Watch this session on ECR Live: Friday, March 8, 16:00–17:30, Room C

Osteoarthritis, a degenerative joint disease, affects a large number of people worldwide. But with the emergence of new MRI techniques, researchers believe they will be able to prevent its development in the near future. Experts will present the latest methods to assess cartilage tissue quality at a very early stage and discuss remaining challenges, in a dedicated New Horizons Session, today at the ECR.

Cartilage is composed of collagen and glycosaminoglycans (GAG), which are responsible for the biomechanical properties of cartilage tissue. An interesting way to image cartilage is to look at the amount of GAG, which decreases at the onset of tissue degeneration, a process which occurs due to ageing or an induced defect, for instance trauma or surgical intervention in the joints. If left untreated, a tissue defect can lead to osteoarthritis. GAGs are known to be among the earliest biomarkers of cartilage degeneration, and if a focal reduction in the amount of GAG can be identified, then therapy to avoid further damage can begin.

Sodium image in the axial plane of the patella shows the patellar cartilage. At the border from the medial to the lateral facet of the patella an area with decreased sodium signal-to-noise ratio (SNR) is visible which corresponds to a decreased content of glycosaminoglycan (GAG) although the cartilage thickness is preserved. This means an early stage of cartilage degeneration in this area with a focal loss of GAG.
(Provided by Prof. Siegfried Trattnig and the MR Centre of Excellence)

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Dr. Alexander Sachs, the Rising Stars representative on the ESR’s Undergraduate Education Subcommittee, talked about his numerous projects and his passion for teaching in an interview with ECR Today.

ECR Today: When did you first take part in the Rising Stars programme?
Alexander Sachs: I first took part in the Rising Stars programme in 2011. I applied to present Sono4You, an ultrasound peer-teaching student project, which I had become involved in. It was the first time I gave a presentation in front of a large audience, but I thought I would just give it a try and so I took a practical approach.

Dr. Alexander Sachs from Vienna is the Rising Stars representative on the ESR’s Undergraduate Education Subcommittee.

ECRT: It seems it paid off since you were elected best student presenter.
AS: Yes, it did have some positive effects. The year after, the ESR asked me if I wanted to coordinate the Hands-on Ultrasound Workshops at ECR 2012, which are strongly connected to the Sono4You tutorials. It was a great opportunity. It went really well and we are repeating the experience this year, with one advanced session and three basic workshops.
I like the idea of raising young people’s interest in radiology. In doing so, I am in contact with many people internationally, be they students or teachers. I really enjoy meeting people of different ages with different ideas; it is quite interesting to see what happens, how they connect, and the results of their cooperation.

ECRT: Can you please tell us about some of the new features of Rising Stars at ECR 2013?
AS: The Sono4You workshops will offer more advanced content to match the level of first-year radiology residents. Generally, the contents will be more interesting; thanks to the feedback we received last year.
Another nice development is that people have become more motivated to enrol as tutors for the peer-teaching sessions. Last year, I really had to motivate people to do so, but now it is much easier, there is a much bigger interest on their part. More students are participating in the programme every year, and I am happy to add my experience or work to this initiative.

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Watch this session on ECR Live: Thursday, March 7, 16:00–17:30, Room D2

Over the past decade, technological improvements have led to the widespread use of imaging modalities in the prediction, diagnosis and follow-up of coronary disease. Radiologists now have the ability to obtain information on the structure of cardiac muscle with MRI and evaluate cardiac arteries with CT, while hybrid imaging will soon allow them to do both. Cardiac CT will also provide more functional information in the future, and its use will continue to grow. Experts will present the newest and upcoming possibilities of cardiac imaging today at the ECR.

Advances in cardiac CT have brought its use in clinical routine to unprecedented levels. The main reason is that image acquisition optimisation strategies allow radiologists to assess blood vessels with the same efficiency as coronary angiography, non-invasively and almost instantaneously.

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With the development of functional imaging, the way patients are imaged has changed, and so has the role of the radiologist. While taking pictures in the basement of a hospital was considered good enough in the twentieth century, radiologists are now required to act as clinicians within multidisciplinary teams. Subspecialisation has become necessary for radiologists in order to keep their leading position in image interpretation. But that is not the only field where radiologists should take the lead, some experts believe. If radiologists were to increase their contribution further up in the diagnostic phase, it would have a significant impact on clinical outcomes and healthcare management. A panel of eminent radiologists will explore ways to do so during a dedicated Professional Challenges Session at ECR 2013.

Professor Andy Adam, professor of interventional radiology at the University of London, will speak about the role of the radiologist in the 21st century.

In the past, radiologists were expected to act as technicians with excellent knowledge of the anatomy. But with the creation of functional imaging, things have become more complicated. The capacity to depict and interpret functions using MRI or PET/CT scans calls for more than the ability to read images, and now thorough knowledge of functional processes and organ systems is expected of radiologists.

Meanwhile, many physicians have been increasingly working with images in recent years. For instance surgeons rely on images to prepare for an intervention, and so do radiotherapists to determine the necessary dose and precise location of a tumour to be destroyed. As their experience with reading images is growing, it is likely that these specialists will find it easier to do so without the help of radiologists in the future.

To put it in a nutshell, if radiology is to achieve its full potential, radiologists will have to make a clinical contribution as well. “If radiologists wish to retain their role as experts in image interpretation, they will not only need a thorough understanding of imaging, but also a detailed understanding of anatomy and pathophysiology, and they will need to subspecialise. That is really something we have to take into account in the future. Radiologists will have to get closer to the patient and talk to the referring physician or surgeon. They will have to become more like clinical doctors than they have been until now,” said Andy Adam, professor of interventional radiology at the University of London.

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Heart disease affects a very large number of people worldwide, and the consequences can be serious and even lethal. Here, and perhaps more than in many other areas of medicine, imaging has helped to improve treatment and prevention. It does so by detecting the disease at an early stage, sometimes even before its emergence, especially in patients at risk of ischaemic heart disease.

Today, diagnosing cardiac patients has become routine for many radiologists. However, some of them may not know of recent developments in this field and they may need to refresh their knowledge. A panel of experts will update both general and specialised radiologists with the latest information available on cardiac imaging, during the dedicated Mini Course ‘Organs from A to Z: Heart’ at ECR 2013. After an introduction to heart anatomy and the main imaging protocols, the course will focus on valvular diseases and cardiomyopathies; two pathologies commonly encountered in radiology practices.

Figure 1:
A) Example of a dilated cardiomyopathy (DCM). Cine-MR images in four-chamber view (left) and short-axis view (right) at end-diastole show significant dilatation of the LV cavity. Ejection fraction was <35% in this patient. (RA = right atrium; LA = left atrium; RV = right ventricle; LV = left ventricle)
B) Example of an asymmetrical, apical hypertrophic cardiomyopathy (HCM). Cine-MR images in a four-chamber (left) and two-chamber view (right) in systole show a markedly thickened left ventricular myocardium predominantly of the apex, as compared with the basal segments (RV = right ventricle; LV = left ventricle).

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The brain remains undoubtedly one of the most mysterious organs of the human body. Magnetic resonance imaging has helped to unveil some of its secrets, and major advances have been made in understanding how the brain functions. Recent developments with resting fMRI (rfMRI) and diffusion MRI (dMRI) indicate that scientists are beginning to see beyond the brain: they have actually started to visualise the human mind. This new information is particularly relevant for understanding complex processes such as dementia, autism and depression. It is also proving increasingly central to the diagnosis of comas and chronic disorders of consciousness.

Leading researchers will discuss where the latest advances have led them and what the future will bring in a dedicated New Horizons Session during ECR 2013. FMRI has been used for over twenty years to visualise changes in brain activity by comparing a task versus a control task, and showing and quantifying how much brain activity is involved in the process. The recent addition of rfMRI enables researchers to track networks that are randomly active. A patient lying in a scanner with no particular task to perform will usually start thinking about the trivialities of the day and go from one thought to the other (“Did I close the door before I left? What am I doing here?” etc.). Neuroresearchers can track this mind mumbling with complex mathematics and extract information from what they call the default mode network.

Fig. 1: Differences in functional connectivity from rfMRI between autistic patients and age- and gender matched controls: the major disconnection is between the cerebellum and frontal language areas.

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At ECR 2013, ‘ESR meets’ will mark Latin America’s return to the congress. After Argentina in 2010 and Brazil in 2011, Chile will be a guest of honour within the popular programme, which promotes dialogue between radiologists from all over the world. ECR delegates will be given the opportunity to learn about the latest developments in Chilean radiology and appreciate the local realities of this faraway, yet culturally similar country. The ESR spoke with Professor Miguel Ángel Pinochet, president of the Chilean Society of Radiology, ahead of the meeting.

Professor Miguel Ángel Pinochet from Santiago, president of the Chilean Society of Radiology

The Radiological Society of South Africa (RSSA) will be a guest of honour at ECR 2013, as one of the three national radiological societies participating in the ‘ESR Meets’ programme. The society, which represents radiologists from South Africa, Namibia and Botswana, is the second African radiological society to have been invited to take part in the popular programme. In a dedicated session that will hopefully begin a new area of collaboration between African and European radiologists, the RSSA’s delegation will focus on two of the biggest health issues in the region: HIV and tuberculosis.

RSSA President, Doctor Clive Wyndham Sperryn from Cape Town.

Spain, home to ECR 2013 president, Professor José Ignacio Bilbao, will be a guest of honour at the ‘ESR meets’ programme next March, at the European Congress of Radiology in Vienna. The European Society of Radiology (ESR) spoke with Professor Carmen Ayuso, president of the Spanish Society of Medical Radiology (SERAM), ahead of the session, which will focus on ischaemic stroke, aortic aneurisms and hepatocellular carcinoma imaging, as well as the general state of radiology in Spain.

Professor Carmen Ayuso from Barcelona, president of the Spanish Society of Medical Radiology (SERAM)

The European Society of Radiology (ESR): What are the latest advances and remaining challenges in ischaemic stroke imaging?
Carmen Ayuso: The latest advances in this field are the generalised use of diffusion-perfusion and perfusion CT in evaluating the penumbra area in stroke patients, and the selection of good candidates for endovascular rescue after endovascular treatment failure. The accurate measure of the real penumbra volume based on these techniques and their accurate correlation with clinical evolution remain a challenge.

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In March 2012, we met with ECR 2013 president, Professor José Ignacio Bilbao to interview him for ECR Today, the daily congress newspaper. He talked about the ECR’s scientific programme, how he plans to increase multidisciplinarity and interactivity next year, as well as his passion for architecture.

ECR 2013 congress president, Prof. José Ignacio Bilbao

ESR: What will be the main highlights of ECR 2013’s scientific programme?
José Ignacio Bilbao: We will have a categorical course devoted to the evaluation of tumour response, which is a major issue. We will focus on how to evaluate response after any kind of therapeutic treatment or palliative procedure. It is not an easy course but it has a very well balanced programme.

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