ECR 2013 Rec: Muscle elastography in patients affected by multiple sclerosis #B0313 #SS510

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B-0313 Muscle elastography in patients affected by multiple sclerosis 

G. Illomei, G. Spinicci, M. Arru, M. Marrosu | Friday, March 8, 10:30 – 12:00 / Room E1

Purpose: The purpose of the study was to investigate the use of real time elastography in evaluating the muscle stiffness comparing to Ashworth scale. The aim of the study is to create an elastography score for MS patients.

Methods and Materials: We investigated 101 MS patients, 61 women and 40 men. Disability score assessed by Expanded Disability Status Score of Kurtzke scale ranged from 0 and 8.5 with a mean value of 3.5. In all patients a neurological examination was performed and referred to Ashworth scale score by a neurologist. All patients underwent real time elastography on Esaote my Lab Twice with transducer with a high frequency probe 4-13 MHz. The muscles examined were quadriceps of both legs. The study was a double-blinded one, and it was approved by local Ethic Committee.

Results: There was full concordance between the Ashworth scale evaluation and elastography score. However, patients classified as score 0 in the Ashworth scale can be spitted in 0a (total normality of muscle fibers elasticity) and 0b (initial compromising of muscle fibers elasticity). The main result of the study was the creation of an elastography score of muscle stiffness in MS patients that can be compared with Ashworth scale.

Conclusion: Ashworth scale is at present the only method to evaluate muscle stiffness in MS patients. Our study demonstrated for the first time that it is possible to have an imaging method to assess this clinical examination giving new possibilities to follow the evolving of the disease in these patients.

 

07
Jul 2013
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Introducing ‘ECR Rec’

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During and after ECR 2013, one of the questions we were asked most frequently by viewers of our online streaming service, ECR Live, was ‘where can I watch a recording of session x?’

At the time, we weren’t able to give any definite answers. We were happy that so many people were interested, just as we were delighted with the success of the project, which saw more than 1,400 lectures broadcast online in 13 separate live streams, but we didn’t have firm plans for what to do with the recordings. Now we do.

We’ve gathered together as many lectures from ECR 2013 as possible and we’ll be presenting them in a series called ‘ECR Rec’, here on the ESR blog throughout the coming months. Naturally, we wanted to make sure to obtain the speakers’ permission before including their material, so the collection only includes lectures from speakers who chose to be a part of the project, but it’s a great cross-section of the ECR 2013 programme, and we’re really proud to be able to present all of the videos completely free of charge.

You can find the first two recordings in the series here:

ECR 2013 Rec: Muscle elastography in patients affected by multiple sclerosis #B-0313 #SS510

ECR 2013 Rec: Crohn’s disease activity: correlation of inflammatory mediators with overall small-bowel motility #B-0198 #SS201a

Keep a close eye on the ESR Blog to see each recording as it’s published.

If you have any comments about the project or would like to request a particular lecture, please let us know in the comments section below.

06
Jul 2013
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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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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.

Overuse injuries in gymnasts and professional golfers

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Watch this session on ECR Live: Sunday, March 10, 08:30–10:00, Room E1

Overuse injuries due to excessive exercise are normally seen in professional athletes, but they are also becoming more frequent in amateur athletes. The Refresher Course on overuse injuries in sports will present three examples of how these injuries, caused by different sports, can be diagnosed and treated.

Gymnastic exercises, for example, are very demanding, not only on the axial but also the peripheral skeleton, and they involve strong forces due to hyperextensive and hyperflexion exercises. A certain degree of hypermobility and increased flexibility is necessary to perform some gymnastic exercises, and so training is required to improve this flexibility. Unnatural movements are sometimes necessary in order to increase this hypermobility and flexibility.

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Advanced MR imaging helps in interpretation of brain tumours

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Watch this session on ECR Live: Saturday, March 9, 16:00–17:30, Room G/H

Advanced MR imaging techniques such as perfusion and functional imaging have been a great help in improving the diagnosis and staging of brain tumours. Unlike conventional MR techniques, advanced MR techniques can be used to obtain information not only on the morphological, but also on the functional characteristics of tumours.

One of the most common types of brain tumour is glioblastoma, which is highly malignant and has a high cell reproduction rate due to the fact that it is nourished by a large network of blood vessels. According to the American Brain Tumour Association there are two types of glioblastoma: primary glioblastomas, which tend to form and make their presence known quickly by growing aggressively, and secondary glioblastomas, which are also aggressive but show slower growth and only represent 10% of all diagnoses.

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