MRI reveals the human connectome

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Watch this session on ECR Live: Friday, March 7, 16:00–17:30, room BRB
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Radiologists often say that the brain is the next frontier. But as diffusion MRI techniques progress, the most mysterious organ in the human body starts to unveil more and more of its secrets, and what was once inconceivable a decade ago is now almost at hand.

White matter fibre pathways of the brain as depicted with MR tractography. (Provided by Patric Hagmann, CHUV-UNIL, Lausanne, Switzerland)

White matter fibre pathways of the brain as depicted with MR
tractography.
(Provided by Patric Hagmann, CHUV-UNIL, Lausanne, Switzerland)

Researchers are now better able to understand how neurons connect with one another and how disease affects these connections in the human brain. The production and later study of maps of neural connections obtained with MRI are vital to this task. A dedicated New Horizons session will cover this fascinating topic today at the ECR.

Patric Hagmann, who will chair the session, is an attending physician and neuroradiologist at Lausanne University Hospital (CHUV, Centre hospitalier universitaire vaudois) in Switzerland. In his introduction, he will describe what he calls the connectome, a term he coined in his thesis on diffusion MRI and brain connectomics back in 2005*.

“We could sum up the connectome as a comprehensive map of neural connections in the brain. The production and study of connectomes is what we refer to as connectomics; it may range from a detailed map of neurons and synapses within part of, or all of, the nervous system to a description of the functional and structural connectivity between all cortical areas and subcortical structures,” he said.

In his presentation, Hagmann will not only introduce important concepts related to connectomics like scaling, the relation between structural and functional connectivity, and the integration-segregation, but also show how advances in MRI facilitate the mapping of the human connectome.

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07
Mar 2014
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American and European emergency radiologists compare experiences

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Watch this session on ECR Live: Friday, March 7, room F1
Four separate sessions, starting 08:30, 10:30, 14:00, and 16:00
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For the fourth year in a row, the European Society of Radiology (ESR) and the Radiological Society of North America (RSNA) will hold a joint course on a hot topic in radiology. After oncologic imaging for the past three years, emergency radiology will be under the scope of North American and European radiologists, who will share and compare their experiences in the dedicated Mini Course today at the ECR*.

MDCT is the best modality for identifying lesions as subtle as active mesentric bleeding and infiltration (arrow) caused by blunt abdominal injury (lap-belt compression). (Provided by András Palkó)

MDCT is the best modality for identifying lesions as subtle as active mesentric bleeding and infiltration
(arrow) caused by blunt abdominal injury (lap-belt compression). (Provided by András Palkó)

Medical emergencies and trauma are responsible for high levels of morbidity and mortality in all age groups worldwide, and trauma is the leading cause of death in people younger than 45. Consequently, the use of imaging in emergency departments has been increasing exponentially since the 1990s. The demand for CT examinations from emergency departments is, for instance, growing annually by 5% to 15%, depending on the institution.

Even with all the advanced tools imaging has to offer, trauma remains a challenge for most emergency services, according to Ulrich Linsenmaier, associate professor of radiology and head of the department of diagnostic and interventional radiology at KMPP Clinics in Munich, Germany. “Even for advanced level 3 medical centres running their own emergency radiology unit, it is a challenge to integrate advanced radiology services into an interdisciplinary team treating patients with acute traumatic and non-traumatic emergencies,” he said.

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07
Mar 2014
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Radiologists must be thorough when investigating malignant primary bone tumours

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Watch this session on ECR Live: Thursday, 16:00–17:30, Room E2
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Malignant primary bone tumours like osteosarcoma and Ewing’s sarcoma are very serious diseases mainly affecting children and teenagers. General radiologists are not likely to see these patients every day at their practice, but when they do, they must know what they have to do to optimise patient care and improve outcomes. Experts will give instructions and share useful advice during the dedicated Multidisciplinary Session today at the ECR.

Conventional x-ray of a tumour in the knee (Image provided by Prof. Koenraad Verstraete)

Conventional x-ray of a tumour in the knee
(Image provided by Prof. Koenraad Verstraete)

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Experts explain how to avoid pitfalls in FDG PET/CT imaging

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Watch this session on ECR Live: Thursday, March 6, 16:00–17:30, Room I/K
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The demand for PET/CT studies is increasing and so is the need for radiologists to improve their knowledge of this important modality. One of the many areas that require their attention is the occurrence of pitfalls related to the uptake of Fludeoxyglucose (18F), commonly called FDG, the most commonly used tracer in PET/CT imaging. A dedicated Special Focus session at the ECR will offer attendees useful clues on how to avoid these pitfalls and correctly interpret images.

Katrine Åhlström Riklund is director of the medical school and deputy head of the department of radiation sciences at Umeå University, Sweden. She is 2nd vice-chairperson of the ESR’s Congress Committee.

Katrine Åhlström Riklund is director of the medical school and deputy head of the department of radiation sciences at Umeå University, Sweden. She is 2nd vice-chairperson of the ESR’s Congress Committee.

FDG uptake by tissue is also a marker for glucose uptake, which is closely correlated with certain types of tissue metabolism. This means that FDG can show not only disease-related changes but also normal, healthy metabolic changes in the body. “Not everything that shines is pathological. To know the difference, you have to train and learn what is really a disease and what is the physiological distribution of this tracer,” said Professor Katrine Åhlström Riklund, a radiologist specialised in nuclear medicine at Umeå, Sweden, who will moderate the session.
To help radiologists, speakers will share advice regarding FDG uptake in oncology, neurology and cardiology.

Most FDG PET/CT studies are currently being carried out to help stage cancer, and plan and follow-up therapy. The combination of FDG and PET/CT imaging is particularly useful in several different malignancies. Because a tumour cell divides rapidly and has a high rate of metabolism, FDG uptake usually corresponds to disease. Once physicians know the extent of the disease, they can make a more accurate diagnosis and treatment plan, especially in targeted therapies.

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06
Mar 2014
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Next year’s ECR set to be Russian Affair

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ECR Today spoke with the next ECR president, Prof. Valentin Sinitsyn. He is chief of the radiology department at the Federal Centre of Medicine and Rehabilitation in Moscow, Russia, and currently serves as president of the European Society of Cardiac Radiology (ESCR).

ECRT: What will be the main highlights of ECR 2014’s scientific programme?

Valentin Sinitsyn: Prepare for more interactivity. People are increasingly interested in interactive sessions to assess what they have learned from a lecture. The ECR has been developing interactive sessions for several years now, but we want to increase that. Today, you can find a lot of information on the internet and many people might not think it is necessary to travel to a congress. We want to create something attractive and show that it is worth coming here. Nothing can replace shaking hands with your colleagues from other countries. I would be very sad if the ECR were entirely online. This is why we are making live meetings more interactive.

ECR 2014 Congress President Valentin Sinitsyn, from Moscow, Russia.

ECR 2014 Congress President Valentin Sinitsyn, from Moscow, Russia.

We would also like to change the format of scientific sessions. Our lectures have the same format they had one or two hundred years ago: a stage and an auditorium. We are currently discussing the concept of a multimedia classroom, a model which was successfully introduced during the last SIRM congress in June 2012. This multimedia classroom offered 60 work stations from different companies with 25 different cases which were discussed at the end. We are currently discussing the structure with Professor E. Neri from Pisa, who was responsible for the scientific programme of that project.

Soon we are going to use smart phones for voting during audience response sessions. But wireless technology has its limits and sometimes networks crash, so it needs a lot of work. Keypads are an old technology but they are very reliable. I am sure that next year, or the year after that, everybody will be able to vote with their own iPads or tablets.

We will also increase the number of multidisciplinary sessions. This is not something we have to do just during the ECR. This year we had the Imaging Biomarker’s Course the day before the congress, which was organised by the European School of Radiology. This will take place again next year with radiation oncology as the topic.

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Rise of mobile technology brings risks as well as benefits

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Watch this session on ECR Live: Monday, March 11, 16:00–17:30, Room F1
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Tablet computers can be a surprisingly divisive subject. The passion with which some people argue the relative merits of competing devices and operating systems can be almost frightening. In the field of medicine, however, there appears to be very little argument about the top product, with professionals from many disciplines enthusiastically embracing the iPad as a tool for research, education and general communication. Instead the most important debate is focused elsewhere, on matters of data security and patient privacy.

As mobile technology spreads throughout the hospital, data naturally follows, and it is slowly falling into the hands of an increasingly broad spectrum of people. Radi-ologists and clinicians therefore need to be aware, not just of the many mobile applications and resources that can potentially aid their work, but of the associated risks and best practices concerning the use of tablet technology.

Dr. Erik Ranschaert (left – pictured here with Dr. Jan Schillebeeckx) from ‘s-Hertogenbosch, the Netherlands, will speak on mobile telera-diology with tablet computers in this Special Focus Session

Dr. Erik Ranschaert (left – pictured here with Dr. Jan Schillebeeckx) from ‘s-Hertogenbosch, the Netherlands, will speak on mobile telera-diology with tablet computers in this Special Focus Session

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ESR set to tackle personalised medicine and face economic realities in 2013

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In an interview with ECR Today, incoming ESR President, Professor Guy Frija explained how the ESR should address the challenges raised by the explosion of ‘omics’ data and the advent of personalised medicine, as well as how it should assess the impact of the financial crisis on the specialty.

ECR Today: What are your plans and ambitions regarding your presidency?
Guy Frija: The development of the ESR since its establishment in 2005 has been amazing: the ESR is now the biggest radiological society in the world, and its annual meeting, the European Congress of Radiology (ECR), is one of the best radiology congresses worldwide. All of this is the result of intense activity in several fields, such as education, research, professional challenges and publications, for the development of which the role of my predecessors was instrumental, along with the dedication of many of our colleagues. Therefore my first goal is to keep up this momentum and run the society appropriately, in accordance with its new statutes. However, life is challenging, and we will have to face many new issues in the coming year.

Professor Guy Frija is head of the imaging department at the Georges Pompidou European Hospital (Hôpital Européen Georges Pompidou, H.E.G.P.) in Paris.

Professor Guy Frija is head of the imaging department at the Georges Pompidou European Hospital (Hôpital Européen Georges Pompidou, H.E.G.P.) in Paris.

The explosion of ‘omics’ (such as metabolomics, proteomics, genomics) data is changing the face of medicine so considerably and rapidly that, if we don’t pay enough attention, our specialty could be threatened. Personalised medicine is not a just a dream, but an actual reality, and we have to adapt our specialty to this new paradigm. This year, DNA sequencing could become available for less than €750 (US$1,000), and in the UK, the Prime Minister David Cameron has launched a programme for the development of personalised medicine. The development of personalised imaging, which has already begun in oncology, should be taken further, and we have to appreciate its impact on education. I will ask two or three subspecialties to reconsider their training charters in light of these new developments. The data explosion related to these changes raises not only the problem of their management, but also of their interpretation in an integrated way: the imaging parameters should be included in this new data knowledge organisation, where knowledge modelling will become a major challenge. The establishment of imaging biobanks should be promoted along with adapted data privacy regulation.

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11
Mar 2013
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Imaging plays major role in fight against head and neck cancers

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Watch this session on ECR Live: Monday, March 11, 08:30–10:00, Room N/O
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Organ-sparing surgery and radiation treatment such as intensity-modulated radiotherapy (IMRT) – often combined with chemotherapy – have increased the need for advanced imaging in the head and neck during pre-treament and post-treatment stages. Precision is vital as any tumour that remains undetected outside the treatment field could adversely affect the patients’ prognosis and survival, according to Professor Vincent Vandecaveye, from the department of radiology at the University Hospitals Leuven in Belgium.

It is important to spot any tumour recurrence as early as possible, especially in the post-treatment phase, in order give the patient the best possible chance of salvage treatment. The most common imaging methods in the head and neck area remain CT, MRI and PET-CT; each comes with its own advantages and disadvantages.

Multiparametric MRI for early treatment prediction of chemoradiation in oropharyngeal cancer:  Upper row is pre-treatment MRI of right base of tongue cancer (a=contrast enhanced T1 as anatomical correlate; b=native b1000 diffusion-weighted image; c= ADC-map; d=perfusion-map of IUAC). Middle row is 2 weeks during chemoradiation: same imaging sets, tumour volume will not help. No significant change in b1000, ADC nor perfusion-MRI indicate non-response and thus high risk of tumour relapse after end of treatment.  Tumour relapse at PET-CT 8 months after end of treatment, proven by histology (k). (Provided by Professor Vincent Vandecaveye)

Multiparametric MRI for early treatment prediction of chemoradiation in oropharyngeal cancer: Upper row is pre-treatment MRI of right base of tongue cancer (a=contrast enhanced T1 as anatomical correlate; b=native b1000 diffusion-weighted image; c= ADC-map; d=perfusion-map of IUAC). Middle row is 2 weeks during chemoradiation: same imaging sets, tumour volume will not help. No significant change in b1000, ADC nor perfusion-MRI indicate non-response and thus high risk of tumour relapse after end of treatment. Tumour relapse at PET-CT 8 months after end of treatment, proven by histology (k). (Provided by Professor Vincent Vandecaveye)

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10
Mar 2013
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Advances in forensic imaging bring new opportunities for radiology

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Watch this session on ECR Live: Sunday, March 10, 14:00–15:30, Room Z

The ability to spot pathological imaging findings among normal post-mortem signs of degeneration may not be a universal skill among radiologists, but it could prove to be a useful, if not essential one. As the reliability of modern forensic imaging rapidly improves, forensic pathologists are increasingly seeking the help of radiologists to examine bodies non-invasively, so they should be prepared to answer that call, according to experts who will speak in a Special Focus Session on ‘Advances in forensic imaging’ today. The development of techniques such as spiral volumetric CT and, more recently, MRI, have dramatically improved the ability of radiologists to determine causes of death and detect other crucial post-mortem signs, providing an invaluable service that can supplement, and in some cases replace, traditional autopsy.

Bone and metal maximum intensity projection (MIP) reconstruction (a) and volume-rendered (VR) 3D-CT reconstruction (b). Homicidal death: characteristic bony and metallic fragments on the exit side of the skull, where the bullet caused a large loss of brain, leading to shattering of the skull.

Bone and metal maximum intensity projection (MIP) reconstruction (a) and volume-rendered (VR) 3D-CT reconstruction (b). Homicidal death: characteristic bony and metallic fragments on the exit side of the skull, where the bullet caused a large loss of brain, leading to shattering of the skull.

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Mar 2013
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Record participation for diploma examination at ECR

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The increasingly popular European Diploma in Radiology (EDiR) attracted a record number of candidates from all over the world to the ECR. As many as 62 residents and radiologists travelled to Vienna to sit the examination, a 50% increase in participation from last year.

This rise reflects the growing quality and recognition of the diploma, according to Dr. Éamann Breatnach from Dublin, scientific director of the European Board of Radiology (EBR), which organises the examination. “People start to see that the diploma is a qualification agreed to by both the EBR and the European Society of Radiology (ESR). There is more recognition of the value of the diploma, which people see as useful for their individual career paths. Holding the diploma shows your employer that you are enthusiastic and have a good knowledge base, and ultimately you can use it to look for employment elsewhere,” he said.

Mariana Jakubowicz and Santiago Andrés from Buenos Aires, Argentina, were amongst the candidates at the European Diploma in Radiology exams which took place Wednesday to Friday during the ECR.

Mariana Jakubowicz and Santiago Andrés from Buenos Aires, Argentina, were amongst the candidates at the European Diploma in Radiology exams which took place Wednesday to Friday during the ECR.

The diploma is officially recognised by the European Union of Medical Specialists (UEMS), and its reputation extends well beyond Europe. Candidates from the Gulf countries have come in large numbers since the introduction of the diploma two years ago, and Americans are beginning to show an interest as well. Furthermore, the Argentine Society of Radiology paid for two young radiologists to take the diploma exam, and covered their travel and accommodation costs. Dr. Mariana Jakubowicz and Dr. Santiago Andrés, residents at the Deutsches Hospital in Buenos Aires, found it to be a great experience and acknowledged the quality of the examination.

“The exam really covered every aspect of general radiology. The written part was tough. There were lots of questions and little time to answer them. Cases were not the simplest. The examination was challenging because of the language, but I know the examiners take that into account. I felt more comfortable during the oral exam though and could comment on the images. Besides, the examiners were very friendly and helpful,” Andrés said.

“One difficulty is that we do things differently back home. For instance I would never do an MR examination for appendicitis but rather an ultrasound or abdominal CT scan, so I am not used to seeing this pathology on MRI. That was a bit confusing. But having a mock exam beforehand could help in this regard,” said Jakubowicz, who confirmed the huge interest among young Argentinean radiologists in working abroad.

Andrés and Jakubowicz also presented papers through EPOS™ – on mammography, usual metastatic sites in PET, whole-body PET-CT examination and on the selection of biopsy sites with PET-CT. Part of the reason why they took the exam in Vienna was so they could also attend the ECR, and diploma candidates were given free access to the congress this year. Conveniently, the examination started a day before the beginning of the ECR, to enable candidates to attend sessions afterwards. Furthermore, the examination was split over three days, sparing candidates long waiting times between the written and oral tests.

This time, diploma organisers invited a panel of observers to attend the orals, in order to train them to become examiners next year. Organisers also announced that they would include a list of recommended literature for the next examination, after candidates requested this option.

“We would like to encourage people to be familiar with the ESR publications, which include the publication on the revised training charter and curriculum, the journals European Radiology and Insights into imaging, and the case material available on Eurorad. But this list is not exclusive and we are aware that there are very good books in languages other than English, so I want to stress that point, and also insist on the European nature of this examination, which is not a language test,” Breatnach said.

In the future, organisers would like to see the diploma become accepted as equivalent to some national qualifications, and negotiations are currently underway.
The examination will also be held during the annual meeting of the Turkish Society of Radiology in November. Candidates will have the option of taking the oral test either in English or in the local language.

Success in the examination will certify a standard of radiological knowledge deemed appropriate by the ESR for independent practise in general radiology. The examination is open to radiologists and radiology residents in their fifth year of training. Examination costs are €500 for ESR full members and members in training, and €1,100 for ESR corresponding members.