk of CT. 


481 patients who during a period of one year (July 2006 – June 2007) presented with acute flank pain were included in a 

retrospective study (54,7 % men, 45,3 % women, mean age 51 years). 271 patients were examined with CT in the acute 

situation and 210 were examined electively. The CT findings, the CT phases performed and the Dose Length Product (DLP) 

were registered. The expected value of the amount of radiation induced deaths in cancer was calculated according to 

the different patients’ ages. 

Results: 

The CT-findings explained the symptoms in 155 (57,2 %) of the acutely examined patients (115 with urethral stone, 40 with 

other findings). Elective CT examination gave the explanation of the symptoms in 31 (14,8 %) patients. The effective dose 

varied between 1,2 and 30,7 mSv (mean 10,9±6,7) and between 1,1 and 22,1 mSv (mean 6,7±4,4) for the acute and the 

elective examinations respectively. The amount of expected radiation induced deaths in cancer was calculated to 0.109 

which means 1 expected death per 4 100 examined patients. 

Conclusions: 

Even though CT offers good diagnostic information in patients with acute flank pain the study shows that the risk of radiation 

has to be taken into consideration, especially in younger patients. 

P36 Usefulness of MDCT urography after excretory urography in obstructed kidneys 


Purpose: 

-To describe our excretory urography (EU) and associated MDCT urography protocol. 

-To demonstrate the diagnostic value of MDCT urography in patients with delayed opacification and a dilated pelvicalyceal 

system in excretory urography. 


Since January 2006 MDCT urography has been used in all cases of delayed enhancement and dilated pelvicalyceal system 

detected with EU (35 patients). 

Results: 

Causes of pieloureteral obstruction diagnosed by MDCT were: 

8 ureteral stones (4 radiolucent and 4 radiopaque), 8 ureteral tumors, 4 bladder tumors, 4 postoperative or postradiation 

ureteral structures, 4 primary and metastatic retroperitoneal tumors that encompass the ureter, 1 chronic infection (tuberculosis), 

1 case of prostate obstruction, 1 case of pelviureteral clots, 1 case of ureteropelvic junction obstruction, 1 case of 

crossing vessels, 1 retrocaval ureter and 1 case of papillary necrosis. 

Correct diagnosis was made in all cases (100%). 

Conclusions: 

In patients with delayed contrast excretion and pelvicalyceal dilatation in EU study, MDCT urography performed immediately 

after EU is useful for detecting the underlying cause of obstruction reducing the time required to attend the patient. 

P37 Usefulness of curved multiplanar reconstructions (MPR) and curved thin maximum intensity projection 

(thin-MIP) reconstructions in urinary tract studies by means of MDCT 


Our objectives are: 

• To show how we carry out curved MPR and curved thin-MIPs (miniMIPs) reconstructions in patients with urinary tract 

diseases. 

• To demonstrate superiority of these reconstructions for detection and characterization of kidney, renal pelvis and ureteral 

diseases. 

MDCT is useful for: 

• Kidney, renal pelvis and ureteral tract calculi detection 

• Renal artery stenosis in patients with hypertension and renal arterial and venous anatomy in potential living renal donors. 

• Aortoiliac arterial map before kidney transplantation and for evaluation of vascular problems after kidney transplantation. 

• Renal cell carcinoma local spreading. 

• Diagnosis of renal pelvis and ureteral tumors, infections, papillary necrosis and other causes of hematuria and urinary tract 

obstruction. 

Curved MPR and curved miniMIP reconstructions display in great detail renal artery wall, arterial and venous anatomic 

variants, small polar arteries and veins (polar, gonadal and lumbar). These reconstructions are superior to thick-MIPs, coronal 

and sagital MIPs and volume rendering (VR) reconstructions to visualize mural ureteral tumors and infections and to depict 

diseases around pyeloureteral system. They are also superior to the other techniques for displaying pyeloureteral system 

when there is no contrast in it. 

94


Conclusion: 

In this poster we demonstrate superiory of curved MPR and curved miniMIP reconstructions to display all the anatomic 

structures and diseases listed above. 

Although they are more time consuming than other types of reconstructions they are imperative for the correct study of 

the urinary tract. 

P38 Assessment of renal vascular changes after ESWL: measured by Ultrasound Resistive Index (RI), ASL 

(FLASH-STAR) and contrast perfusion MRI 

M.M.H. Abd Ellah, L. Pallwein, F. Aigner, C. Kremser, M. Schocke, C. Wolf, G. Bartsch, F. Frauscher 


Purpose: 

Value of ASL (FLASH-STAR) MRI sequence for evaluation of renal vascularity (blood flow) in patients undergoing ESWL. 


We examined 11 patients with renal stones planned for ESWL, 12 hours before and 24 hours after ESWL using a whole body 

1.5 Tesla MR Scanner. A ASL (FLASH-STAR) sequence was applied for both kidneys (treated and untreated). Results were 

obtained by subtraction of two data sets acquired alternately with and without flow inversion, which were then analysed 

using the free software ImageJ. All patients also underwent MR contrast perfusion imaging using a T1-map sequence followed 

by a dynamic saturation recovery sequence. RI was measured in all patients using Doppler US in the upper, middle 

and lower parts. The results for the different imaging techniques were compared. 

Results: 

ASL values were significantly decreased in both kidneys (before treatment: mean 65.3 +/- 9.9; after treatment: 52.1 +/- 7.4; 

p


Conclusions: 

The MR urethrography showed an optimal diagnostic accuracy and good tolerance respect to reference technique. The 

advantage is that doesn’t use radiation in young patient. The disadvantages: discomfort to perform the Permiction phase, 

claustro-phobia,ferromagnetic device. 

P42-P50: Male Imaging 

P42 The value of perfusion CT in evaluation the locoregional staging in post-radical prostatectomy patients with 

elevated PSA level in blood serum 


Purpose: 

The aim of the study is evaluation of p-CT efficiency in assessment of cancer foci within prostate gland in patients with 

elevated PSA level, who followed radical prostatectomy after p-CT exam. 


Prostate perfusion CT was performed in Oncology Institute, Kraków in 2006 in 24 patients, aged 49-72. That examination was 

followed by core needle biopsy of the prostate (6-12 cores). In evaluated group PSA level in the blood ranged from 5,15 to 

33,1 ng/ml. Gleason score estimated after radical prostatectomy ranged from 5 to 8. Following parameters were estimated: 

BF, BV, PS and MTT, for both prostate lobes on three levels: base, mid-gland and apex. 

Statistics were analized considering correlation between presence of pathological foci found in p-CT examination, level of 

serum PSA and histopathologic findings in removed prostate gland. 

Results: 

On the basis of material analysis we concluded correlation between serum PSA level and Gleason score in post-radical 

prostatectomy patients. 

The higher the level of serum PSA, the higher Gleason grade. 

A positive correlation was found between serum PSA and presence of pathological lesions detected in p-CT. The 

higher the level of serum PSA, the higher the probability of detecting pathological lesion within prostate gland. 

We also proved no significant correlation between histopathologic outcomes concordance with serum PSA level. 

However, we indicated no correlation between Gleason score and p-CT examination results, what further results in opinion, 

that there is no relation between Gleason score and presence of pathological foci detected in p-CT examination. 

P43 Correlation between 3T MRI Apparent Diffusion Coefficient and Prostate Cancer Gleason Score in radical 

Prostatectomy Specimens 

T. Hambrock, R. Somford, H.J. Huisman, C. Hulsbergen-van de Kaa, I. van Oort, F.J.A. Witjes, 

J.O. Barentsz (Nijmegen, The Netherlands) 

Purpose: 

Correlate 3T MRI Apparent Diffusion Coefficient (ADC) values and prostate tumor Gleason score (GS). 


20 Patients with prostate cancer received a Diffusion-Weighted (b-values: 0, 50, 500, 800) 3T MRI. ADC maps were aligned 

to step-section prostatectomy specimens. Regions of Interest (ROI) were drawn on ADC maps over tumor. Additional ROIs 

were drawn in adjacent normal prostate. Prostatectomy determined GS was correlated to a) mean tumor ADC values 

b) contrast-to-noise (CNR) estimations of mean ADC of tumor to directly surrounding normal prostate. Pearson correlation 

coefficients were determined. 

Results: 

60 Tumor lesions were annotated. Tumors were stratified into GS 5, 6, 7, 8, 9. Distribution of tumors were: Gleason score 5 (3 

tumors), Gleason score 6 (25), Gleason score 7 (20), Gleason score 8 (7) and Gleason score 9 (5). Mean ADC values (x10-3 

mm 2 /s) of tumors were: Gleason score 5 - 1.15 (± 0.08), Gleason score 6 - 1.38 (±0.18), Gleason score 7 - 1.00 (± 0.28), Gleason 

score 8 - 0.77 (± 0.09) and Gleason score 9 - 0.87 (± 0.23). The CNR estimations revealed a CNR of 1.2 (± 0.38) for Gleason 

score 5, 1.5 (± 0.96) for Gleason score 6, 3.2 (± 1.10) for Gleason score 7, Gleason score 8 - 3.7 (± 0.85) and Gleason score 9, 

4.9 (± 1.41). Correlation coefficients were significant between mean tumor ADC values and GS (r 0.62, p-value < 0.001) as 

well as CNR estimates and GS (r 0.73, p-value < 0.001). 

Conclusions: 

3T MR ADC of prostate tumors correlates well to GS. This correlation appears to be strongest for CNR of mean ADC. 

P44 Effect of Computer Assisted Diagnosis on Characterization of Prostate Lesions on 

Dynamic Contrast Enhanced MR Imaging 

T. Hambrock, P. Vos, H.J. Huisman, F.J.A. Witjes, C. Hulsbergen-van de Kaa, J.O. Barentsz 


Purpose: 

Determine the effect of a Computer Assisted Diagnostic (CAD) method to aid radiologists in differentiating benign from 

malignant prostatic lesions on Dynamic Contrast Enhanced MR images (DCE-MRI). 


34 Patients with prostate cancer received a 1.5 T DCE-MRI prior to prostatectomy. Prostatectomy step sections were used as 

ground truth. Regions of interest (ROI) were placed on MR images in normal, benign (but tumor suspicious) as well as tumor 

96


regions of the peripheral zone. R1 relaxation and pharmacokinetic features were extracted from these ROI’s and used to 

train a support vector machine as classifier. Output of the classifier was used as a measure of malignancy likelihood. A multireader 

observer study was performed and readers received 5 training cases on prostate evaluation. Three readers indicated 

a malignancy likelihood of predetermined ROI’s on a hanging protocol before and after CAD malignancy likelihood 

results were presented to them. Receiver operating characteristic (ROC) analysis was performed to determine if CAD resulted 

in a significant improvement of lesion characterization accuracy. 

Results: 

The diagnostic accuracy (Az) of differentiating benign from malignant areas in the prostate on DCE-MR images were 0.83, 

0.67 and 0.73 for the different readers before CAD support (combined Az 0.74) while addition of CAD predicted malignancy 

likelihood resulted in an improved lesion differentiation ability with accuracies of 0.88, 0.88 and 0.78 respectively (combined 

Az of 0.84) (p < 0.05). 

Conclusions: 

The addition of CAD support for DCE-MRI in the differentiation between benign and malignant lesions in the prostate improves 

reader accuracy. 

P45 Contrast enhanced colour Doppler targeted prostate biopsy for prostate cancer detection: 

Results of 2008 men 

F. Aigner, E. Pallwein, L. Pallwein, V. Spiss, M. Mitterberger, W. Jaschke, G. Bartsch, F. Frauscher 


Purpose: 

To compare the prostate cancer detection rate of contrast enhanced colour Doppler ultrasound targeted biopsy with gray 

scale US guided systematic biopsy in a series of 2008 men. 


In a 4 year period 2008 male screening volunteers with a total prostate specific antigen of 1.25 ng./ml. or greater and free-tototal 

prostate specific antigen less than 18% were included. Mean patients age was 60 +- 9.3 years , mean PSA value was 6.5 

+- 14.7 ng/ml. Two independent examiners evaluated each patient and a single investigator performed 5 or fewer contrast 

enhanced targeted biopsies into hypervascular regions in the peripheral zone during intravenous infusion of the US contrast 

agent SonoVue. Subsequently another examiner performed 10 systematic prostate biopsies. The cancer detection rates of 

the 2 techniques were compared. 

Results: 

Overall, cancer was detected in 559 patients (28%), including 476 (24%) by contrast enhanced targeted biopsy and in 410 

(20%) by systematic biopsy. Cancer was detected by targeted biopsy alone in 149 patients (27%) and by systematic biopsy 

alone in 83 (15%). The detection rate for targeted biopsy cores (10.8% or 961 of 8,880 cores) was significantly better than for 

systematic biopsy cores (4.5% or 923 of 20,080 cores, p


localization inside or outside the testis and a possible histologic characterization of its nature. For intratesticular malignancies, 

the local extension of the disease was assessed. MR imaging findings were correlated with the surgical and histologic results. 

Results: 

MR imaging studies yielded an accuracy rate of 100% in defining lesions inside or outside the testicles. The sensitivity, specificity, 

positive and negative predictive value of MR imaging in detecting testicular malignancies were 100%, 80%, 94%, and 

100%, respectively. The local extension of testicular neoplasms was correctly assessed in 94% of cases. 

Conclusions: 

MR imaging is highly accurate in the differentiation of extratesticular from intratesticular masses, providing satisfactory results 

in the distinction between benign from malignant testicular masses and allowing an accurate evaluation of the local extent 

of the disease, in cases of testicular carcinomas. 

P48 Effect of vasectomy on testicular blood flow evaluated by color Doppler Ultra-sound resistive index 

measurement 

R. Faschingbauer, E. Pallwein, L. Pallwein, F. Aigner, M. Mitterberger, F. Frauscher (Innsbruck, Austria) 

Purpose: 

The objectives of this study were to evaluate the testicular blood flow in patients after vasectomy by use of color Doppler 

ultrasound resistive index measurement. 


The study included 50 healthy men, whose received a vasectomy. Patients were assessed before and 1, 3 and 6 months after 

surgery. Both testes were examined (linear array 15 MHz transducer - Acuson, Sequoia). The Resistive Index (RI) of the testicular 

artery were measured at two locations: the convoluted aspect and the marginal aspect of the artery. Additionally the 

volume of the testicles was determined. 

Results: 

All measures were obtainable. The mean volume of the testes was 17.5± 5.7 mL before and 19.7± 7.1 mL after vasectomy. 

RI ranged from 0.45 to 0.67 . Measures for left and right testes were similar (P > 0.10). The majority of the measures showed 

higher RI values at the cord location than at the marginal aspect of the artery (P < 0.05). 

The overall increase of RI was significantly (P < 0.05) and ranged from 0.51± 0.09 (before vasectomy) to 0.59± 0.08 (3 and 6 

months after vasectomy). The RI returned to basic values at the 6 month control (mean RI: 0.52± 0.07) after treament. 

Conclusions: 

The significant increase of RI after vasectomy may indicate a slightly decreased perfusion of the testicles due to swelling 

based on a transitory disturbance of lymph drainage. Further investigation will show the utility of RI measurements in 

estimation of testicular function. 

P49 Erectile Dysfunction: Spectrum of Penile Doppler US Findings 

N. Bhuskute, M.J. Weston (Leeds, United Kingdom) 

Purpose: 

LEARNING OBJECTIVES: 

1. To understand the normal ultrasound appearances of penis and common arterial variations 

2. To understand that various penile Doppler US findings can be observed depending on aetiology of erectile dysfunction 

3. To familiarise with the spectrum of penile Doppler US findings 

Abstract: 

Doppler ultrasound findings in cases of erectile dysfunction are of different types depending upon cause of the problem. 

We describe normal penile Doppler waveforms along with common anatomical variations and temporal response to vasoactive 

agents. Illustrations are also made of unilateral cavernous artery Doppler abnormality as commonly seen in cases of 

pelvic trauma or surgery. With trauma to the penis or the perineum, distortion or reconstruction of penile vascular anatomy 

may be encountered and these along with post traumatic sequelae in erectile tissues (e.g. arteriovenous fistula in posttraumatic 

high-flow priapism) are also discussed. This exhibit will show this spectrum of normal and abnormal Doppler US findings 

in erectile dysfunction. 

P50 Neurinoma of the penis: a case report with radiologic-pathologic correlation and review of the literature 

G.M. Argiolas, G. Catani, S. Mallocci, D. Sirigu, G.T. Bitti (Cagliari, Italy) 

Purpose: 

To describe the imaging features of a penile schwannoma, correlate with gross pathology and histology, and review the 

literature on this rare location of a common tumor. 


A 58-year-old man presented to his primary care physician complaining of obstructed urination and dysuria. 

Physical examination demonstrated a hard periurethral mass on the right side of the penile root. 

Cross-sectional imaging (multiplanar MR examination was performed on a high field unit also after administration of a gadolinium-based 

contrast material and MDCT without and with iodinated contrast media), and US examination with CD interrogation. 

The patient underwent surgical excision of the mass, and pathologic examination was performed. 

Results: 

A 4.0 x 2.0 cm fusiform mass, compressing the corpora cavernosa and corpus spongiosum in the penile root was demonstrated; 

the lesion was covered by the tunica albuginea. Typical features of schwannoma were exhibited by the lesion, which 

was hypointense on T1 and hyperintense on T2 and strongly enhanced; the shape was also typical with well defined borders 

98


and presence of a capsule. A cluster of small, serpiginous vessel was located on the distal pole of the mass, a finding often 

present in benign neural tumors. Gross pathology and histology were evaluated and correlated to imaging: a dark, rubbery 

mass 4.0 x 3.0 cm in size was found, with an appearance that suggested a testis; histology demonstrated. 

Conclusions: 

Schwannoma is a common tumor, but penis is a rare site. 

A review of the literature showed that only 20 cases, to our knowledge, have been described in the English literature. 

The lesion we observed originated on the side of the penile shaft, enclosed in the tunica albuginea, derived from minor nerve 

fibers; opposedly, most of the cases previously described arise on the dorsal surface of the penis, where the dorsal penile 

nerves are. Our case was unusual also because most of the penile schwannoma described in the literature are located more 

distally in the penis. 

P51-P52: New Developments in Imaging 

P51 Signal intensities in whole-body MRA at 3T: a randomized trial of gadofosveset and gadoterate 

Y.W. Nielsen, V.B. Løgager, H.S. Thomsen (Herlev, Denmark) 

Purpose: 

To investigate whole-body magnetic resonance angiography (WB-MRA) in a high-field MRI system using two different contrast 

agents: Gadofosveset trisodium (Vasovist) and gadoterate meglumine (Dotarem). 


20 patients with intermittant claudication were examined using either 0.03 mmol/kg body weight gadofosveset (n=10) or 0.3 

mmol/kg gadoterate (n=10). After randomization first-pass WB-MRA was performed using four stations that covered the arteries 

from the neck to the feet. The following stations were used: 1) thoracic aorta and supra-aortic branches, 2) abdominal 

aorta and iliac arteries, 3) thigh arteries and 4) the crural arteries. The body-coil was used for signal reception. Signal to noise 

ratio (SNR) was measured in all four stations. The wilcoxon ranked sum test was used to test for significant differences. 

Results: 

WB-MRA was successfully performed in 16 patients. In 4 patients (gadofosveset n=3, gadoterate meglumine n=1), evaluation 

of one vessel region was hampered by mistiming between contrast and image acquisition. Gadoterate gave higher SNR 

than gadofosveset in 3 stations (1, 2 and 3). The difference was significant in station 2 (p0.05). 

Conclusions: 

Gadoterate at 0.3 mmol/kg serves better for first-pass WB-MRA at 3T, than gadofosveset at 0.03 mmol/kg. The finding is 

consistent with the rapid drop of relaxivity for gadofosveset at field strengths higher than 1.5T. 

P52 The Internet portal dedicated to urologic ultrasound as a multidisciplinary educational space 

W. Bialek P. Michalak, K. Bar, J. Michalak (Lublin, Poland) 

Purpose: 

The aim of the project was creation of an Internet portal dedicated to urologic ultrasound as a new multifunctional tool for 

urologists, radiologists and other medical professionals who support urologists in their everyday practice. 


The team of programmers planned sophisticated architecture and constructed an upgradeable software project with 

ASP.NET 2.0 technology according to technical requirements determined by physician. The core element of the project was 

huge unrestricted database to be operated from the platform of Internet. The main assumption was to create a modern but 

simple and user friendly portal that is able to cover every aspect of urologic ultrasound (scientific, educational, commercial, 

social etc.). 

Results: 

After 10 months of collaborative work of programmers, multimedia experts and physicians internet portal was born online. It 

has got a multimedia data base for case reports (complete descriptions of case stories from anamnesis to follow-up, illustrated 

with high-quality ultrasound images and videos, corresponding video clip recordings of endoscopic examinations, 

schemes, radiological and pathological images and reports, literature links etc.) with a unique multimedia browser giving 

possibility to make adjustments - to “tune” images and clips according to user preferences and for analyzing videos frame 

by frame. There is also opportunity to learn how, and explore by himself sample 3D volumes. 

Conclusions: 

Sonography is a common imaging modality, appreciated by medical professionals connected with diagnostics and treatment 

of urologic diseases. Considering present capabilities and excellent perspectives in the future, an Internet portals seem 

to be ideal tools of communication and exchange of information for them. 

99


Abd Ellah M.M.H. (Austria) 

Aigner, F. (Austria) 

Alleman, W.G. (USA) 

Argiolas, G.M. (Italy) 

Barentsz, J. (The Netherlands) 

Bergman, A. (Sweden) 

Beyersdorff, D. (Germany) 

Bhuskute, N. (United Kingdom) 

Bialek, W. (Poland) 

Björkman, H. (Sweden) 

Brkljacic, B. (Croatia) 

Builov, V.M. (Russia) 

Buñesch, L. (Spain) 

Byun, J.Y. (South Korea) 

Capaccio, E. (Italy) 

Chapple, C. (United Kingdom) 

Chlapoutakis, K.G. (Greece) 

Claudon, M. (France) 

Cohan, R. (USA) 

Coppenrath, E. (Germany) 

Cornud, F. (France) 

Cowan, N. (United Kingdom) 

Cucci, E. (Italy) 

Cuenod, C.A. (France) 

Cunha, T.M. (Portugal) 

Curry, N. (USA) 

Dahlman, P. (Sweden) 

Damasio, M.B. (Italy) 

Danza, F.M. (Italy) 

Darge, K. (USA) 

Degenhart, C. (Germany) 

Derchi, L. (Italy) 

Duarte, M. (Portugal) 

El-Saied El-Azab, M. (Egypt) 

El-Ghar, M.E. Abou (Egypt) 

El-Sayed, R. Farouk (Egypt) 

Faschingbauer, R. (Austria) 

Franiel, T. (Germany) 

Figueiras, R.G. (Spain) 

Firouznia, K. (Iran) 

Forstner, R. (Austria) 

Frauscher, F. (Austria) 

Fütterer, J.J. (The Netherlands) 

100 

List of Authors 

Ghattamaneni, S. (United Kingdom) 

Gokan, T. (Japan) 

Gradl, J. (Austria) 

Grenier, N. (France) 

Hallscheidt, P. (Germany) 

Hambrock, T. (The Netherlands) 

Hamm, B. (Germany) 

Hanna, S.A.Z. (Egypt) 

Heinz-Peer, G. (Austria) 

Hejmnk, S.W.T.P. (The Netherlands) 

Henriques, H.C. (Portugal) 

Hyland, R.E. (United Kingdom) 

Iotti, A. (Italy) 

Jeon, H.J. (South Korea) 

Keanie, J.Y. (United Kingdom) 

Kenney, P. (USA) 

Kim, J. (South Korea) 

Kingma, H.J. (The Netherlands) 

Kinkel, K. (Switzerland) 

Laville, M. (France) 

Y. Lee, Y. (South Korea) 

Lichy, M.P. (Germany) 

Lienemann, A. (Germany) 

Lim, K.J. (South Korea) 

Lobo, L. (Portugal) 

Lönnemark, M. (Sweden) 

Loewe, C. (Austria) 

Łuczynska, E. (Poland) 

Magnusson, A. (Sweden) 

Maniatis, P. (Greece) 

Mancarella, I. (Italy) 

Mannelli, L. (United Kingdom) 

Masselli, G. (Italy) 

Meindl, T. (Germany) 

Molen, A. v.d. (The Netherlands) 

Mueller-Lisse, U.G. (Germany) 

Mueller-Lisse, U.L. (Germany) 

Nair, S.B. (United Kingdom) 

Namkung, S. (South Korea) 

Neukamm, M. (Germany) 

Nielsen, Y.W. (Denmark) 

Nolte-Ernsting, C. (Germany) 

Pabon-Ramos, W.M. (USA) 

Pallwein, E. (Austria) 

Palma, S.M.P. (Portugal) 

Papadopoulou, F. (Greece) 

Pavlica, P. (Italy) 

Persson P. (Germany) 

Portnoy, O. (Israel) 

Rajaram, S. (United Kingdom) 

Ramchandani, P. (USA) 

Reddan, D. (Ireland) 

Refaie, H.F. (Egypt) 

Regier, M.- (Germany) 

Regine, G. (Italy) 

Restaino, G. (Italy) 

Riccabona, M. (Austria) 

Roy, C. (France) 

Sandler, C. (USA) 

Shebl, H.M. (Egypt) 

Scheidler, J. (Germany) 

Scherr, M.K. (Germany) 

Schlemmer, H. (Germany) 

Schneider, K. (Germany) 

Sebastià, C. (Spain) 

Spencer, J. (United Kingdom) 

Stief, C. (Germany) 

Tahir, N. (United Kingdom) 

Takahashi, S. (Japan) 

Thoeny, H.C. (Switzerland) 

Thomsen, H.S. (Denmark) 

Triantopoulou, C. (Greece) 

Tsili, A.C. (Greece) 

Tuncay Turgut, A. (Turkey) 

Valentino, M. (Italy) 

Vakaki, M. (Greece) 

Vikram, R. (USA) 

Vrang, M. (Denmark) 

Wasserman, N. (USA) 

Yakar, D. (The Netherlands) 

Yamamura, J. (Germany) 

Yarmenitis, S.D. (Greece) 

Zagoria, R. (USA) 

Zantl, N. (Germany)

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