Neuroradiology (Suppl 1):S1–S1 94 Neuroradiology (2012) (2012) 54 54 (Suppl 1):S1–S109 DOI 10.1007/s00234-012-1062-4

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ESNR 2012

20th ADVANCED COURSE IN DIAGNOSTIC NEURORADIOLOGY & 4th ADVANCED COURSE IN INTERVENTIONAL NEURORADIOLOGY 20th September 2012 36th EUROPEAN SOCIETY OF NEURORADIOLOGY ANNUAL MEETING 21st – 23rd September 2012 EDINBURGH INTERNATIONAL CONFERENCE CENTRE EDINBURGH, SCOTLAND PRESIDENT Prof Robin Sellar LOCAL ORGANISING COMMITTEE Prof Robin Sellar Dr Andrew Farrall Dr Rod Gibson Annie Sellar Dr David Summers Prof Joanna Wardlaw Dr Phil White

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ESNR Presidential Address Dear Colleagues,

It is my great honor and privilege to welcome in Edinburgh all the participants of the 36th Annual Meeting of the European Society of Neuroradiology (ESNR), the 20th Advanced Course in Diagnostic Neuroradiology and the 4th Advanced Course in Interventional Neuroradiology. Edinburgh is an outstanding venue to hold our annual meeting: not only is Edinburgh a city steeped in history, but also a modern and technologically advanced metropolis, and a hub of neuroradiological diagnosis and treatment in Scotland, and far beyond. Our congress president, Prof. Robin Sellar, and his local organizing committee, are to be congratulated for putting together an attractive scientific program, including some of the finest experts in neuroradiology. The ESNR Annual Meeting and Advanced Courses constitute a unique platform, providing the best of science and education in neuroradiology, and a great opportunity for neuroradiologists and other professionals to interact and exchange ideas with their colleagues from Europe and beyond. During the past years, the European Society of Neuroradiology has gone through many changes, and it remains a daunting challenge to steer our society along the right path. Few of you will be aware that a “new” ESNR society was formed under Swiss law, to replace the “old” ESNR, which was founded in 1969 under French law. Being a society under Swiss law offers a number of administrative advantages, and gives us the advantage of political “neutrality”. In just a few years, our membership has more than tripled, and at the end of 2011, ESNR could proudly boast well over 1,000 individual members. The website, and more importantly, the underlying database structure, has been significantly upgraded so that neuroradiologists have access to up-to-date information about our society, can apply online for membership, upgrade their personal data or pay membership dues. Moreover, thanks to the amendments in our constitution (voted on December 17, 2011 during a special business meeting in Antwerp), we are now not only a society of “individual members”, but we also have “institutional members”. This membership category was created to provide representation within ESNR to neuroradiologists who are members of European National Neuroradiological Societies or, in their absence, the corresponding sections of Neuroradiology within National Societies of Radiology. Several countries have already met the criteria for institutional membership, and our goal is to unite all neuroradiologists in Europe, in order to give them an opportunity to participate in the decision-making process of ESNR. The ESNR has continued to invest time, energy and leadership in education, and this focus is embodied by the European School of Neuroradiology (ESONR). ESONR offers three levels of courses. The “first level” provides introductory courses in basic neuroradiology, the so-called Galen Foundation Courses, which are organised in conjunction with the European School of Radiology (ESOR). The “second level” is our flagship product: the Pierre Lasjaunias European Course of Neuroradiology (PL-ECNR). The 12th Cycle of the PL-ECNR will take place from 2012 to 2014, and will be co-directed by prof. T. Tali and prof. A. Gouliamos; the course venue will alternate between Turkey and Greece. Upon successful completion of the PL-ECNR, consisting of 4 course modules, participants are eligible to participate in the final examination in order to obtain the European Certification of Neuroradiology (ECONR). The “third level” consists of courses of higher qualification, including interventional, spine, pediatric, and advanced diagnostic neuroradiology. In addition to the activities organized in the setting of ESONR, we should not forget to mention the creation of joint ESNR/ASNR sessions during the annual meetings of both societies, and the Joint Meeting of ASSR and ESNR on Spine Radiology, of which the third edition will take place in Milan in 2013. The state of the European Society of Neuroradiology is strong, and getting stronger. As neuroradiologists, we should remain focused on the opportunities being placed before us. We need to keep our focus on education, in order to build recognition and demand for neuroradiologists in the healthcare system throughout Europe. During my term as president of ESNR, this has been my responsibility and my goal. I am, now more than ever, convinced that ESNR is up to the task of promoting neuroradiology in Europe. It has been a privilege to work with the officers and committee members of ESNR and I look forward, with great confidence, to handing over my presidential duties to prof. Turgut Tali, who will continue to work for our society. I am sure that he will provide outstanding leadership, and continue the process of change that we have started. I wish you all a happy and successful meeting. Long live ESNR ! ! ! Prof. dr. Paul M. Parizel ESNR President This supplement was not sponsored by outside commercial interests. It was funded entirely by the publisher

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Welcome Address On behalf of the European Society of Neuroradiology, in conjunction with the British Society of Neuroradiologists (BSNR), it is my pleasure to welcome you to the 36th Annual Congress of the European Society of Neuroradiology. The ESNR meeting is now firmly established as a world leading forum for the advancement of neuroradiology. The 36th Congress will provide parallel advanced courses in diagnostic and interventional neuroradiology on 20th September. Then the main ESNR Congress from 21st-23rd September will host world renowned keynote speakers with an emphasis on updates in key clinical areas of diagnostic and interventional neuroradiology as well as reviews of cutting edge techniques. Refresher courses will be embedded within the scientific programme. We have put together an exciting scientific programme bringing together experts in neuroradiology, with invited lecturers, symposia, workshops, proffered papers and poster presentations.

The scientific programme will include the following themes: & & & & & & & & & & &

Stroke White Matter Disease Brain Tumours and Masses Skull Base and Cranial Nerve Imaging Spine Paediatric Neuroradiology Dementia Meet the Experts Sessions Neurointervention Hot Topics Interventional Neuroradiology ○ ○ ○ ○ ○

Aneurysms AVMs Acute Stroke Dural Fistulas Spinal Vascular Disease

Edinburgh, the capital of Scotland, is a delightful city to stroll round with its magnificent castle and rambling small wynds. It has many fascinating museums and galleries. Scotland is famous for its wild and rugged countryside, its golf courses and its whisky. I am delighted to welcome you to Edinburgh for a most memorable conference. Professor Robin Sellar On behalf of the Local Organising Committee

This supplement was not sponsored by outside commercial interests. It was funded entirely by the publisher

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The European Society of Neuroradiology Board of the ESNR Executive Committee President Vice-President Past-President Secretary General Treasurer Chairman NDs Council Chair of Subspecialty Committees

Paul M. Parizel E. Turgut Tali Marco Leonardi Guido Wilms Johan Van Goethem Laurent Pierot Michael Söderman Mario Muto Andrea Rossi Alex Rovira Majda Thurnher

National Delegates Belgium Bosnia Herzegovina Bulgaria Croatia Denmark Finland France Germany Greece Hungary Italy United Kingdom

N. Sadeghi Z. Merhemic L. Penev S. Jankovic V. A. Larsen R. Vanninen L. Pierot M. Schumacher (ad I.) A. Gouliamos P. Barsi M. Muto S. Barker

Latvia Luxembourg The Netherlands Norway Poland Portugal Serbia and Montenegro Spain Sweden Switzerland Turkey

G. Krumina G. Dooms F. Barkhof P. Due-Tønnessen J. Walecki N. Canto-Moreira T. Stosic-Opincal A. Rovira R. Siemund K. O. Loevblad E. T. Tali

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Committees of the ESNR Standing Committees Technical Committees

Sub-speciality Committees

Ad Hoc Committees

Rules A. Goulão (Chair) M. Moersdorf M. Muto A. Rovira T. Tali

Diagnostic Neuroradiology M. Thurnher (Chair)

Advisory Board A. Valavanis (Chair) C. Andreula S. Bakke P. Ferro Vilela M. Gallucci P. Sundgren O. Schubiger R. Sellar

Membership P. Ferro Vilela Audit M. Sasiadek (Chair) G. Pellicanò Ch. Romanowski

Scientific Committees Publication P. Sundgren (Chair) M. Essig S. Sunaert A. Valavanis Scientific Programme L. Pierot (Chair) P. Jissendi Tchofo M. Sasiadek Scientific Award J. Wilmink (Chair) B. Appel (Co-Chair) J. Fiehler A. Rovira ESONR P. Maly Sundgren (Chair) A. Gouliamos M. Gallucci M. Muto A. Rossi A. Rovira M. Söderman E.T. Tali M. Thurner

Interventional Neuroradiology M. Söderman (Chair) Head and Neck Neuroradiology A. Rovira (Chair) Paediatric Neuroradiology E-T. Tali A. Rossi (Chair) Spine Neuroradiology M. Muto (Chair)

Liaison E-T. Tali European Exchange Programme M. Schumacher (Chair) J. Ruscalleda R. von Kummer T. Yousry Federation of Neuroradiological Societies L. Picard

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The ESNR Awards: The Founders of European Neuroradiology and The Lucien Appel Prize of the ESNR History In 2008 the ESNR Executive Committee of the ESNR decided to introduce two new scientific prizes, alongside the existing Lucien Appel Prize of the ESNR which is awarded annually to reward the achievements of young neuroradiologists. These Founders Awards have been created in honour of the founders of European neuroradiology, and are presented for the best works in diagnostic and interventional neuroradiology, respectively. The Lucien Appel Prize is now awarded for the best research work in neuroradiology.

Rules for participation Article 1: The three prizes reward the achievements of young scientists, under the age of 40 years, working in the field of neuroradiology in a European centre and having been accepted as Full or Junior Members of the ESNR. Article 2: The prizes, each to the amount of € 4000, will be awarded every year during the annual congress of the ESNR or during the Symposium Neuroradiologicum, when applicable. In addition, the prizes will include full reimbursement of the registration fees for the meeting. Article 3: The candidates must be the first author or the last author (principal investigator as evidenced by supporting publications) of an original work in the fields of research in neuroradiology, diagnostic or interventional neuroradiology, published in a scientific journal within the previous three years or still unpublished, and must not have received any other prize for the same work. Candidates are requested to include a statement to this effect in their letter of application. Article 4: All submissions must be in English and should include: & & &

an application letter the scientific work to be submitted the full Curriculum Vitae of the candidate

These can be submitted as electronic documents attached to an e-mail to the address below. Please note that each submitted article and its relevant images should be included in a separate attachment. By submitting the work the author agrees, if declared the winner, to present the

work at the next ESNR Annual Congress or Symposium Neuroradiologicum. Article 5: Multiple submissions may be entered by a single author, only when in the judgement of the Scientific Awards Committee these clearly deal with different topics. Article 6: Entries by candidates who have received ESNR Scientific Awards in previous years are not eligible for submission. Article 7: Authors are requested to indicate to which of the three awards categories each scientific paper is addressed. If the Scientific Awards Committee considers another category to be more appropriate the submission may be re-classified in consultation with the author. Article 8: A Scientific Jury will assess and rate the submitted papers. The Jury is composed of the members of the Scientific Awards Committee, plus four internationallyknown specialists in neuroradiology. Article 9: The Scientific Award Committee will designate the laureates after the assessments of the jurors have been received, as a rule by July 1st. If the Committee decides that in any category no submission meets its qualification requirements, no prize will be awarded in that category. Article 10: All candidates will be notified in writing of the results of the assessment. The laureates will be invited to give a ten-minute oral presentation at the ESNR Annual Congress or Symposium Neuroradiologicum. The names of the laureates as well as the titles and abstracts of their scientific works will be placed on the ESNR website and published in the society pages of Neuroradiology. The winning papers, if still unpublished, will be submitted for publication in "Neuroradiology”, the official ESNR journal. Article 11: All possible questions and problems regarding the awarding of the Prizes will be dealt with at the discretion of the Scientific Awards Committee and the ESNR Executive Committee. Article 12: Candidacy implies acceptance of the rules. Please send your submissions to: Prof. Guido Wilms ESNR Secretary GeneralE-mail: [email protected]

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THE DEADLINE FOR RECEIPT OF SUBMISSIONS IS MAY 1ST

Congress of the ESNR The European Society of Neuroradiology holds each year a scientific congress at a place and date designated by the Executive Committee. The business meeting (General Assembly) of the Society is held in conjunction with this annual scientific congress. Since its creation in 1969, the ESNR has organised 31 scientific congresses. In recognition of the importance of the Symposium Neuroradiologicum, which is held every four years, no scientific congress of the ESNR is held in the year of the Symposium.

Future Congresses XXXVII Congress September 19-22, 2013 Frankfurt, Germany President: Friedhelm Zanella XXXVIII Congress September 2015 Naples, Italy President: Mario Muto XXXIX Congress September 2016 Serbia President: Tatjana Stosic-Opincal

Symposium Neuroradiologicum Future Symposia XX Symposium September 7-14, 2014 Istanbul, Turkey President: E.T. Tali The European Course in Neuroradiology The European Course in Neuroradiology has been a story of success ever since the first course in Toulouse in 1984. More than 500 young neuroradiologists have completed the cycle of three courses over the past 21 years. The ECNR was conceived as a means to create a common and shared culture, common meeting points and a common standard of

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knowledge. The form that was adopted and used for the coming 6 cycles, each consisting of three courses, included the major bodies of knowledge as described by the headlines; intracranial nervous system, the spine and spinal cord and the base of the skull, maxillofacial and head and neck neuroradiology. ECNR – the new concept The ongoing work within the ESNR, through the established European Board of Neuroradiology, is focused on establishing a European certification in neuroradiology. This work will initially have to concentrate on the development of European standards of training in neuroradiology. One of the corner stones of such a program is an assessable and lasting common training program. Specialist training in Europe is officially monitored and regulated by UEMS, a Brussels based organisation of representatives for established medical specialities. UEMS defines three arms of specialist training; knowledge, competence and attitude. The mandate of UEMS can be defined as an administrative way of establishing a European certification in a medical speciality, i.e. neuroradiology. An alternative way of establishing European standards of training in neuroradiology would be using an academic way. An Academic certification can be designed as a Master of Medical Sciences with major in neuroradiology. Such programs can be established locally, e.g. in Barcelona and Stockholm. Although academic Master programs may have a very high standard of training, they do not provide any official license to practice neuroradiology in any European country. The recommendations of UEMS, as well as any Master program, include theoretical training in key subjects for a certain speciality. Acceptable theoretical training must include defined curricula as well as examinations. Furthermore, it should be possible to complete a medical speciality or a Master program in two years. Harmonisation with these rules and regulations are the very strong reasons to change the format of ECNR to include four courses given over a twoyear-cycle. It was felt that this would also be a good time to change the topics of ECNR to reflect a wider scope of neuroradiology from a standpoint of knowledge rather than that of practice. This change will increase our possibility to include anatomists, clinicians and interventionalists in the faculties. The following topics have been chosen, each to be covered in six full days of lectures and workshops: &

Anatomy, congenital malformations and genetics.

&

Trauma, Infection, Inflammation and Degenerative Disease Tumours of the Brain and Spinal Canal Vascular Disease of the Brain and Spinal Canal

& &

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Seventh Cycle - Scientific Director: Guido Wilms (Leuven) First Course Second Course Embryology, Anatomy, Malformations Tumours of the CNS Crieff, October 4 – 11, 2002 Riga, April 11 - 18, 2003 Local Director: Wendy J. Taylor Local Director: Cosma Andreula Third Course Fourth Course Vascular Disease of the CNS Trauma and Degenerative Disease of the CNS Malta, October, 24 - 30, 2003 Riga, April 23-27, 2004 Local Director: Athanassios Gouliamos Local Director: Johan Van Goethem Eighth Cycle -Scientific Director: Ernst-Wilhelm Radü First Course: Embryology/Anatomy/Malformations/Genetics Basel, October 22-26, 2004 Second Course: Tumours of the CNS - Basel, March 18-22, 2005 Third Course: Vascular Diseases of the CNS - Basel, October 21-25, 2005 Fourth Course: Trauma/Degenerative Diseases of the CNS Basel, March 10-14, 2006 Ninth Cycle - Scientific Director: Ernst-Wilhelm Radü First Course: Embryology/Anatomy/Malformations/Genetics Basel, October 20 - 24, 2006 Second Course: Tumours of the CNS - Basel, March 23 - 27, 2007 Third Course: Vascular Diseases of the CNS - Basel, November 2 - 6, 2007 Fourth Course: Trauma/Degenerative Diseases of the CNS Basel, April 11 - 15, 2008 Tenth Cycle - Scientific Directors: Massimo Gallucci, Alex Rovira First Course: Embryology/Anatomy/Malformations/Genetics Tarragona, October 10 – 14, 2008 Second Course: Tumors and Tumor-like Vascular LesionsRome, March 20 – 24, 2009 Third Course: Vascular Diseases - Tarragona, October 9-13, 2009

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Fourth Course: Trauma/Degenerative/Metabolic/Inflammatory Diseases - Rome, March 19-23, 2010 Eleventh Cycle - Scientific Directors: Massimo Gallucci, Alex Rovira First Course: Embryology/Anatomy/Malformations/Genetics Tarragona, November 5-9, 2010 Second Course: Tumors and Tumor-like Vascular LesionsRome, March 25-29, 2011 Third Course: Vascular Diseases - Tarragona, October 28 November 1, 2011 Fourth Course: Trauma/Degenerative/Metabolic/Inflammatory Diseases - Milano, April 12-16, 2012 Twelfth Cycle - Scientific Directors: Athanasios Gouliamos, E. Turgut Tali First Course: Embryology/Anatomy/Development and Malformations of the CNS - Antalya, November 1-6, 2012 Second Course: CNS Tumors - Athens, April 8 – 13, 2013 Third Course: Vascular Diseases - Antalya, October 2013 Fourth Course: Trauma/Degenerative/Metabolic/Inflammatory Diseases - Athens, April 2014 The Refresher Course of the ESNR Preceding the annual congress, a one-day long Refresher Course is offered to the members of the Society each year. This new educational activity of the ESNR, initiated in 1987, is conceived to enhance and increase the clinical and biological background of Neuroradiologists; to refresh pertinent anatomic knowledge and to update recent advances in imaging techniques and in the diagnostic management of neurological as well as head and neck diseases. Neuroradiology Neuroradiology, published by Springer Verlag, was founded as the official organ of the European Society of Neuroradiology in 1970. Since 1981, Neuroradiology is also the official organ of the Japanese Neuroradiological Society. The Founding Editors of the journal are: M.M. Schechter, New York (deceased) A. Wackenheim, Strasbourg (deceased) S. Wende, Mainz (deceased)

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Programme at a Glance Advanced Course Thursday 20th September 20th Advanced Course on Diagnostic Neuroradiology 07.30 – 18.30 Registration (Strathblane Hall) 07.30 – 18.30 Speaker Preview (Harris 1) 09.00 – 10.30 Session 1A (Fintry) 10.30 – 11.00 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 11.00 – 13.00 Session 2A (Fintry) 13.00 – 14.00 Lunch / Exhibition / Posters (Strathblane & Cromdale Halls) 14.00 – 16.00 Session 3A (Fintry) 16.00 – 16.30 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 16.30 – 17.30 Session 4A (Fintry) Thursday 20th September 4th Advanced Course on Interventional Neuroradiology 07.30 – 18.30 Registration (Strathblane Hall) 07.30 – 18.30 Speaker Preview (Harris 1) 08.00 – 09.00 Session 1B (Sidlaw) 09.00 – 11.00 Session 2B (Sidlaw) 11.00 – 11.30 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 11.30 – 13.00 Session 3B (Sidlaw) 13.00 – 14.00 Lunch / Exhibition / Posters (Strathblane & Cromdale Halls) 14.00 – 15.30 Session 4B (Sidlaw) 15.30 – 16.00 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 16.00 – 18.00 Session 5B (Sidlaw)

36th ESNR Annual Meeting Friday 21st September 07.00 – 18.30 Registration (Strathblane Hall) 07.00 – 18.30 Speaker Preview (Harris 1) 08.00 – 09.30 Refresher Course 1A (Sidlaw) 08.00 – 09.30 Refresher Course 1B (Fintry) 09.30 – 10.30 ESNR Opening Ceremony & Plenary Session 1 (Pentland Auditorium) 10.30 – 11.00 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 11.00 – 13.00 Session 1A (Sidlaw) 11.00 – 13.00 Session 1B (Fintry) 13.00 – 14.00 Lunch / Exhibition / Posters (Strathblane & Cromdale Halls) 14.00 – 15.00 Plenary Session 2 (Pentland Auditorium) 15.00 – 16.00 Parallel Session 1A (Various) 15.00 – 16.00 Parallel Session 1B (Various) 16.00 – 16.30 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 16.30 – 17.30 Parallel Session 2A (Various) 16.30 – 17.30 Parallel Session 2B (Various) 17.30 – 19.00 BSNR AGM (Sidlaw) 20.00 – 23.00 BSNR Members & ESNR Presidents Dinner (Royal College of Surgeons)

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Saturday 22nd September 07.00 – 18.30 Registration (Strathblane Hall) 07.00 – 18.30 Speaker Preview (Harris 1) 08.00 – 09.30 Refresher Course 2A (Moorfoot) 08.00 – 09.30 Refresher Course 2B (Kilsyth) 09.30 – 10.00 State of the Art Session 1A (Sidlaw) 09.30 – 10.00 State of the Art Session 1B (Fintry) 10.00 – 10.30 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 10.30 – 11.00 State of the Art Session 2A (Sidlaw) 10.30 – 11.00 State of the Art Session 2B (Fintry) 11.00 – 12.30 Parallel Session 3A (Various) 11.00 – 12.30 Parallel Session 3B (Various) 12.30 – 13.00 ESNR General Assembly (Pentland Audotorium) 13.00 – 14.00 Lunch / Exhibition / Posters (Strathblane & Cromdale Halls) 14.00 – 14.30 State of the Art Session 3A (Sidlaw) 14.00 – 14.30 State of the Art Session 3B (Fintry) 14.30 – 16.00 Parallel Session 4A (Various) 14.30 – 16.00 Parallel Session 4B (Various) 16.00 – 16.30 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 16.30 – 17.30 Quiz (Pentland Auditorium) 17.30 – 18.30 BSNR James Bull Lecture (Pentland Auditorium) 19.30 – Midnight ESNR Gala Dinner (Assembly Rooms) Sunday 23rd September 07.00 – 12.30 Registration (Strathblane Hall) 07.00 – 12.30 Speaker Preview (Harris 1) 08.00 – 09.30 Refresher Course 3A (Sidlaw) 08.00 – 09.30 Refresher Course 3B (Fintry) 09.30 – 10.00 Plenary Session 3 (Pentland Auditorium) 10.00 – 10.30 Tea / Coffee / Exhibition / Posters (Strathblane & Cromdale Halls) 10.30 – 13.00 Session 2A (Pentland Auditorium) 13.00 – 13.15 Closing Lecture & Ceremony (Pentland Auditorium)

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20th Advanced Course on Diagnostic Neuroradiology Cross Sectional: Tumour Imaging Thursday 20th September 07.30 – 18.30

Registration & Speaker Preview Open

07.30 – 19.30

Exhibition & Posters Open

09.00 – 10.30

Session 1A: Multimodality Imaging of Brain Tumours

Location Strathblane Hall & Harris 1 Strathblane & Cromdale Halls Fintry

Lecture 1a.1: Imaging Appearance and Diagnosis of Both Common and Rare Neoplasms in the CNS: How Genetics and Pathology Affect Treatment Anne Osborn, USA Lecture 1a.2: Low Grade Brain Tumours Adam Waldman, UK Lecture 1a.3: High Grade Brain Tumours Alex Rovira, Spain 10.30 – 11.00

Tea / Coffee / Exhibition / Posters

11.00 – 13.00

Session 2A: Advanced Techniques in Brain Tumour Imaging

Strathblane & Cromdale Halls Fintry

Lecture 2a.1: Applications of Advanced Neuroimaging Techniques to Brain Tumour Surgery Ian Whittle, UK Lecture 2a.2: Perfusion Weighted Imaging Paul Parizel, Belgium Lecture 2a.3: Diffusion Weighted Imaging Pia Sundgren, Sweden Lecture 2a.4: Emerging MRI Techniques for Tumour Imaging Dorathee Auer, UK 13.00 – 14.00

Lunch / Exhibition / Posters

14.00 – 16.00

Session 3A: ASNR - ESNR Combined Session Speakers TBC

16.00 – 16.30

Tea / Coffee / Exhibition / Posters

Strathblane & Cromdale Halls

16.30 – 17.30

Session 4A: Tumours of the Spine Lecture 4a.1 Tumours of the Spine Charles Romanowski, UK

Fintry

Lecture 4a.2 Treatment of Spinal Tumours Mario Muto, Italy

Strathblane & Cromdale Halls Fintry

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4th Advanced Course on Interventional Neuroradiology Acute Stroke and Spinal Vascular Disease Thursday 20th September 07.30 – 18.30

Registration & Speaker Preview Open

07.30 – 19.30

Exhibition & Posters Open

08.00 – 09.00

Session 1B: Early Riser Session Peri-therapeutic Management of Brain AVM Chair: Georges Rodesch, France

Location Strathblane Hall & Harris 1 Strathblane & Cromdale Halls Sidlaw

Lecture 1b.1 Integrative Physiology and the Genetics of Cerebral AVMs William Young, USA 09.00 – 11.00

Session 2B Chair: Serge Bracard, France

Sidlaw

Lecture 2b.1 Angiogenesis and Collaterals Their Development and Importance in Cerebral AVMs Georges Rodesch, France Lecture 2b.2 Evaluation of Cerebral AVMs. How Does Anatomical Analysis Effect Management Anton Valavanis, Switzerland Lecture 2b.3 The Role of Venous Drainage during the Evolution of a Cerebral AVMs Serge Bracard, France Lecture 2b.4 The Effect of AVMs on the Surrounding Brain Environment in Paediatrics and Adults Joti Bhattacharya, UK 11.00 – 11.30

Tea / Coffee / Posters / Exhibition

Strathblane & Cromdale Halls

11.30 – 13.00

Session 3B Chair: Michael Soderman, Sweden

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Lecture 3b.1 Advanced Structural Analysis of Cerebral AVMs Sven Haller, Switzerland Lecture 3b.2 What Does MR Analysis Tell Us About Cerebral AVM Pathophysiology? Mats Cronquist, Sweden Lecture 3b.3 Rapid Acquisition MRA/MRV for Cerebral AVM Analysis Speaker TBC

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13.00 – 14.00 14.00 – 15.30

Lunch / Exhibition / Posters Session 4B: Focus on Dural Fistula Chair: John Millar

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Strathblane & Cromdale Halls Sidlaw

Lecture 4b.1 Key Anatomical Features of Cerebral Dural Fistulas Christophe Cognard, France Lecture 4b.2 Indications, Approaches and Outcomes of Surgical Extirpation of Dural Fistulas Michael Lawton, USA Lecture 4b.3 Is There any Role for Glue Embolisation of Dural AVFs Georges Rodesch, France Lecture 4b.4 Complex Dural Fistulas Speaker TBC 15.30 – 16.00

Tea / Coffee / Exhibition / Posters

16.00 – 18.00

Focus on Risk Management and Complications of Dural Fistulas and AVMs Chair: Serge Bracard, France Lecture 5b.1 Risk Management for DAVF’s Michael Soderman, Sweden Lecture 5b.2 Complications with Case Discussions Panel: Christophe Cognard, France, Michael Lawton, USA, Robin Sellar, UK & Michael Soderman, Sweden

Strathblane & Cromdale Halls Sidlaw

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36th ESNR Annual Meeting 2012 Friday 21st September 2012 07.00 – 18.30

Registration & Speaker Preview Open

08.00 – 17.30

Exhibition & Posters Open

08.00 – 09.30

Refresher Course 1A: CNS Infection

Location Strathblane Hall & Harris 1 Cromdale & Strathblane Halls Sidlaw

Refresher Lecture 1a.1 The Changing Face of CNS Infections Anne Osborne, USA Refresher Lecture 1a.2 HIV Majda Thurner, Austria Refresher Lecture 1a.3 Spine Infection Charles Romanowski, UK 08.00 – 09.30

Refresher Course 1B: Endovascular Therapy Aneurysm – Summation of Recent Evidence

Fintry

Refresher Lecture 1b.1 Update on Evidence Base for Aneurysm Endovascular Therapy Andrew Molyneux, UK, Phillip White, UK & Anil Gholkar, UK 09.30 – 10.30

ESNR Opening Ceremony & Plenary Session 1

Pentland Auditorium

Welcome Address of the Congress President Prof. Robin Sellar Welcome Address by ESNR President and Presentation to the Honorary Members Prof. Paul Parizel Ceremony of the Awards of The ESNR Overview and a Proclamation by the President of the Awards Committee Plenary Session 1 Award Winners Presentations: Plenary Lecture 1 Dying Distally or Proximally? Imaging of Diabetic Polyneuropathy Dr Mirko Pham, Germany Plenary Lecture 2 Prevalence of MRI-defined Recent Silent Ischemia and Associated Bleeding Risk with Thrombolysis Dr Marie Tisserand, France Plenary Lecture 3 Mechanical Thrombectomy in Acute Stroke: Prospective Pilot Trial of the Solitaire FR™ Device While Under Conscious Sedation Dr Sébastien Soize, France 10.30 – 11.00

Tea / Coffee / Exhibition / Posters

11.00 – 13.00

Session 1A: Special Focus Session on Multiple Sclerosis MAGNIMS MS special section

Strathblane & Cromdale Halls

Sidlaw

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Lecture 1A.1 MRI Diagnostic Criteria in Multiple Sclerosis Alex Rovira, Spain Lecture 1A.2 Imaging of Cortical Pathology in Multiple Sclerosis Mike Wattjes, The Netherlands Lecture 1A.3 MRI as a Biomarker in Multiple Sclerosis Federik Barkhof, The Netherlands Lecture 1A.4 MS - Treatment-Related Complications Tarek Yousry, UK 11.00 – 13.00

Session 1B: Focus on Flow Diversion

Fintry

Lecture 1B.1 Flow Diverters – What Evidence Do We Have for Efficacy? Istvan Szikora, Hungary Lecture 1B.2 Flow Diverters – What do we know about Risks? Andrew Molyneux, UK Lecture 1B.3 Alternatives to Intraluminal Flow Diverters Monika Killer –Oberpfalzer, Austria Lecture 1B.4 Surgical Alternatives Have Their Place Richard Nelson, USA Lecture 1B.5 Panel Q&A with Interactive Cases Robin Sellar, UK 13.00 – 14.00 14.00 – 15.00

Lunch, Exhibition and Posters Viewing Plenary Session 2: Stroke Chair: Joanna Wardlaw, UK

Strathblane & Cromdale Halls Pentland Auditorium

Plenary Lecture 4 Perfusion - Advances in Diagnostic Imaging Methods in Stroke Max Wintermark, USA Plenary Lecture 5 Treatment of Acute Ischaemic Stroke. Systemic and Local Rudiger von Kummer, Germany 15.00 – 16.00

Parallel Session 1A: Scientific Papers 1A.1 Stroke and Cerebrovascular Disease 1 O1A-1.1 Micro-embolic Signals and Plaque Haemorrhage Independently Predict Recurrence in Patients with Carotid Artery Disease Dorothee Auer, UK

Moorfoot

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O1A-1.2 How Useful Is Routine 24 Hour CT Head Scan After Thrombolysis For Hyperacute Cerebral Infarction? Permesh Singh Dhillon, UK O1A-1.3 Reorganization of Sensorimotor Cortex in Ischemic Stroke during the Imitation of Walking: Functional Magnetic Resonance (fMRI) Study Marina Krotenkova, Russia O1A-1.4 Diffusion-weighted Imaging and MR-perfusion in Different Acute Stroke Subtypes Alexander Suslin, Russia O1A-1.5 Factors Associated with Negative MRI Scan in Minor Stroke Stephen Makin, UK O1A-1.6 Influencing Factors on Increased CT Density of Intracranial Blood Vessels Astrid Grams, Germany 15.00 – 16.00

Parallel Session 1A: Scientific Papers 1A.2 Advanced Imaging Techniques 1 O1A-2.1 [14 C]2-Deoxyglucose Autoradiography Confirms Metabolism within the Penumbra; Identified by PFC Enhanced Dynamic Lactate Metabolic MR Imaging Celestine Santosh, UK O1A-2.2 Timing Parameters from ASL and DSC-MRI Reveal Cerebral Perfusion Territory Boundaries Gerard Thompson, UK O1A-2.3 DTI-based Functional Diffusion Maps and Histogram Analysis to Evaluate Structural Changes in Cerebral Gliomas after Chemotherapy Antonella Castellano, Italy O1A-2.4 Cerebral Blood Volume Calculated by Dynamic Susceptibility Contrast-enhanced Perfusion MR Imaging: Preliminary Correlation Study with Genetic Profiles in Glioblastoma Inseon Ryoo, Republic of Korea O1A-2.5 The role of 1 H-magnetic Resonance Spectroscopy (MRS) and Volumetric Analysis in the Diagnosis of Multiple System Atrophy (MSA) Viren Kadodwala, UK

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O1A-2.6 High-resolution 3D-PSIF DWI in the Diagnosis of Cholesteatomas on 3 T MRI Takao Kodama, Japan 15.00 – 16.00

Parallel Session 1A: Scientific Papers 1A.3 Inflammatory Diseases of the Brain

Tinto

O1A-3.1 Paternal Occupation in Childhood Predicts Risk of Late-life Cerebrovascular Disease Christopher McNeil, UK O1A-3.2 Evaluation of Metabolic, Perfusion and Microstructural Cerebral Alterations in Patients with Hepatitis C Viral Infection using MR Spectroscopy, Perfusion and Diffusion Tensor Imaging Anna Zimny, Poland O1A-3.3 Impaired Physical Health Mediates the Relationship between Cerebrovascular Disease in the Basal Ganglia and Posterior Fossa and Depressive Symptoms Alison Murray, UK O1A-3.4 Brain Magnetic Resonance In Episodic Hepatic Encephalopathy Alex Rovira, Spain O1A-3.5 Multimodal Approach in Diagnosis and Monitoring of Cerebral Changes in Asymptomatic Patients with HIV Infection using MR Spectroscopy, Perfusion and Diffusion Tensor Imaging Anna Koltowska, Poland O1A-3.6 Metabolic Alterations and Atrophy of the Gray (GM) and White Matter (WM) in Patients with Clinically Isolated Syndrome (CIS):1 H MRS and MRI Volumetric Study Oleksyi Omelchenko, Ukraine O1A-3.7 MRI and Clinical Follow-up in Adult-onset Autosomal Dominant Leukodystrophy (ADLD) with Autonomic Symptoms Johannes Finnsson, Sweden 15.00 – 16.00

Parallel Session 1B: Scientific Papers 1B.1 Aneurysm 1 O1B-1.1 Update on Coil Usage from HELPS RCT Johann du Plessis, UK

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O1B-1.2 Double Lumen Remodeling Balloons Ascent and Scepter. New Far Better Tools for Balloon Assisted Coiling Technique Krzysztof Kadziolka, France O1B-1.3 Endovascular Treatment of MCA Aneurysms: Clinical and Radiological Outcomes of a Large Series Alex Mortimer, UK O1B-1.4 Endovascular Treatment of Cranial Aneurysms with the Pipeline Flow Diverting Stents: Our Initial Results Ismail Oran, Turkey O1B-1.5 Flow Diverter Stents in the Treatment of Challenging Intracranial and Extracranial Aneurysms: Experience in an Irish Institution Mark McCusker, Ireland O1B-1.6 Intra-Aneurysmal Flow Disruption: Preliminary Clinical Experience of a New Approach for the Endovascular Treatment of Intracranial Aneurysms Laurent Pierot, France 15.00 – 16.00

Parallel Session 1B: Scientific Papers 1B.2 Stroke 1 O1B-2.1 Prevalence of Anterior Internal Auditory Canal "diverticulum" on CT in Patients with Otosclerosis Christianne Hoeberigs, The Netherlands O1B-2.2 Radiochemotherapy Induced Modification of Local Tumor Blood Supply Estimated by DCE-CT and Fractal Analysis in Head and Neck Tumors Andrij Abramyuk, Germany O1B-2.3 Predictive MR Imaging Features in Vestibular Schwannoma Radiosurgery Estanislao Aranam, Spain O1B-2.4 3T in Neuroradiology, State of the Art Raffaele Agati, Italy O1B-2.5 Interacranial Dural Ectasias: Empty Meckel’s Cave, Empty Sella, Optic Nerve Ectasia, IAC Ectasia, Encefaloceles and Arachnoid Cysts. Are the Related to Dural Anomalies or Altered CSF Dynamics? Diana Quiñones-Tapia, Spain

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16.00 – 16.30 16.30 – 17.30

Tea / Coffee / Exhibition / Posters Parallel Session 2A: Scientific Papers 2A.1 Brain Tumours

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O2A-1.1 Primary Central Nervous System Lymphoma: Radiologic-pathologic Correlation A Neelakantan, UK O2A-1.2 Bimodal Histogram Analysis of Wash-in - Emax Ratio: Dynamic Contrast-enhanced Perfusion MRI Parameter in Metastatic Brain Tumor after Radiosurgery Young Jun Choi, Republic of Korea O2A-1.3 MR Perfusion and Permeability Imagings in Differentiation of True Progression from Pseudoprogression in Patients with Malignant Gliomas Kook-Jin Ahn, Republic of Korea O2A-1.4 The Importance of Co-Deletions 1p36/19q13 in Tumor Imaging Diagnosis Joana Barata Tavares, Portugal O2A-1.5 Accuracy in Detection of Pituitary Adenoma in Cushing Disease based on Preoperative 3T MRI Tomas Belsan, Czech Republic O2A-1.6 Orbital Tumors: Differential Diagnosis Using CT Perfusion Irina Schcurova, Russia 16.30 – 17.30

Parallel Session 2A: Scientific Papers 2A.2 Other Topics O2A-2.1 Pseudotumour Cerebri (PTC): A Review of the Findings on MRI Edel Kelliher, Ireland O2A-2.2 Alcoholic Cerebellar Degeneration: Not all down to Alcohol? Nigel Hoggard, UK O2A-2.3 Perfusion CT in the Differential Diagnosis Between Brain Tumors and Nonneoplastic Lesions Davide Gadda, Italy

Kilsyth

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O2A-2.4 Differentiating Glioblastoma Multiforme and Cerebral Metastases Based on Maximum 2D Axial Measurements of Tumour Core Diameter, Peri-lesional Signal Diameter and Ratio of Tumour Core Diameter to Peri-lesional Signal Diameter Richa Sinha, UK O2A-2.5 Role of Multi-tract Tractography in the Pre-surgical Selection and Planning of Eloquent Intra-axial Lesions Giuseppe Kenneth Ricciardi, Italy O2A-2.6 Usefulness of 11 C-methionin-PET in Noninvasiv Grading of Brain Tumors Bernadett Szucs, Hungary 16.30 – 17.30

Parallel Session 2B: Scientific Papers 2B.1 Aneurysm 2 O2B-1.1 & O2B-1.2 (Shared Presentation) Update on the Pragmatic Ischaemic Stroke Thrombectomy Evaluation: PISTE Trial Philip White, UK THRACE: Randomized Trial and Cost Effectiveness Evaluation on Intra-arterial Thrombectomy in Acute Ischemic Stroke Serge Bracard, France O2B-1.3 Mechanical Thrombectomy in Acute Stroke: Evaluation of the Solitaire FRTM Device while under Conscious Sedation Sébastien Soize, France O2B-1.4 Stroke Endovascular Intervention at King's Marius Poitelea, UK O2B-1.5 Talk TBC O2B-1.6 Intra-arterial Intervention for Acute Ischaemic Stroke: The Irish Experience Following Introduction of a 24/7 Thrombectomy Service Sarah Power, Ireland O2B-1.7 Endovascular Treatment of Carotid Stenosis : 103 Procedures Daehyun Hwang, Republic of Korea

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16.30 – 17.30

Parallel Session 2B: Scientific Papers 2B.2 Spine and Miscellaneous

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O2B-2.1 Spinal Ependymomas - Radiological/Pathological Correlation of Recurrence Rate and Clinical Outcome Post Resection Seamus Looby, Ireland O2B-2.2 Comparison Between Radiofrequency Targeted Vertebral Augmentation, Balloon Kyphoplasty and Vertebroplasty using high Viscosity Cement in Treatment of Vertebral Compression Fractures Bassem Georgy, USA O2B-2.3 Evaluation of Dual Energy Myelography CT after Lumbar Osteosynthesis Astrid Grams, Germany O2B-2.4 MR Imaging in Adult Spinal Cord Injury without Radiographic Abnormalities Laura Frascheri, Spain O2B-2.5 Computer-Assisted Diagnosis of Degenerative Lumbar Spine MR Imaging Estanislao Arana, Spain O2B-2.6 Vertebral Augmentation with Targeted Cement Deposition after Channels Creation using a Nitinol Wire, the "Blazer" System Bassem Georgy, USA 17.30 – 19.00 20.00 – 23.00

BSNR AGM BSNR Members and ESNR Presidents Dinner

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36th ESNR Annual Meeting 2012 Saturday 22nd September 2012 07.00 – 18.30 08.00 – 17.30 08.00 – 09.30

Registration & Speaker Preview Open Exhibition & Posters Open Refresher Course 2A: Paediatric Neuroradiology

Location Strathblane Hall & Harris 1 Cromdale & Strathblane Halls Moorfoot

Refresher Lecture 2a.1 Foetal Imaging Speaker TBC Refresher Lecture 2a.2 Paediatric Stroke Kling Chong, UK Refresher Lecture 2a.3 Multimodal Advanced Neuroimaging of Paediatric Brain Tumours Andrea Rossi, Italy 08.00 – 09.30

Refresher Course 2B: How to Tackle Unusual Aneurysms

Kilsyth

Refresher Lecture 2b.1 Giant Aneurysms Georges Rodesch, France Refresher Lecture 2b.2 Dissecting Aneurysms Isil Saatci, Turkey Refresher Lecture 2b.3 Mycotic Aneurysms Speaker TBC 09.30 – 10.00

State of the Art Session 1A Imaging the Cranial Nerves Jan Casselman, Belgium

Sidlaw

09.30 – 10.00

State of the Art Session 1B Can Computational Flow Dynamics Deliver Real Benefits to the Interventionist? Daniel Rüfenacht, Switzerland

Fintry

10.00 – 10.30 10.30 – 11.00

Tea / Coffee / Exhibition / Posters State of the Art Session 2A Small Vessel Disease Joanna Wardlaw, UK

10.30 – 11.00

State of the Art Session 2B Developing Stroke Intervention as the Primary Therapeutic Modality for Ischaemic Stroke Jan Gralla, Switzerland

11.00 – 12.30

Parallel Session 3A: Scientific Papers 3A.1 Paediatric Neuroimaging

Strathblane & Cromdale Halls Sidlaw

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O3A-1.1 Diffusion Tensor Imaging and Tractography in Joubert Syndrome: Unraveling Brain Stem Fibre Tracts Sandeep Bhuta, Australia O3A-1.2 Perfusion Parameters of Pilocytic Astrocytomas: Additional Oddities of these Tumors Matia Martucci, Italy O3A-1.3 Persisting Cerebellar Efferent Pathway Degradation Following Postoperative Cerebellar Mutism Rob Dineen, UK O3A-1.4 Ready to be Born: Fetal Neural Networks Just Before Birth Renzo Manara, Italy O3A-1.5 Venous Embryogenesis Using 3D and Angiographic Rendering at the Early Post-embryonic Stages in Human Marc Braun, France O3A-1.6 Characteristic Brain MRI Findings in Children with EAST Syndrome and Confirmed Potassium Channel KCNJ10 Recessive Mutations Roxana Gunny, UK O3A-1.7 Clippers: 3.0t MR Investigation and Role of Susceptibility Weighted Images Mario Sabato, Italy O3A-1.8 Usefulness of Ictal ElectroencephalographyFunctional MRI in Localization of Epileptogenic Area in Patients with Refractory Neocortical Focal Epilepsy Nuria Bargalló, Spain O3A-1.9 The Use of Diffusion Tensor Tractography to Analyse Changes in Large-Scale Brain Networks in Temporal Lobe Epilepsy Julie Chandra, UK 11.00 – 12.30

Parallel Session 3A: Scientific Papers 3A.2 Stroke and Cerebrovascular Disease 2 O3A-2.1 CT Angiography in Acute Ischaemic Stroke: Looking Beyond the Thrombus to Optimise Patient Outcome Jan Cunningham, Ireland

Kilsyth

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O3A-2.2 DSA-based, Dynamic 2D Whole Brain Perfusion Evaluation in Steno-occlusive Cerebrovascular Disease Zsolt Kulcsar, Switzerland O3A-2.3 Quantification of CT Perfusion Parameters and Penumbra Based on ASPECTS Ayelet Eran, Israel O3A-2.4 Computed Tomographic Angiography and Venography for Patients with Spontaneous Acute Intracerebral Haemorrhage: Report of a Clinical Series and Meta-analysis George Kwok Chu Wong, Hong Kong O3A-2.5 Comparison of Common Carotid, Internal Carotid and Vertebral Arterial Compliance in Young Healthy Controls and Elderly Subjects Measured with 3D Time of Flight MRA Robert Bert, USA O3A-2.6 CT Brain Perfusion Patterns in Acute Stroke with Atherosclerosis of Extracranial Blood Vessels Maija Radzina, Latvia O3A-2.7 Haemorrhagic Transformation in Different Ischemic Stroke Pathogenetic Subtypes: MRI Investigation Marina Krotenkova, Russia O3A-2.8 Diffusion-Weighted Imaging in TIA Patients Joanna Wardlaw, UK O3A-2.9 DWI/PWI- Combined Determinant of Endovascular Reperfusion Therapy in Acute Stroke Patients Within 4.5 Hours of Onset due to the Carotid Artery Occlusion Takahisa Mori, Japan 11.00 – 12.30

Parallel Session 3B: Scientific Papers 3B.1 Stroke 2 O3B-1.1 MRI Patterns in Natalizumab-Associated Progressive Multifocal Leukoencephalopathy (PML) in MS Patients: Updated Recommendations Tarek A. Yousry, UK

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O3B-1.2 Cognitive Deficits in Early Multiple Sclerosis Correlate with Inflammatory Hemodynamic Changes Efrosini Papadaki, Greece O3B-1.3 Baseline Brain Inflammation and its Relationship with Grey, White and Brain Volume Changes During the First Year of Natalizumab Therapy in Relapsingremitting Multiple Sclerosis Patients Alex Rovira, Spain O3B-1.4 Brain Medullary Veins Visibility with Susceptibility-Weighted MR Imaging in Clinically Isolated Syndromes and Relapsing Remitting Multiple Sclerosis Alex Rovira, Spain O3B-1.5 Grey Matter in Multiple Sclerosis Shows 'Normal Aging' Jean Lee, UK O3B-1.6 Cortical-juxtacortical Lesions in Clinically Isolated Syndromes: Distribution, and Diagnostic Value Cristina Auger, Spain O3B-1.7 Usefulness of Apparent Diffusion Coefficient Measurements Within Normal Appearing White and Grey Matter in the Differential Diagnosis of Patients with Multiple Sclerosis and Cerebral Small Vessel Disease Joanna Bladowska, Poland O3B-1.8 Brain Involvement in Alström Syndrome Valentina Citton, Italy O3B-1.9 Is the Airway Collapsibility on Sleep Cine MRI Related to Small Vessel Disease on Brain MRI in Obstructive Sleep Apnea? Hyobin Seo, Republic of Korea 11.00 – 12.30

Parallel Session 3B: Scientific Papers 3B.2 Vascular Malformations O3B-2.1 Carotid-Cavernous Fistula- The Oxford Experience Neil Rane, UK

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O3B-2.2 Interest of Using a Spherical Convex Anamorphosis for a Better Understanding of the Angio-Architecture of Brain AVMs Frédéric Clarençon, France O3B-2.3 Elaboration of a Semi-Automated Algorithm for Brain Arteriovenous Malformations Segmentation: Initial Results Frédéric Clarençon, France O3B-2.4 Nature Course and Morphological Change of Flow-related Aneurysm in Brain Arteriovenous Malformation after Radiosurgery Chao-Bao Luo, Taiwan O3B-2.5 Endovascular Treatment of Cerebral Venous Sinus Thrombosis in Children: A Case Series Alex Mortimer, UK O3B-2.6 Talk TBC O3B-2.7 MR Imaging Features of Amyloid-Related Imaging Abnormalities (ARIA) in Patients Treated with Bapineuzumab Jerome Barakos, USA O3B-2.8 An MRI Rating Scale for Amyloid-Related Imaging Abnormalities (ARIA) Frederik Barkhof, The Netherlands O3B-2.9 The Untreated Course of Cerebral Cavernous Malformations: Results from the First Prospective, Population-based Cohort Study JM Hall, UK 12.30 – 13.00

ESNR General Assembly

13.00 – 14.00

Lunch / Exhibition / Posters

Strathblane & Cromdale Halls

14.00 – 14.30

State of the Art Session 3A Imaging the Temporal Bone Jan Casselman, Belgium

Sidlaw

14.00 – 14.30

State of the Art Session 3B Device Regulation in the EU: Where Are We Headed? Speaker TBC

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Pentland Auditorium

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14.30 – 16.00

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Parallel Session 4A: Scientific Papers 4A.1 Stroke and Cerebrovascular Disease 1 O4A-1.1 Associations between White Matter Hyperintensities on Cerebral Magnetic Resonance (MR) Images, Markers of Atherosclerosis, and Cognitive Function. The Tromsø Dementia Study Marit Herder, Norway O4A-1.2 Peculiarities of the Brain Metabolism in Patients with Parkinson's Disease (PD) and Different Level of Cognitive Impairment (CI): in vivo 1H MRS study Zinayida Rozhkova, Ukraine O4A-1.3 Comparison of White Matter Abnormality in Parkinson Disease with and without Dementia: Evaluation with Diffusion Tensor Imaging and Tract-based Spatial Statistics Study Sang Joon Kim, Republic of Korea O4A-1.4 The Role of Magnetic Resonance Imaging and Computed Tomography of the Brain in First Episode of PsychosisThe Role of Magnetic Resonance Imaging and Computed Tomography of the Brain in First Episode of Psychosis Dan Connolly, UK O4A-1.5 Neuropsychological Evaluation and Conventional Brain MR Imaging - Avoiding Age Related Cognitive Decline Sofia Reimão, Portugal O4A-1.6 MRI of Brain Hematoma : What Does the "Spot Sign" Mean ? Stéphanie Condette-Auliac, France O4A-1.7 Diffusion MRI and Plaque Haemorrhage Independently Predict Recurrent Events in Patients with Carotid Artery Disease Dorothee Auer, UK O4A-1.8 Vertebrobasilar Insufficiency Syndrome Treated with Extracranial Stenting Ian Rennie, UK O4A-1.9 Morphological, Distributional, Volumetric and Intensity Characterisation of Periventricular White Matter Hyperintensities Maria Valdes Hernandez, UK

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Parallel Session 4A: Scientific Papers 4A.2 Advanced Imaging Techniques 2

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O4A-2.1 GP Rapid Access to CT Brain Imaging: Does it Increase Patient or Doctor Anxiety? Husnain Ali, UK O4A-2.2 CTA in Suspected Acute Cerebral Ischaemia Who are we Scanning? Paul Smith, UK O4A-2.3 Dynamic 4D MR Angiography Versus Time of Flight MR Angiography in the Evaluation of Cerebral Vascular Lesions Hung-Chieh Chen, Taiwan O4A-2.4 A Second Opinion by a Neuroradiologist Does it change anything? Elizabeth Ryan, Ireland O4A-2.5 Diffusion Tensor MRI Measures of the Substantia Nigra as Biomarkers in Parkinson's Disease Stefan T Schwarz, UK O4A-2.6 Acute Alcohol Ingestion Significantly Affects Resting State Networks and Induces Cerebellar Chemical Changes on MR Spectroscopy Stuart Currie, UK O4A-2.7 Intracranial Arterial Tortuosity and Ectasia in Acromegaly: An MRA Quantitative Study Joseph Gabrieli, Italy O4A-2.8 Prospective Comparison of Late 3T Magnetic Resonance Imaging with Conventional Angiography in Evaluating the Patency of Cerebral AVMs Treated with Stereotactic Radiosurgery Nader Khandanpour, UK O4A-2.9 MRI-Criteria of Brain Abscess Development in Septic Patients Aram Tonoyan, Russia 14.30 – 16.00

Parallel Session 4B: Scientific Papers 4B.1 Aneurysm 3 O4B-1.1 Blood Blister Aneurysms - Should we Leave Them Alone??! Priya Bhatnagar, UK

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O4B-1.2 Follow-up Imaging of Spontaneous Subarachnoid Haemorrhage in Patients with Negative Initial CTA and Catheter Angiography: A Review of 109 Cases Anoma Lalani Dias, UK O4B-1.3 A Protection Technique using Looping of the Microcatheter Tip During Coil Embolization of Middle Cerebral Artery Aneurysms Located at the Entry of Acutely Angulated Branches Young Dae Cho, Republic of Korea O4B-1.4 Careful Coiling of Wide Neck, Ruptured and Unruptured Intracranial Aneurysms Without Supporting Devices - A Single Center Experience Svetlana Milosevic Medenica, Serbia O4B-1.5 Long Term Follow-up Study of Aneurysm Recurrence and In-stent Stenosis Rates after Neuroform-stent Assited Treatment of Cerebral Aneurysms Zsolt Kulcsar, Switzerland O4B-1.6 Detection of True Aneurysm using High Resolution Time-of-flight Magnetic Resonance Angiograph (HR-MRA) at 3.0 Tesla: Correlation with Standard Digital Subtraction Angiography (DSA) Chul-ho Sohn, Republic of Korea O4B-1.7 Flat-detector DSA for Peri-therapeutic Quantitative Hemodynamic Measurement in Carotid Aterial Occlusive Disease Wan-Yuo Guo, Taiwan O4B-1.8 Endovascular Management of Patients with Head-and-Neck Cancers and Associated Carotid Blowout Syndrome from the External Carotid Artery: Factors Influencing the Outcome Feng-Chi Chang, Taiwan O4B-1.9 Carotid Artery Stenting: the Irish Experience Joanna Pearly-Ti, UK 14.30 – 16.00

Parallel Session 4B: Scientific Papers 4B.2 Paediatric & Miscellaneous O4B-2.1 Early White Matter Changes can Predict Late Neurodevelopmental Outcome in Neonates Suffering from Hypoxic Ischemic Encephalopathy: A Tract-based Spatial Statistics Study Lajos Rudolf Kozák, Hungary

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O4B-2.2 Role of Diffusion-Weighted Imaging in the Follow-up of Children Treated for Medulloblastoma Luc van den Hauwe, Belgium O4B-2.3 Evaluation of a Decision Support System Integrating Multiparametric MRI Data to the Radiological Phenotyping of Paediatric Posterior Fossa Tumours Stavros Stivaros, UK O4B-2.4 Pineal Germ Cell Tumors, Pre-operative Diagnosis by Clinical and Image Findings Yueh-hsun Lu, Taiwan O4B-2.5 A Novel, Clinically Distinctive Cerebrovascular Phenotype is Associated with Mutations in ACTA2 Dawn Saunders, UK O4B-2.6 ‘To Be or Not To Be?' The Relationship Between the Clinicopathological Diagnosis and Neuroimaging in the Identification of Focal Cortical Dysplasia Type IIB Roxana Gunny, UK O4B-2.7 Combining MR Diffusion Measures to Discriminate Paediatric Brain Tumours Amir Awwad, UK O4B-2.8 Comparing DCE-T1 and DSC-T2* MR Perfusion in Differentiating High from Low Grade Paediatric Brain Tumours Dorothee Auer, UK O4B-2.9 Quantitative Approach for Classification of the Malignancy Grade of the Brain Tumors in Children: DWI, DTI, and in-vivo 1H MRS Study Alex Dukhosky, Ukraine 16.00 16.30 17.00 17.30 19.30

– – – – –

16.30 17.00 17.30 18.30 00.00

Tea / Coffee / Exhibition / Posters Quiz – Brain / Spine Quiz – Head and Neck BSNR James Bull Lecture ESNR Gala Dinner

Strathblane & Cromdale Halls Pentland Auditorium Pentland Auditorium Pentland Auditorium Assembly Rooms

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36th ESNR Annual Meeting 2012 Sunday 23rd September 2012 07.00 – 12.30

Registration & Speaker Preview Open

07.30 – 12.30 08.00 – 09.30

Speaker Preview Refresher Course 3A: Degenerative Diseases of the Brain

Location Strathblane Hall & Harris 1 Harris 1 Sidlaw

Refresher Lecture 3a.1 Imaging in Parkinson's Disease Dorothee Auer, UK Refresher Lecture 3a.2 Microbleeds and Clinical Significance Hans Rolf Jaeger, UK

08.00 – 09.30

Refresher Lecture 3a.3 Imaging in Prion Diseases Robert Will, UK & David Summers, UK Refresher Course 3B: Spinal Intervention

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Refresher Lecture 3b.1 Vertebroplasty – Where are We Now? Deborah Annesley-Williams, UK Refresher Lecture 3b.2 What is the Role for Kyphoplasty and Other Advanced Spinal Augmentation Techniques Mario Muto, Itlay Refresher Lecture 3b.3 Value Imaging Prior to Spine Intervention Pia Sundgren, Sweden

09.30 – 10.00

Refresher Lecture 3b.4 New Opportunities for Treating Low Back Pain Giuseppe Bonaldi, Italy Plenary Session 3

Pentland Auditorium

Plenary Lecture 6 White Dots and Black Spots in the Brain Anne Osborn, USA 10.00 – 10.30

Tea / Coffee / Exhibition / Posters

10.30 – 13.00

Session 2A: Neuroimaging Biomarkers of Pre-Dementia Alzheimer's Disease: Organised by the Committee of the European Association of Nuclear Medicine (EANM) Chair: Flavio Nobili, Italy Lecture 2a.1 Presentation of the Symposium Flavio Nobili, Italy Lecture 2a.2 New Frontiers in Morphological and Functional MRI Wiesje Van der Flier, The Netherlands

Strathblane & Cromdale Halls Pentland Auditorium

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Lecture 2a.3 FDG PET as a Biomarker for Diagnosis, Prognosis and Outcome in AD Karl Herholz, UK Lecture 2a.4 Amyloid-PET: An Upcoming Revolution in Diagnosis of Dementia? Koen Van Laere, Belgium Lecture 2a.5 FDG-PET Versus Amyloid-PET: Antagonists or Allies? Alexander Drzezga, Germany 13.00 – 13.15

Closing Lecture & Ceremony Presentation from ESNR Annual Meeting 2013 Prizes Thank you Robin Sellar

Pentland Auditorium

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20 ADVANCED COURSE IN DIAGNOSTIC NEURORADIOLOGY

Lecture 1a.3 HIGH GRADE BRAIN TUMOURS

20TH SEPTEMBER 2012

Alex Rovira CARM, Unitat de Ressonància Magnètica, Hospital Vall d’Hebron, Spain

INVITED SPEAKER ABSTRACTS SESSION 1A: MULTIMODALITY IMAGING OF BRAIN TUMOURS Lecture 1a.1 IMAGING APPEARANCE AND DIAGNOSIS OF BOTH COMMON AND RARE NEOPLASMS IN THE CNS: HOW GENETICS AND PATHOLOGY AFFECT TREATMENT Anne Osborn Department of Radiology, University of Utah, USA Preoperative standard and advanced MR imaging techniques allow preoperative localization and identification of suspected CNS neoplasms. Understanding the gross and histopathologic appearance of CNS neoplasms provides the foundation for correct interpretation of imaging findings. In some cases genetic analysis plays the most essential role in treatment planning. This introduction and overview to the current WHO Classification of Brain Tumors illustrated with radiologic-pathologic correlations also includes new tumor entities introduced since the most recent 2007 schema. Lecture 1a.2 LOW GRADE BRAIN TUMOURS Adam Waldman The Imperial College of London, UK The management of adult diffuse low grade (WHO grade II) gliomas is challenging. They frequently present in young patients with seizures but who are otherwise well, grow slowly, but at an a unpredictable time undergo malignant transformation to high grade lesions which are rapidly fatal. The potential benefits of treatment must be balanced against the risk of morbidity, and knowledge of the risk of early malignant progression is essential to informed decisions between surveillance and early intervention in an individual patient. Conventional MRI and tissue sampling gives only limited information in this regard. The use of quantitative and physiological MRI to stratify risk, detect the early stages of malignant transformation and guide clinical management of low grade gliomas will be discussed.

High-grade gliomas are the most common central nervous system primary tumors in adults. Despite efforts to improve treatment by combination of therapies (neurosurgery, radioand chemotherapy), high-grade glioma patients still have a dismal prognosis. The therapeutic management and prognosis of these tumors depend on their type and grade, and on exact definition of boundary. MR imaging is the neuroradiological technique of choice for the diagnosis, treatment planning, and monitoring of patients with high grade gliomas. However, conventional MR techniques have limited sensitivity and specificity in the definition of tumor type, grade and extent. In recent years, a variable combination of proton MR spectroscopy (1 H-MRS), diffusion tensor imaging (DTI) and dynamic susceptibility weighted contrast-enhanced (DSC) imaging, which highlight metabolic, structural and/or functional properties of brain tumors, have been increasingly used to improve the ability to characterize these lesions and to assess treatment response. More recently dynamic contrast enhanced T1Weighted (DCE) permeability imaging has also been incorporated within the brain tumor imaging protocols, as this sequence provides valuable information about blood-brain-barrier integrity, vascular morphology, and the nature of neovascularization, as well as tumor pathophysiology and prognosis. All these advanced techniques have transformed neuroradiology of gliomas from a purely anatomy-based discipline to one that incorporates functional, hemodynamic, metabolic and cytoarchitectural information. Despite the potential value of these advanced techniques, still much work is required to validate them as biomarkers in tumor diagnosis, prognosis and treatment response, not only in clinical trials but also in clinical practice. In this lecture the biological background of these MRI techniques, their applicability and current limitations will be highlighted. SESSION 2A: ADVANCED TECHNIQUES IN BRAIN TUMOUR IMAGING Lecture 2a.1 APPLICATIONS OF ADVANCED NEUROIMAGING TECHNIQUES TO BRAIN TUMOUR SURGERY Ian Whittle Edinburgh Centre of Neuro-Oncology, West of Scotland Cancer Network, Glasgow, UK Abstract not available at time of publication

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Lecture 2a.2 PERFUSION WEIGHTED IMAGING IN BRAIN TUMOURS Parizel P.M., van den Hauwe L., De Belder F., Venstermans C., Van Goethem J., Van der Zijden T., Voormolen M., Van Hecke W. Dept. of Radiology and Neuroradiology, Antwerp University Hospital & Antwerp University, Belgium In recent years, the management of patients with brain tumours has changed significantly. Thanks to technological advances, it is now possible to perform comprehensive neuro-imaging studies that not only yield high-resolution anatomical images, but also provide an insight into tissue characteristics. Perfusion-weighted imaging (PWI) gives information regarding the microvasculature of tissues, and plays an increasingly important role in the diagnosis, treatment planning and follow-up of patients with brain tumours. PWI is performed by rapid intravenous injection of a Gd contrast agent, and following the passage of the contrast bolus over time; this technique is called “dynamic susceptibility contrast (DSC)” imaging. DSC is usually followed by a series of rapidly repeated T1-weighted images, showing progressive enhancement of the tumour; this is known as “dynamic contrast-enhanced (DCE)” T1-weighted imaging. Alternatively, PWI can be performed with arterial spin labelling (ASL), a technique in which magnetically labelled blood acts as an endogenous tracer to provide quantitative cerebral blood flow (CBF) measurements. In patients with brain tumours, PWI provides physiological information regarding the capillary microcirculation. PWI gives access to relative and/or absolute measurements of the parameters of cerebral microvascularisation, yielding parametric images of regional cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT) and capillary permeability. PWI is helpful in grading glial tumours, the idea being that the more aggressive a glioma is, the more abnormal the vasculature (with notable exceptions including pilocytic/pilomyxoid astrocytoma, oligodendroglioma, neurocytoma, and some dysembryoplastic tumours). PWI parameters can be used to predict future tumour behaviour and outcome, and may influence the decision on where to obtain a surgical biopsy. Since the

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introduction of temozolimide chemoradiotherapy, PWI with assessment of CBV and capillary permeability has been found to be of great value in distinguishing tumour progression from therapy-induced so-called pseudoprogression. Similarly, PWI significantly contributes towards differentiating radiation necrosis from recurrent tumour. PWI also plays a role in the differentiation of neoplastic from non-neoplastic mass lesions (e.g. brain abscess). In summary, PWI offers a unique insight into physiological tumour characteristics such as microvasculature and capillary permeability. The purpose of this lecture is to demonstrate the technique, advantages and limitations of PWI in routine high-end neuroradiology of brain tumours. Lecture 2a.3 DIFFUSION WEIGHTED IMAGING Pia Sundgren Head of the Department of Diagnostic Radiology, Clinical Sciences, Lund, Lund University, Lund Sweden Many brain lesions may present with similar imaging characteristics on conventional brain MRI, for example malign neoplasm and abscesses as well as cystic metastasis. Diffusion weighted imaging (DWI) have shown to be able to distinguish these entities based on diffusion characteristics and the apparent diffusion coefficient (ADC) and are commonly used today in clinical practice. In addition recent studies in patients with high grade glioma have demonstrated the use of ADC maps to show tumor recurrence; the ADC measure decrease during treatment and an increase of the ADC during therapy is suggestive of tumor progression. In addition recent studies using so called parametric response maps have demonstrated that using ADC in this setting has the possibility for predicating overall survival. Another more advanced diffusion method the diffusion tensor imaging (DTI) and tractography has shown to be very helpful for presurgical planning and is nowadays commonly used to assist the neurosurgeon in the work-up prior to surgery. New methods to look at diffusion are emerging such as diffusion kurtosis imaging (DKI) that might add additional information about the tumor and its surrounding tissue.

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In the present lecture the use and benefits with diffusion weighted imaging in tumor imaging and management and in predicting overall survival will be discussed. Lecture 2a.4 EMERGING MRI TECHNIQUES FOR TUMOUR IMAGING Dorothee Auer Arthritis Research UK Pain Centre, Nottingham, UK Functional MR imaging as a virtual biopsy tool in brain cancer: What does it offer, and what are the limitations and further development needs? Contrast enhanced MRI (CE-MRI) remains the cardinal diagnostic tool in brain cancer both in clinical practice and to assist outcome assessment in clinical trials. However, CE-MRI predominantly depicts the blood brain barrier breakdown rather than informing on cell lines, or relevant tumour biology. Thus, diagnosis of brain cancer still requires diagnostic brain surgery. Also during follow-up, CE-MRI lacks accuracy to differentiate treatment related changes, tumour response and tumour progression. This led to the definition of radiological pseudo-progression and pseudo-regression causing significant uncertainty for patient management. Hence, considerable research efforts are undertaken to develop and validate advanced MRI (diffusion, perfusion, metabolic and physiological MRI, referred to as ‘functional MRI’) as improved biomarkers in neurooncology. This presentation will summarise the current state of the art and on-going research developments of advanced MRI in adult and paediatric brain cancer. SESSION 3A: ASNR – ESNR COMBINED SESSION Abstracts not available at time of publication SESSION 4A: TUMOURS OF THE SPINE Lecture 4a.1 TUMOURS OF THE SPINE Charles Romanowski Royal Hallamshire Hospital, Sheffield, UK Tumours of the spine can be divided into extradural lesions, intradural / extramedullary lesions or intramedullary tumours.

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Extradural metastatic disease is the commonest tumour that involves the spine whilst intramedullary tumours of the spinal cord are relatively rare. This review looks at the radiological features of the different categories of spinal tumours, concentrating especially on intramedullary and intradural / extramedullary lesions. Many of the primary tumours that occur within the spine are slow growing and hence patients may present relatively late. Pain is the most frequent presentation. Motor and sensory deficits will occur corresponding to the level of involvement by the spinal cord tumour. In children pain is still the most frequent presenting symptom although abnormalities of the spinal curvatures can also occur. Astrocytomas and ependymomas are the most frequent intramedullary tumours. Haemangioblastomas may also be seen occasionally. Metastases to the cord itself are still relatively rare, but are usually associated with rapid clinical deterioration and marked oedema within the cord on imaging. Schwannomas and meningiomas are the commonest intradural / extramedullary lesions. Drop metastases spread through CSF pathways may also lie on the surface of the cord or along the roots of the cauda equina. Extradural metastatic disease to the spine is common and may present with acute cord compression or cauda equina symptoms. Many of these patients therefore require urgent evaluation. DWI may be of help in distinguishing metastatic from benign causes of collapse. Lecture 4a.2 TREATMENT OF SPINAL TUMOURS Mario Muto Antonio Cardarelli Hospital, Naples, Italy The spine can be affected by several primary or secondary tumors, with progressive osteolysis of every part of the vertebra (i.e. posterior arch, pedicles and body), causing unsustainable local pain and motor impairment secondary to vertebral collapse. The Management of spinal tumors remains complex especially for malignant lesions and it includes medical therapy (corticosteroids, chemotherapy), radiotherapy and surgical treatment and percutaneous technique with antalgic effect. Vertebroplasy can be performed in patients affected by osteolisis metastatis lesions or mixed metastasis lesions with a

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double goal: a vertebral augmentation effect increasing spinal stability when spine osteolysis occurs, with almost immediate pain resolution and mechanical stabilization of the vertebra, preventing creep deformation of the vertebral body and complication related to neural compression, and focal pain resolution related to the disease. Radiofrequency device can be performed alone or associated with vertebroplasty in order to combine an antalgic effect with a carcinolisis effect. Vertebral osteoangioma represent a frequent condition very often completely asymptomatic, sometimes can be aggressive or symptomatic with focal pain or neurological symptmos. Percutaneous embolization with vertebroplasty represent the first choice treatment to avoid vertebral collapse and to perform a venous embolization. Aneurysmal bone cist can be treated by vertebroplasy in order to restore vertebral alteration and pain relief. Symptomatic and benign lesions,as osteoma-osteoid, can be treated by percutaneous radiofrequency technique with antalgic effect.

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lacking. One of the most interesting components of the lesional phenotype is the presence of macrophage infiltration, even in the absence of prior intracranial hemorrhage, which may be in part related to a high incidence of silent leaks of RBC into the nidal tissues. Common polymorphisms in several candidate SNPs, most interestingly pro-inflammatory SNPs, interleukin-1ß and tumor necrosis factor-a are associated with arteriovenous malformation rupture. These observations suggest that even without a complete understanding of the determinants of arteriovenous malformation development, the recent discoveries of downstream derangements in vascular function and integrity may offer potential targets for development of therapy and of clinically useful biomarkers. A tantalizing concept is that familial brain AVMs in HHT serve as a Mendelian instance of the more common sporadic cases, analogous to the relationship between sporadic and inherited cerebral cavernous malformations. The recent development of mouse models of the human bAVM phenotype can provide a platform for mechanistic studies of pathogenesis and preclinical studies of potential medical therapies.

4th ADVANCED COURSE IN INTERVENTIONAL NEURORADIOLOGY 20TH SEPTEMBER 2012 INVITED SPEAKER ABSTRACTS SESSION 1B: PERI-THERAPEUTIC MANAGEMENT OF BRAIN AVM Lecture 1b.1 INTEGRATIVE PHYSIOLOGY AND THE GENETICS OF CEREBRAL AVMS William Young Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA Molecular characterization of bAVM lesional tissue implicates angiogenic (vascular endothelial growth factor, ANG-2, matrix metalloproteinase-9) and inflammatory (cytokines and chemokines) pathways, but the pathogenesis remain obscure and medical therapy is

SESSION 2B Lecture 2b.1 ANGIOGENESIS AND COLLATERALS THEIR DEVELOPMENT AND IMPORTANCE IN CEREBRAL AVMS Georges Rodesch Service de Neuroradiologie Diagnostique et Thérapeutique / Vice President of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) Hôpital FOCH 40, France Arteriovenous malformations of the central nervous system are evolutionary dynamic diseases. Time has thus to be considered when analysing such a lesion: brain AVMs may be absent and develop, or exist and regress. The congenital nature of these lesions has therefore been even questioned. This dynamic aspect is related to angiogenesis and vascular remodelling. Angiogenesis belongs to the daily life of brain

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AVMs, and includes either non sprouting or sprouting phenomena. Non sprouting angiogenesis is the creation of a new vascular wall without creation of a new vascular lumen. Angioectasia and leptomeningeal supply belong to that category. Sprouting angiogenesis consists in the budding of new vessels from pre-existing ones: angiogenesis due to clot resorbtion, or creating dural attachments, is related to that category. Ischemia may induce a mixed type of angiogenesis (sprouting and non sprouting). The angiogenic phenomena seen in brain AVMs are thus morphological answers to biological triggers or anomalies. They will contribute to constitute the angioarchitecture of the lesions, and may participate to build up their natural history. The brain being an archeological organ constituted by a paleo, archi and neopallium, and the neopallium being made of several histogenetic subunits, each of them being under the influence of specific genes, transmitters and biological factors, angiogenesis may potentially be a tailored answer of an AVM to a trigger that is specific to the location of the shunt in a given patient. Emphasized more than 30 years ago by Lasjaunias and Berenstein, updated recently by Valavanis, the concept of “host” for a brain AVM in such a patient could be influenced by the histogenetic unit in which it is embedded. Improvements in the understanding of brain AVM will therefore have to leave the current technical and morphological grounds for a proper insight into the biology of the vessel. Lecture 2b.2 EVALUATION OF CEREBRAL AVMS. HOW DOES ANATOMICAL ANALYSIS EFFECT MANAGEMENT Anton Valavanis Institute of Neuroradiology, University Hospital Zurich, Switzerland Abstract not available at time of publication Lecture 2b.3 THE ROLE OF VENOUS DRAINAGE DURING THE EVOLUTION OF A CEREBRAL AVMS Serge Bracard Neuroradiologie, Hôpital Saint Julien, France Abstract not available at time of publication

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Lecture 2b.4 THE EFFECT OF AVMS ON THE SURROUNDING BRAIN ENVIRONMENT IN PAEDIATRICS AND ADULTS Joti Bhattacharya Department of Radiology, Royal Hospital for Sick Children, Glasgow, UK Abstract not available at time of publication SESSION 3B Lecture 3b.1 ADVANCED STRUCTURAL ANALYSIS OF CEREBRAL AVMS Sven Haller Service neuro-diagnostique et neuro-interventionnel DISIM, Geneva University Hospital, Switzerland The presentation reviews standard (T1w, T2w, FLAIR) and advanced (diffusion, perfusion, functional and susceptibility weighted) magnetic resonance imaging (MRI) in the context of brain arterio-venous malformations (AVMs). Angiographic MRI sequences will be the topic of the next two sessions. The first part of the presentation discusses baseline / pretherapeutic evaluation of AVMs in MRI. Basic parameters are size of nidus, location (superficial/profound, gyral/sulcal, eloquence of region), arterial feeders and venous drainage (the latter two will be discussed in more detail in the following sessions). Additional parameters are presence of arteriovenous shunting, steal phenomenon, hemorrhage and venous congestion. The second part of the presentation will discuss follow-up imaging after intervention. Lecture 3b.2 WHAT DOES MR ANALYSIS TELL US ABOUT CEREBRAL AVM PATHOPHYSIOLOGY? Mats Cronquist Center for Medical Imaging and Physiology, Lund University Hospital, Sweden

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The mechanisms and full understanding of cerebral AVM, the various underlying causes for their clinical presentations are not yet fully understood. Haemorrhage has been proven to be more frequent in CAVM with previous bleeds, small size, associated aneurysms and deep venous drainage etc. Seizure is more associated in CAVMs with larger size, frontal location and cortical drainage. Pure focal neurological deficits are rare commonly seen in brainstem or deeply located CAVM. The rapid development in MR and CT techniques has allowed us to perform excellent imaging of CAVM including morphology, vascular architecture, cerebral perfusion and functional imaging. “Steal phenomena” has for a long time been postulated as one major cause of CAVM related symptoms but this term is controversial and still not fully proven. With an increasing number of CAVM treated by embolization the interest of alterations in hemodynamics adjacent to the AVM before and after treatment has enlarged. Few studies have been published however, recent reports has revealed perfusion impairment in the immediate perinidal environment but no particular CT or MR perfusion pattern is established in the various presentation of CAVM. We presented a retrospective analysis of MR diffusion and perfusion made immediate preand post endovascular treatment. The purpose was to gather further understanding of the patophysiology related to BAVM, its treatment and secondary complications. We suggested that venous impairment is likely a more important factor in its early presentation and treatment related complications. In this lecture I want to illustrate our experiences, complications, predictors of potential complications, and related MR patterns. I will describe how these findings have influenced our treatment strategy.

develop after cerebral venous thrombosis or any other aggression of the dura-mater (cranial trauma, tumor, surgery…). Symptoms and Neurological risks : All the symptoms are due to the arterialization of venous drainage: -sinuses: pulsatile tinnitus, intracranial hypertension, venous dementia, ophtalmic veins : exophtalmia, diplopia, decreased visual acuity, -cortical veins : neurological deficit, seizures, venous infarctions, brain hematomas Type of venous drainage is the only angiographic factor correlated with agressive neurologic behavior Classification of venous drainage: Type I: Functional symptoms only, No neurological risks Type IIa: Same symptoms but risk of intracranial hypertension (headaches, transient visual obscurations, decreased visual acuity, diplopia (VI), bilateral papilledema or optic disk atrophy). No risk of focal neurological symptoms or hemorrhage Type IIb, III, IV, V: Risk of hemorrhage - IIb 10 % - III: 40 % - IV: 80 % Type V: Drainage into perimedullary veins, Venous Hypertension of the conus medullaris, Progressive Myelopathy. Therapeutic strategy depends on the Type of venous drainage: Type I: No treatment, arterial embolization with Onyx, rarely sinus occlusion. The embolization may be performed but any therapeutic risk should be avoided due to the absence of neurological risk in Type I. The use of a balloon within the sinus can allow complete occlusion of the fistula and preservation of the sinus patency. Type II a: Due to the risk of intracranial hypertension a more aggressive treatment aiming at DAVF cure is often required. However, the sinus should not be occluded if the cortical veins are not arterialized.

Lecture 3b.3 RAPID ACQUISITION MRA/MRV FOR CEREBRAL AVM ANALYSIS

Lecture 4b.2 INDICATIONS, APPROACHES AND OUTCOMES OF SURGICAL EXTIRPATION OF DURAL FISTULAS

Speaker to be confirmed at time of publication

Michael Lawton Department of Neurological Surgery, University of California, San Francisco, USA

SESSION 4B: FOCUS ON DURAL FISTULA Lecture 4b.1 KEY ANATOMICAL FEATURES OF CEREBRAL DURAL FISTULAS Christophe Cognard Hopital Purpan, Toulouse, France INTRODUCTION Dural AV fistulas (DAVF) are arteriolo-venous shunts located within the dura-mater. They are acquired in origin and probably due to opening of physiological micro-shunts. They may

OBJECTIVE Tentorial dural arteriovenous fistulae (DAVF) are rare, have a high risk of hemorrhage, often cannot be obliterated endovascularly, and frequently require microsurgical interruption of the draining vein. We differentiated these fistulae into 6 types and developed specific operative strategies based on these types. METHODS During a 9-year period, 31 patients underwent microsurgical treatment for tentorial fistulae: 7 Galenic DAVFs, 8 straight sinus DAVFs, 3 torcular DAVFs, 3 tentorial sinus DAVFs, 8 superior petrosal sinus DAVFs, and 2 incisural DAVFs.

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RESULTS The posterior interhemispheric approach was used with Galenic DAVFs; the supracerebellar-infratentorial approach was used with straight sinus DAVFs; a torcular craniotomy was used with torcular DAVFs; the supratentorialinfraoccipital approach was used with tentorial sinus DAVFs; the extended retrosigmoid approach was used with superior petrosal sinus DAVFs; and a pterional or subtemporal approach was used with incisural DAVFs. Angiographically, 94 % of fistulae were obliterated completely. Four patients had transient neurological morbidity; none had permanent neurological morbidity; and there was no operative mortality (mean follow-up, 4.2 years). CONCLUSION Tentorial DAVFs can be differentiated based on fistula location, dural base, associated sinus, and direction of venous drainage. The operative strategy for each type is almost algorithmic, with each type having an optimum surgical approach and an optimum patient position that allows gravity to retract the brain, open subarachnoid planes, and shorten dissection times. No matter the type, the fistula is treated microsurgically by simple interruption of the draining vein. Lecture 4b.3 IS THERE ANY ROLE FOR GLUE EMBOLISATION OF DURAL AVFS Georges Rodesch Service de Neuroradiologie Diagnostique et Thérapeutique / Vice President of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) Hôpital FOCH 40, France Abstract not available at time of publication Lecture 4b.4 COMPLEX DURAL FISTULAS Speaker to be confirmed at time of publication SESSION 5B: FOCUS ON RISK MANAGEMENT AND COMPLICATIONS OF DURAL FISTULAS AND AVMS Lecture 5b.1 RISK MANAGEMENT FOR DAVF’S Michael Soderman Department of Neuroradiology, Sweden Dural arteriovenous fistule (DAVF) may cause severe bruit. In addition if cortical venous reflux is present there is also

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risk for neurological decline or death, secondary to hemorrhage or intracranial venous hypertension. Thus there is an impetus to treat. The treatment options are endovascular, surgery or radiosurgery. Many DAVF are simple to treat while others are more challenging or impossible to treat with an acceptable risk. Current data about the natural history of DAVF is limited and to some extent contradictory. We will review data and to some extent relate these to a treatment perspective. This presentation may be seen as an introduction to the following workshop about complications from DAVF treatment. Lecture 5b.2 COMPLICATIONS WITH CASE DISCUSSIONS: MANAGEMENT AND COMPLICATIONS OF INR TREATMENT FOR DURAL FISTULAS AND AVMS Christophe Cognard¹, Michael Lawton², Robin Sellar³, Michael Soderman4 ¹Hopital Purpan, Toulouse, France; ²Department of Neurological Surgery, University of California, San Francisco, USA; ³Western General Hospital, Edinburgh, UK; 4Department of Neuroradiology, Sweden This session will concentrate on cases where complications have happened in treating dural fistulas and cerebral AVMs. In managing AVMs, the importance of having a clear strategy will be stressed, whether it is to undertake targeted embolisation of risk factors such as nidal aneurysms or whether it is to attempt complete obliteration by embolisation. Complete embolisation carries the risk of haemorrhage and cases will be shown that illustrate the signs of impending rupture such as occlusion of a major draining vein and sluggish venous flow as well as indications for emergency surgical intervention. The problems of treating AVMs with en passage feeding vessels will also be covered. The complications of dural fistula management are very dependent on the site of the dural fistula. Some branches of the external carotid also supply cranial nerves and these territories need to be embolised with care. Likewise cavernous sinus fistulas are often fed by branches arising from the internal carotid - retrograde embolisation may result in major strokes. When transvenous approaches are used inappropriate occlusion of major sinuses can convert dural fistulas into higher grade fistulas with significant risk of cerebral haemorrhage or result in intracranial hypertension.

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36th ESNR ANNUAL MEETING 21st – 23rd September 2012 INVITED SPEAKER ABSTRACTS FRIDAY 21st SEPTEMBER REFRESHER COURSE 1A: CNS INFECTION Refresher Lecture 1a.1 THE CHANGING FACE OF CNS INFECTIONS Anne Osborne Department of Radiology, University of Utah, USA The rapidly changing worldwide patterns of increased travel, migration, and vector-borne illnesses together with growing numbers of surviving immunocompromised patients is also changing the imaging presentation of infectious and post-infectious disorders. This lecture will demonstrate both the typical and atypical faces of brain infection and present helpful clues that may suggest the correct diagnosis. Refresher Lecture 1a.2 HIV Majda Thurnher Department of Radiology, Medical University of Vienna, Austria Shortly after an individual becomes infected with HIV, the virus can invade the brain and persist in this organ for life. Brain and CSF contain different virus genotypes than other tissues. Systemic treatment does not necessarily prevent viral replication in the CNS. Resistant virus may reseed HIV back into the systemic circulation upon failure of therapy. Despite the potent cART some patients will continue to have an ongoing milder brain injury despite well controlled plasma viral load. Current estimates find that nearly 50 % of HIV patients demonstrate neuropsychological testing performance that is below expectations compared to age, education, gender, and ethnicity matched normative groups. The broad implementation of antiretroviral combination therapy (cART) has significantly changed the clinical course of HIV Infection. The introduction of highly active antiretroviral therapy (HAART) has changed HIV infection from a devastating and fatal disease to a chronic illness. Although eradication of the virus is still not possible, long-term suppression of viral replication is associated with immunereconstitution, a marked reduction of opportunistic diseases, and an improved quality of life. However, the restoration of the immune function may go through the phase of clinical deterioration called immune reconstitution inflammatory syndrome (IRIS). It can occur with or without

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underlying opportunistic infection. The spectrum of clinical presentation ranges from mimicking acute infection to worsening of treated underlying infection. Two possible clinical scenarios have been reported in IRIS; a) “unmasking” and b) “paradoxical”. This lecture attempts to highlight the complexities and controversies related to: the natural history, diagnosis and management of HIV infection; antiretroviral therapy and immunotherapy. Refresher Lecture 1a.3 SPINE INFECTION Charles Romanowski Royal Hallamshire Hospital, Sheffield, UK Spinal infection still causes significant morbidity. Patients with reduced immuno-competency (for whatever reason) are particularly vulnerable to spinal infection. Staphylococcus Aureus is the commonest agent to involve the spine and may result in relatively rapid progression of symptoms due to production of proteolytic enzymes that destroy normal tissue barriers. Tuberculosis however remains a significant cause of spinal infection. Other groups of organisms including viral infections, fungal infections as well as parasitic infections do occur but these are far less common. The imaging modality of choice in these patients with spinal infection is MRI. This allows demonstration of the anatomy in multiple plains and allows spread of infection into different compartments to be most accurately detected. This review will discuss the role of imaging in patients with spinal infection, with emphasis particularly on role of MR imaging. REFRESHER COURSE 1B: ENDOVASCULAR THERAPY ANEURYSM – SUMMATION OF RECENT EVIDENCE Refresher Lecture 1b.1 UPDATE ON EVIDENCE BASE FOR ANEURYSM ENDOVASCULAR THERAPY Andrew Molyneux¹, Phil White², Anil Gholkar³ ¹Oxford Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, UK; ²Western General Hospital, Edinburgh, UK; ³Regional Neurosciences Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK The objective of this presentation is to review the latest evidence from randomised clinical trials of endovascular coil treatment of cerebral aneurysms, in respect of the both clinical outcomes and the risk of delayed re-bleeding and where possible comparing it with the results of neurosurgical clipping. The talk will highlight the difficulties and challenges of conducting rigorous clinical trials, in respect of both ruptured and

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unruptured aneurysms. It will review some of the reasons behind the failure of the Trial of Endovascular aneurysms management (TEAM), a randomized trial of unruptured cerebral aneurysm treatment, which was stopped prematurely. It will examine the shortcomings and the strengths of randomised clinical trials compared with other types of studies. Based on the most recent published data for patients with ruptured cerebral aneurysms suitable for coiling there is overwhelming evidence of improved clinical outcomes in coiled patients at follow up compared with neurosurgical clipping. The remains considerable uncertainty concerning the best management for small incidental unruptured cerebral aneurysms. The role of Flow Diverters in the treatment of cerebral aneurysms which can be treated by standard or stent assisted coiling is uncertain at the present time and will be reviewed. References: 1. A randomised controlled trial of hydrocoil versus bare platinum in the endovascular treatment of intracranial aneurysms- the Hydrocoil Endovascular aneurysm occlusion and Packing Study (HELPS) trial. White PM1, Lewis SC2, Gholkar A3, Sellar RJ1, Nahser H4, Cognard C5, Forrester L1, Wardlaw JM1,6 for the HELPS trial collaboration. Lancet May 2011 377 1657. 2. Cerecyte Coil Trial American Journal of Neuroradiology online: December 2011 3. Barrow Ruptured Aneurysm Trial Journal of Neurosurgery on line: January 2012

P L E N A RY S E S S I O N 1 : AWA R D W I N N E R S PRESENTATIONS Plenary Lecture 1 DYING DISTALLY OR PROXIMALLY? IMAGING OF DIABETIC POLYNEUROPATHY Mirko Pham Heidelberg University Hospital, Heidelberg, Germany Plenary Lecture 2 PREVALENCE OF MRI-DEFINED RECENT SILENT ISCHEMIA AND ASSOCIATED BLEEDING RISK WITH THROMBOLYSIS Marie Tisserand Neuroradiology Department Nancy France, Nancy, France Plenary Lecture 3 MECHANICAL THROMBECTOMY IN ACUTE STROKE: PROSPECTIVE PILOT TRIAL OF THE S O L I TA I R E F R ™ D E V I C E W H I L E U N D E R CONSCIOUS SEDATION Sébastien Soize Hopital Maison Blanche, Reims, France

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SESSION 1A: SPECIAL FOCUS SESSION ON MULTIPLE SCLEROSIS (MAGNIMS MS SPECIAL SECTION) Lecture 1a.1 MRI DIAGNOSTIC CRITERIA IN MULTIPLE SCLEROSIS Alex Rovira Hospital Universitari Vall d’Hebron, Barcelona– Spain The exact diagnosis of multiple sclerosis (MS) still remains challenging in some cases, as there is no single test can that can provide a definite diagnosis of this disease. The introduction of expensive and not completely free from side effects of different disease modifying treatments that reduce the number and severity of clinical relapses an may slow progression of disability, particularly when administered during the early phases of the disease, makes the accuracy of an early diagnosis more imperative than ever. Diagnostic criteria for MS include clinical and paraclinical assessments emphasizing the need to demonstrate demyelinating lesions within the central nervous system (CNS) lesions disseminated in space (DIS) and time (DIT), and to exclude alternative diagnosis that could mimic MS. Although the diagnosis can be made on clinical grounds alone, MRI is usually required to support the clinical diagnosis and in a significant proportion of patients can even replace some clinical criteria. This possibility was included in the McDonald 2001 criteria that integrated MRI features in the diagnostic scheme, allowing an earlier and more accurate diagnosis of the disease. However, both the initial version of the McDonald criteria and the revised version published in 2005, received some criticism such as being too complicated for demonstration DIS and DIT, too difficult to remember, and too restrictive for both DIS/DIT. Recently, the International Panel presented the 2010 revisions to the McDonald criteria for diagnosis of MS based on new evidences that while maintaining the good specificity of the previous versions, have increased the sensitivity and simplified the criteria for both DIS and DIT. With this new version a diagnosis of MS can be established with one single MR obtained at any time after symptoms onset, allowing a very early and relatively accurate diagnosis. Nevertheless, we should keep in mind that for optimal application of these MRI criteria, scans must be technically adequate and neuroradiologist must consider the clinical information to properly interpret the imaging findings, and be expert enough to recognize the full range of brain and spinal cord abnormalities that suggest the diagnosis of MS, as several other disorders can cause white matter lesions with imaging characteristics similar to those seen in MS. References: &

Montalban X, Tintoré M, Swanton J, et al. MRI criteria for MS in patients with clinically isolated syndromes.Neurology. 2010;74:427-34.

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Swanton JK, Rovira A, Tintore M, et al. MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study. Lancet Neurol. 2007;6:677-86 Rovira A, Swanton J, Tintoré M, et al. A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. Arch Neurol. 2009;66:587-92. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 201;69:292-302.

Lecture 1a.2 IMAGING OF CORTICAL PATHOLOGY IN MULTIPLE SCLEROSIS Mike Wattjes VU University Medical Centre, Amsterdam – The Netherlands Multiple sclerosis (MS) has been considered as a white matter inflammatory demyelinating disease, which is still reflected by current imaging and clinical diagnostic criteria. Driven by new immunehistochemical methods and advances in MRI it is increasingly recognized that MS is also a gray matter disease. Imaging of gray matter pathology is crucial since gray matter lesions are highly associated with clinical outcome measures and prognosis of patients with clinically isolated syndromes and early MS. Imaging of gray matter pathology includes an multimodality approach considering the detection of focal gray matter lesions, atrophy, magnetization transfer imaging, diffusion tensor imaging, MR spectroscopy, tissue relaxation time measurements and functional MRI. Particularly, regarding the detection of focal gray matter lesions, new MRI techniques such as high field MRI and the application of dedicated pulse sequences (double inversion recovery, T1-weighted 3D spoiled gradient recalled echo, phase-sensitive inversion recovery) have substantially improved the sensitivity in the detection of gray matter lesions. However, using these newer techniques the sensitivity is still not optimal and it is believed that we are imaging the tip of the iceberg. In addition, the scoring and interpretation of gray matter lesions on MRI is sophisticated and has not been finally standardized. Further advances in the understanding of imaging features of gray matter lesions are needed for the inclusion of focal gray matter lesion as an outcome measure in clinical treatment trials. References: & & &

Hulst HE, Geurts JJ. Gray matter imaging in multiple sclerosis: what have we learned? BMC Neurol 2011; 11:153 Filippi M, Rocca MA, Barkhof F, et al. Association between pathological and MRI findings in multiple sclerosis. Lancet Neurol 2012; 11: 349-360. Geurts JJ, Roosendaal SD, Calabrese M, et al. Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology 2011; 76; 418-424.

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Calabrese M, Battaglini M, Giorgo A, et al. Imaging distribution and frequency of cortical lesions in patients with multiple sclerosis. Neurology 2010; 75: 1234-40. Filippi M, Rocca MA, Calabrese M, et al. Intracortical lesions±relevance for new MRI diagnostic criteria for multiple sclerosis. Neurology 2010; 75: 1988-94.

Lecture 1a.3 MRI AS A BIOMARKER IN MULTIPLE SCLEROSIS Federik Barkhof VU University Medical Centre, Amsterdam – The Netherlands Over the past 15 years, MRI lesion activity has become the accepted surrogate primary outcome measure in proof-ofconcept placebo-controlled clinical trials of new immunomodulating therapies in relapse-onset multiple sclerosis (MS). In parallel, the number of patients that are available for the placebo arm of trials has declined, and more-aggressive drugs are being developed. This warrants a critical review to ensure efficient MRI —and patient—resource utilization. Recently, an international panel reviewed the methodology for efficient use of MRImonitored trials in relapse-onset MS. The MAGNIMS group, in collaboration with North-American experts provided up-to-date recommendations for scan acquisition, image analysis, outcomemeasure definition and standards of reporting. Factors to consider for optimizing trial design, such as outcome measure selection and the unique requirements of phase II and phase III trials, including active-comparator studies, are outlined. Important new issues concern safety considerations in the use of MRI in MS trials, and the safety-related responsibilities of the various parties involved in conducting such trials. For individual patients, it is much harder to make strong recommendation, but ongoing MRI activity (>2 new T2 lesions /year) under treatment is indicative of suboptimal treatment response, and the same applies to ongoing features of neurodegeneration, such as cerebral atrophy. Since safety monitoring is also increasingly required, follow-up MRI under treatment is becoming more common practice in MS. References: & &

Barkhof F, Simon JH, Fazekas F, et al. MRI monitoring of immunomodulation in relapse-onset multiple sclerosis trials. Nat Rev Neurol. 2011;8:13-21 Barkhof, F. Filippi, M. MRI—the perfect surrogate marker for multiple sclerosis? Nat. Rev. Neurol. 2009; 5, 182-183.

Lecture 1a.4 MS - TREATMENT-RELATED COMPLICATIONS Tarek Yousry UCL Institute of Neurology, London, United Kingdom Natalizumab is an effective treatment for patients with multiple sclerosis (MS) that is associated with a small but severe

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risk of progressive multifocal leukoencephalopathy (PML). The magnetic resonance imaging (MRI) diagnosis of PML in natalizumab treated MS patients is as important as it can be challenging especially in the early phases of the disease. Recommendations were published in 2006 to improve early diagnosis of PML using MR. However, due to the small number of MS patients initially diagnosed with PML, the imaging criteria could only be derived from PML lesions in patients with human immunodeficiency virus (HIV). More data, derived from natalizumab treated MS patients is now available. We will review this data, focusing on the characteristics of PML in its early pre-symptomatic and clinical phase as well as those of IRIS-PML. PML lesions are typically hypointense on T1 and hyperintense on T2, FLAIR and DWI sequences. In the presymptomatic phase, attention to the subcortical location is critical. The MR features of PMLIRIS are quite similar, with more widespread involvement of the brain and the identification of T1 hyperintenseities. In summary, awareness, vigilance and the knowledge of the typical clinical features of PML are central to making the correct diagnosis. References: & &

Yousry TA, Major EO, Ryschkewitsch C, et al. Evaluation of patients treated with natalizumab for progressive multifocal leukoencephalopathy. N Engl J Med 2006;354:924–933. Bag AK, Cure JK, Chapman PR, Roberson GH, Shah R. JC virus infection of the brain. AJNR Am J Neuroradiol 2010;31:1564–1576.

SESSION 1B: FOCUS ON FLOW DIVERSION Lecture 1b.1 FLOW DIVERTERS – WHAT EVIDENCE DO WE HAVE FOR EFFICACY? Istvan Szikora, Berentei Zs, Marosfői M, Gubucz I National Institute of Neurosciences, Budapest, Hungary PURPOSE to analyze existing literature in lieu of our own experience regarding efficacy of flow diversion for the treatment of intracranial aneurysms. METHODS AND MATERIALS Data from two prospective single arm multicenter clinical trials, one registry, a multicenter data survey and 7 single center reports were analyzed and compared to the single center experience of the authors. RESULTS The rate of complete occlusion at 6 months ranged from 84-93 % in trials. In one trial (PUFS) 97 % of aneurysms with complete occlusion remained occluded at one

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year. A registry demonstrated complete occlusion in 49 % of all aneurysms at different time points up to 6 months post procedure. Single center case series reported a rate of complete occlusion ranging from 5294 % at 6 months and in one series 95 % at one year. According to a multicenter data survey this was associated with a 6.7 % rate of periprocedural thromboembolic and 1.8 % hemorrhagic complications. Clinical outcome was further complicated by a 0.7 % rate of delayed aneurysm rupture and 1 % delayed parenchymal hemorrhages. Delayed rupture affected only large and giant aneurysms having an incidence of 2.1 % among those lesions. Our own experience of 99 aneurysms in 84 patients demonstrates complete angiographic occlusion in 84 % at 6 months and 1 year and 100 % at three years in 15 patients. MRI confirmed disappearance of the aneurysm in 20 out of 21 cases at 12 months. This resulted in improvement of vision in 7 out of 10 cases and elimination or improvement double vision in 12 out of 13 cases. Thromboembolic complications occurred in 6 % and hemorrhagic events in 3 % resulting in 4 % permanent morbidity and 3 % mortality. CONCLUSION Existing data suggests that flow diversion provides significantly higher rate of complete occlusion at short and mid-term as compared to coil packing for large and broad neck aneurysms. This treatment if highly efficacious in eliminating compression symptoms but seems to be ineffective in preventing from aneurysm rupture in about 2 % of large and giant aneurysms. Lecture 1b.2 FLOW DIVERTERS – WHAT DO WE KNOW ABOUT RISKS? Andrew Molyneux Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, University Oxford. On behalf of the UK Neurointerventional Group (UKNG). Review of the data from the U.K. Flow diverter registry Introduction: The objective of this presentation is to review the latest data from the UK Flow Diverter registry which seeks to capture all cases performed in the UK. METHODS A central registry of Flow diverter cases has been established by the UKNG to collect all cases of Flow Diverters used in the UK to treat cerebral aneurysms. The data have been collected retrospectively from the introduction and prospectively from the start of the formal registry in January 2011. We attempt to obtain details of devices used from the manufacturers to ensure as complete ascertainment of cases as possible. The collection of such data in this National registry

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is a requirement of the UK National Institute of Clinical Excellence (NICE) for treatment of patients with Pipeline devices and it is strongly encouraged for all similar devices by the UK Medicine and Healthcare Regulatory Agency (MHRA) and the UKNG RESULTS More than 200 patients have been entered into the registry. The key findings available to date will be presented: The baseline characteristics of the patients and aneurysms selected for treatment. The procedural complication rates, in particular the risk of procedural or immediate post procedural haemorrhage, the risk of thrombo-embolic complications and the rate of post procedural neurological complications and parent vessel occlusion. The discharge and 30 day mortality and morbidity associated with the procedure. The efficacy of treatment in respect of reported aneurysm occlusion rates at the time of the procedure, at follow-up and the risk of late complications, including the frequency and timing of delayed aneurysm rupture. CONCLUSIONS The UK registry will provide invaluable information in respect of the safety and efficacy of Flow Diverters in the setting of widespread clinical practice. The registry will provide more reliable evidence of the risks and benefit of these devices and help to define their role in the management of patients with cerebral aneurysm than the published individual cases series with their inevitable risks of bias. Lecture 1b.3 ALTERNATIVES TO INTRALUMINAL FLOW DIVERTERS Monika Killer –Oberpfalzer Research Institute of Neurointervention / Department of Neurology, Paracelsus Medical University Salzburg, Austria Intraluminal flow diverters have shown, in preclinical studies and in early clinical reports, the ability to achieve complete occlusion in a high proportion of aneurysms. Excellent occlusion rates after flow-diverter therapy are seen even in large and giant aneurysms, which normally show recanalization rates of ?50 % after coil embolization. But, important shortcomings are in discussion and limit widespread application of these intraluminal flowdiverters. Dual antiplatelet therapy limits the use in especially unruptured aneurysms, given the risk of hemorrhagic complications if patients require external ventricular drainage. Use of these endoluminal devices is further limited in ruptured aneurysms because closure of the aneurysm is delayed by weeks or months after implantation, such that an acutely ruptured aneurysm would not be adequately protected in the short term.

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The WEB or the LUNA device is an intrasaccular ellipsoid braided-wire embolization device designed to provide flow disruption along the aneurysm neck. The the acute and chronic performance of the WEB device regarding immediacy, degree, and durability of aneurysm occlusion will be discussed. Lecture 1b.4 SURGICAL ALTERNATIVES HAVE THEIR PLACE Richard Nelson Frenchay Hospital, Bristol, UK Abstract not available at time of publication Lecture 1b.5 PANEL Q&A WITH INTERACTIVE CASES Robin Sellar Western General Hospital, Edinburgh, UK Abstract not available at time of publication PLENARY SESSION 2: STROKE Plenary Lecture 4 PERFUSION - ADVANCES IN DIAGNOSTIC IMAGING METHODS IN STROKE Max Wintermark Neuroradiology Department, University of Virginia, Virginia, USA With the advances in terms of perfusion imaging, the “time is brain” approach used for acute reperfusion therapy in ischemic stroke patients is slowly being replaced by a “penumbra is brain” or “imaging is brain” approach. But the concept of penumbra-guided reperfusion therapy has not been validated. The lack of standardization in penumbral imaging is one of the main contributing factors for this absence of validation. This article reviews the issues underlying the lack of standardization of perfusion-CT for penumbra imaging, and offers avenues to remedy this situation.With the advances in terms of perfusion imaging, the “time is brain” approach used for acute reperfusion therapy in ischemic stroke patients is slowly being replaced by a “penumbra is brain” or “imaging is brain” approach. But the concept of penumbra-guided reperfusion therapy has not been validated. The lack of standardization in penumbral imaging is one of the main contributing factors for this absence of validation. In my presentation, I will review the issues underlying the lack of standardization of perfusion-CT for penumbra imaging, and offers avenues to remedy this situation.

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Plenary Lecture 5 TREATMENT OF ACUTE ISCHAEMIC STROKE. SYSTEMIC AND LOCAL Rudiger von Kummer Department of Neuroradiology, University Hospital Car Gustav Carus, Germany In acute ischemic stroke, treatment delivery approach is still disputed. Many favor prompt treatment with IV rtPA after exclusion of intracranial hemorrhage with non-enhanced CT. They argue that the search for a more specific treatment with advanced brain imaging studies consumes the time period in which reperfusion therapy is beneficial. Intravenous rtPA has enhanced the proportion of patients without disabling stroke in 2 randomized controlled trials (RCT) by absolute 13 % and 7 %, an effect that disappeared within the first 6 hours of stroke onset. This effect was 15 % in an RCT with IA proUrokinase. Patients with MCA occlusions being treated with IA urokinase in Bern within 6 hours of stroke onset had more frequently (29 %) a favorable clinical outcome than patients being treated with IV rtPA within 3 hours (13 %). A similar effect showed the combined IV-IA treatment with rtPA compared to a historical control group treated with IV rtPA only. Although the results of RCT directly comparing IV vs. IA treatment are not yet available, there is increasing evidence that arterial recanalization and brain tissue reperfusion are the key factors enabling good clinical outcome after ischemic stroke. It was shown that the probability of good clinical outcome is more than 70 %, if angiographic reperfusion is achieved within 4 hours of stroke onset and declining thereafter. Many stroke patients may have better chances to benefit from advanced diagnostics and tailored treatment than from IV rtPA. We should provide the chances. SATURDAY 22nd SEPTEMBER REFRESHER COURSE 2A: PAEDIATRIC NEURORADIOLOGY Refresher Lecture 2a.1 FOETAL IMAGING Speaker to be confirmed at time of publication Refresher Lecture 2a.2 PAEDIATRIC STROKE Kling Chong Great Ormond Street Hospital for Children, Institute of Child Health, London

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Stroke is a clinical diagnosis, but radiology is now required for the initial diagnosis and on subsequent follow-up. Peer reviewed evidence-based clinical guidelines for the diagnosis and management of Stroke in Childhood have been published 1. Diagnostic definitions and imaging recommendations from the International Pediatric Stroke Study Group (IPSS) are available5 The risk factors and variety of underlying pathologies & aetiologies are very different from adult stroke. A large proportion have multiple pathologies and risk factors that act synergistically to result in stroke. Diagnostic imaging strategies need to be tailored accordingly. For the acute diagnosis of arterial ischaemic stroke in childhood, cross-sectional brain imaging is mandatory. Brain MRI should be undertaken as soon as possible, with CT as an acceptable initial alternative, if MRI is not available in the first 48 hrs. Supportive investigations for cause of stroke, and for use with the diagnostic definitions of disease subtypes, include imaging of the entire intra- and extra-cranial cerebral vasculature and echocardiography. This should be undertaken within 48 hours of presentation of arterial ischaemic stroke. The use of thrombolytic agents in children is not recommended unless part of an ongoing study. However, diagnostic imaging is used to guide the use of aspirin, anticoagulation and other therapeutic interventions. References: 1. Management of stroke in infants and children: a scientific statement from a special writing group of the American Heart Association Stroke Council and the Council of Cardiovascular Disease in the Young. Roach ES, Golomb M, Adams R et al. Stroke 39, 2644-2691 (2008)1. 2. Investigation of risk factors in children with arterial ischaemic stroke. Ganesan V, Pregler M, McShane, et al, Annals of Neurology 53:167-173 (2003) 3. Conventional cerebral angiography in children with ischaemic stroke. Ganesan V, Savvy L, Chong WK, et al, Pediatric Neurology 20: 38-42 (1999) 4. Knowledge of Consequences: Understanding Stroke in Children. Roach ES, deVeber GA & Kirkham FJ. J Child Neurol 15: 277-278 (May 2000) 5. Toward the definition of cerebral arteriopathies of childhood. Sébire G, Fullerton H, Riou E & deVeber G. Curr Opin Pediatr 16:617–622; (2004) Refresher Lecture 2a.3 MULTIMODAL ADVANCED NEUROIMAGING OF PAEDIATRIC BRAIN TUMOURS Andrea Rossi Neuroradiology Department, Gaslini Children’s Hospital, Italy

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While magnetic resonance imaging (MRI) has been instrumental in significantly improving patient care in children harbouring brain tumours, conventional sequences lack information regarding functional parameters including cellularity, haemodynamics, and metabolism. Advanced MR imaging modalities, such as diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), perfusionweighted imaging (PWI), and magnetic resonance spectroscopy (MRS) have significantly improved our understanding of the physiopathology of brain tumours and have provided invaluable additional information for treatment planning and monitoring of treatment results. The most important application of DWI is the estimation of cellularity, which is a function of tumour grading; in general, ADC values are inversely correlated with tumour grade. DTI and fibre tractography are important tools for preoperative mapping of brain tumours including the identification of relationship to functional areas such as major fibre tracts. The principal application of PWI to paediatric brain tumour imaging is in the field of preoperative tumour grading, as a complementary tool to DWI; the average perfusion of high grade lesions is significantly higher than that of low-grade neoplasms. Other important uses of PWI include targeting biopsy to areas of likely higher grade, and the differentiation of focal radiation necrosis from residual/recurrent tumour. MRS also provides insight into tumour grading, with the assumption that choline/N-acetylaspartate ratios increase with grade as a function membrane turnover and neuronal replacement, and may show peculiar metabolites that may refine the diagnostic accuracy. REFRESHER COURSE 2B: HOW TO TACKLE UNUSUAL ANEURYSMS Refresher Lecture 2b.1 GIANT ANEURYSMS Georges Rodesch Service de Neuroradiologie Diagnostique et Thérapeutique / Vice President of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) Hôpital FOCH 40, France Abstract not available at time of publication Refresher Lecture 2b.2 DISSECTING ANEURYSMS Isil Saatci Radiology Department, Hacettepe University Hospital, Turkey

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Treatment of dissecting aneurysms are often challenging. In many situations, surgical treatment is not an option and endovascular techniques are considered. Endovascular options include parent artery occlusion, endosaccular treatments, enforcement of the parent artery with the use of single or multiple stents. In the recent years, flow diverters have started to provide a solution for such lesions. However, necessity of double anti-platelet agent use before and after the endovascular treatment of dissecting aneurysms has its inherent risks i.e. being on anti-platelet drugs when the aneurysm is not yet secured. In this presentation endovascular therapeutic options for dissecting aneurysms with their pros and cons will be discussed with examples. Refresher Lecture 2b.3 MYCOTIC ANEURYSMS Speaker to be confirmed at time of publication STATE OF THE ART SESSION 1A IMAGING THE CRANIAL NERVES J. W. Casselman1,2,3, J. Delanote1 Department of Radiology AZ St-Jan Brugge AV, Brugge, Belgium1 ;University of Ghent, Gent, Belgium2; Department of Radiology4 & Otorhinolaryngology5 St- Augustinus, Wilrijk, Belgium3 The oculomotor (III), trochlear (IV) and abducent (VI) nerves supply motor fibers to the extraocular muscles of the globe and levator muscle of the eyelid. The third nerve also supplies parasympathetic pupillomotor fibers to the ciliary ganglion. Lesions of the oculomotor nerves can affect their nucleus, fascicular segment, cisternal segment, cavernous segment or their course in the orbital apex. The MR technique must be adapted to each of these anatomic locations. The nucleus and fascicular segment are best seen on selective axial T2/PD TSE or m-FFE/Medic/Merge images and diffusion weighted images. The cisternal segment should be examined using axial heavily T2-weigthed submillimetric images (e.g. FIESTA, 3D-TSE, DRIVE, b-FFE) and coronal Gd-enhanced T1-weighted images. The latter are also suited to study the cavernous segment. The orbital apex region is best evaluated on coronal Gd-enhanced T1-weighted images with Fat Saturation (e.g. Dixon sequence). The nerve palsy can be isolated but frequently adjacent involved structures cause additional neurologic deficits. These additional symptoms are helpful in the localization of the lesion. Many lesions can affect the oculomotor nerves but unfortunately imaging can remain negative (e.g. diabetic &

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hypertensive ocular motor nerve dysfunction). Infarctions, aneurysms, fistulas, neurovascular conflicts, trauma, schwannomas, cavernous hemangiomas, skull base tumors, lymphoma, leukemia, leptomeningeal carcinomatosis, meningiomas, pituitary tumors, inflammatory (e.g. multiple sclerosis, lupus, Behçet, ophthalmoplegic migraine, Tolosa-Hunt) and infectious diseases (e.g. rhombencephalitis, Lyme disease, herpes zoster, fungal infection, cavernous sinus thrombosis) etc. are some of the most frequent causes and will be discussed and illustrated. STATE OF THE ART SESSION 1B CAN COMPUTATIONAL FLOW DYNAMICS DELIVER REAL BENEFITS TO THE INTERVENTIONIST? Daniel Rüfenacht Neuroradiology Department, Gaslini Children’s Hospital, Italy Computational Flow Dynamics (CFD) allows for calculating and visualizing the energy of blood with a focus on the interaction between circulating blood and the vessel wall, i.e. wall shear stress. This is of specific interest in view of the extraordinary sensibility of endothelial cells towards shear, a force that is a factor of 103-4 smaller than blood pressure. Also the coagulation system is very sensitive to shear forces, allowing for thrombocytes to aggregate easier when flow is reduced. Thus, vessel wall homeostasis is closely linked to wall shear stress due to blood flow. Variable high and low mean shear stresses induce and entertain destructive remodeling further supported by wall adherent clot formation, inducing inflammatory reactions with consecutive reduction of the vessel wall biomechanical strength what may entail aneurysm growth and rupture. CFD analysis may permit to test use of devices in the virtual reality prior to endovascular implantation, allowing for planning optimal conditions for the reverse remodeling of cerebral aneurysms. Progresses in medical imaging and medical device technology, and both in synergy, have contributed to stepwise visualize and influence the conditions that are responsible for bringing vascular structures out of, and with treatment, back in biological balance. CFD, currently hailed and hated by our peers, carries the potential to forecast clot development, a key item when it comes to understand and predict the aneurysm life cycle. Clot having the potential to induce destructive and reverse remodeling, it is key to investigate in this critical difference – computational biology may offer answers to this question and support at the same time validation efforts for CFD.

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STATE OF THE ART SESSION 2A SMALL VESSEL DISEASE Joanna Wardlaw Division of Clinical Neurosciences, Western General Hospital, UK Abstract not available at time of publication STATE OF THE ART SESSION 2B DEVELOPING STROKE INTERVENTION AS THE PRIMARY THERAPEUTIC MODALITY FOR ISCHAEMIC STROKE Jan Gralla Department of Diagnostics and Interventional Neuroradiology, University of Berne, Switzerland Acute ischemic stroke is one of the major sources of morbidity and mortality in the industrialized countries. Outcome depends on the length of time between onset of symptoms and revascularization, the recanalization rate, and on whether or not intracranial hemorrhage occurs. Intravenously administered tissue plasminogen activator (IV tPA) has been shown to improve patient outcome. However, the time window for treatment and the recanalization rate of both approaches are limited, and the application of thrombolytic drugs increases the risk of symptomatic intracranial hemorrhage. The success of recanalization, furthermore, depends on the occlusion site; proximal occlusions of large vessels such as the internal carotid artery (ICA) have a poor recanalization rate after IV tPA. The introduction of mechanical thrombectomy (MT) has undoubtedly expanded the time window for stroke treatment and broadened the treatment to patients in whom IV tPA or IAT failed or is contraindicated. The latest results on stentretrievers indicate that MT can achieve high recanalization rates in conjunction with short recanalization times and lowrisk device-related adverse events. More importantly, recent data shows that the increased recanalization rate of MT improves clinical outcome. Considering the poor recanalization rate and clinical outcome of patients suffering from proximal vessel occlusions and large thrombus burden (e.g. MCA trunk, ICA termination), MT is likely to become the primary therapeutic modality. Selection criteria based on pre-therapeutic imaging and clinical parameters need to be defined. Furthermore, periprocedural aspects of the intervention (additional use of thrombolytic drugs, anesthesia) have to be investigated and characterized to establish interventions as the primary therapeutic modality for ischemic stroke.

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STATE OF THE ART SESSION 3A IMAGING THE TEMPORAL BONE J. W. Casselman1,3,4, E. F. Offeciers5, A. Zarowski5, B. De Foer4, R. Kuhweide2, T. Somers5 & B. Lerut2 Department of Radiology1 & Otorhinolaryngology2; AZ St-Jan Brugge AV, Brugge, Belgium; University of Ghent, Gent, Belgium3; Department of Radiology4 & Otorhinolaryngology5 St- Augustinus, Wilrijk, Belgium5 Today the temporal bone can be studied using high resolution CT and MR. New generation Cone Beam CT (CBCT) is gradually replacing the standard MDCT. Submillimetric T2/T1-weighted and non-EPI DWI sequences are now routinely available on most of the existing MR systems. Otosclerosis is one of the most frequent indications to perform CT of the temporal bone. One should always check the fisulla antefenestram, the round window and the nipple sign anteroinferior to the internal auditory canal. The involvement of the fisulla antefenestram and stapes footplate is only possible when “double oblique” reconstructions are made. Otitis Media with associated Conductive Hearing Loss (CHL) is still best examined on CT. CBCT made evaluation of tympanic membrane involvement, ossicular lysis & luxation and tympanosclerosis etc. more accurate. This is crucial pre-operative information for the surgeon. Cholesteatoma is today initially studied with MR. Unlike CT, MR is able to characterize cholesteatoma when a nonEPI DiffusionWeighted sequence is used. This is not only used in the diagnosis of new cholesteatomas but also to detect residual or recurrent cholesteatomas after surgery. Today the role of CT is to provide the surgeon with a “road-map” once surgery is planned. Fractures and ossicular luxations are best studied on CT. CBCT made the diagnosis of even subtle ossicular fractures and luxations possible. However, an additional MR should be performed when post-traumatic severe hearing loss remains unexplained on CT. Contrast-enhanced MR is needed in case of severe progressive post-traumatic facial nerve palsy. Vestibulocochlear nerve schwannomas must be examined using submillimetric T2 and contrast-enhanced T1weighted images. Contrast is needed to detect the small intralabyrinthine schwannomas and to distinguish the normal ganglion of Scarpa from small schwannomas originating in the ganglion of Scarpa. The radiologist should also provide the surgeon with information about the possibility to perform hearing preservation surgery, about lesion growth and its relation to the facial nerve.

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STATE OF THE ART SESSION 3B DEVICE REGULATION IN THE EU: WHERE ARE WE HEADED? Speaker to be confirmed at time of publication SUNDAY 22nd SEPTEMBER REFRESHER COURSE 3A: DEGENERATIVE DISEASES OF THE BRAIN Refresher Lecture 3a.1 IMAGING IN PARKINSON'S DISEASE Dorothee Auer Arthritis Research UK Pain Centre, Nottingham, UK Parkinson’s disease (PD) is a common age related neurodegenerative disease with even higher assumed preclinical prevalence in the elderly. There is a need for novel biomarkers to assist early diagnosis and monitoring of the progression of PD. Clinical diagnosis is usually made after an estimated delay of 5 years from onset when motor symptoms occur. Nuclear medicine techniques can assist the diagnosis by using specific radioligands to depict the striatal effects from dopaminergic cell loss in the substantia nigra. There is no standardised pathway for using MRI in the diagnostic work-up of parkinsonian syndromes. Standard MRI is sometimes used for the differential diagnosis of vascular parkinsonism; and diffusion MRI was shown to aid the differentiation of PD from atypical parkinsonian syndromes. The recently developed neuromelanin sensitive MRI holds promise to directly visualise the degeneration in the substantia nigra, and hence to provide a biomarker of the disease process itself. In addition, advanced analysis of network dysfunction using structural and functional MRI may allow to develop additional biomarkers that reflect specific motor and non motor dysfunction. This presentation will give an overview and critical appraisal of these recent developments. Refresher Lecture 3a.2 MICROBLEEDS AND CLINICAL SIGNIFICANCE Hans Rolf Jaeger Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UK Abstract not available at time of publication

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Refresher Lecture 3a.3 IMAGING IN PRION DISEASES Robert Will, David Summers Department of Clinical Neurosciences, Western General Hospital, Edinburgh Different forms of CJD distinguished by variation in aetiology include sporadic CJD, variant CJD, which is caused by zoonotic infection with BSE, and rarer iatrogenic and familial subtypes The diagnosis of CJD depends on assessment of clinical characteristics in conjunction with specialist investigations: EEG, analysis of CSF proteins and neuroimaging. Brain MRI has become an increasingly important diagnostic tool in CJD in recent years, with the identification of patterns of signal change that allow discrimination between the sporadic and variant form with high sensitivity and specificity. Different subtypes of sporadic CJD which are classified according to genotype at codon 129 of PRNP and the biochemical form of the prion protein in the brain show different MRI changes. However, there are shared features that allow good discrimination from other causes of subacute dementia and MRI has now been introduced into the formal criteria for case classification of sporadic CJD. In variant CJD the MRI findings have been included in the diagnostic criteria since these were first formulated and this reflects the high sensitivity and specificity of the ‘pulvinar sign’ in the diagnosis of vCJD. There are a number of potential false positive findings for both sporadic and variant CJD that should be recognised. Information on the utility of MRI in the diagnosis of CJD is mainly based on studies in specialist centres. The preliminary findings of a web-based study of the more general utility of MRI in the diagnosis of CJD, the PROMISE study, will also be presented. REFRESHER COURSE 3B: SPINAL INTERVENTION Refresher Lecture 3b.1 VERTEBROPLASTY – WHERE ARE WE NOW? Deborah Annesley-Williams Radiology Department, Nottingham University Hospital, UK VERTOS II shows that vertebroplasty is superior to conservative treatment in a subgroup of patients with acute osteoporotic vertebral compression fractures. Pain relief after vertebroplasty is immediate and sustained for at least a year. The INVEST and Buchbinder trials are more challenging to interpret. A placebo response to treatment is well described and may be amplified when the treatment is invasive.

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However, I would hesitate to attribute the considerable clinical success of vertebroplasty purely to placebo. In both INVEST and Buchbinder trials, a considerable number of patients approached declined to participate. This may have been because patients with more severe back pain opted immediately for vertebroplasty. The success of vertebroplasty in VERTOS II, where one of the inclusion criteria was a VAS score greater than 5, supports this assumption. Vertebroplasty may be more effective in the treatment of fractures of a certain age or stage of healing. In VERTOS II, fractures were acute as determined by back pain of less than 6 weeks duration, whereas in both INVEST and Buchbinder trials duration of back pain was up to a year, suggesting chronic fracture. Currently published trials have not assessed the long term outcome in vertebroplasty patients compared with those having control intervention. It is to be determined whether the long term outcome is similar in both groups. The most important factor in successful vertebroplasty is patient selection. Further research is required to identify the subgroup of patients to benefit from vertebroplasty. Refresher Lecture 3b.2 Parallel Session 1A - Scientific Papers 1A.3 WHAT IS THE ROLE FOR KYPHOPLASTY AND OTHER ADVANCED SPINAL AUGMENTATION TECHNIQUES Mario Muto, Uarnieri G. Neuroradiology Dept ,Cardareli Hospital, Naples, Italy Kyphoplasty, developed as an evolution of Vertebroplasty, consists in delivering cement – polymethylmethacrylate or other types of cement, into the fractured vertebral body under fluoroscopic guidance after a dedicated balloon tamps has created a cavity within the compacted trabecular bone.The rationale of this procedure is to combine the vertebroplasty rationale in which the injection of cement (polymethyl-methacrylate or other type) within the collapsed soma stabilizing the movements of the trabecular and cortical microfractures -responsible for the pain - making more compact and stable the vertebral body with a consequent antalgic effect with the vertebral height restoration effect of the dedicated balloon tamps that can restore the physiological height of the collapsed vertebral body, reducing the kyphotic deformity of the vertebral body, with antalgic effect and improviement of respiratory and gastro-intestinal disfunction. Recently many devices are developed by industries in order to combine antalgic effect with vertebral augmentation and hight restoration. They are Vertebral body Stent system, Kiwa , Spine Jack that have different rate of vertebral

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restoration and differente rate of leakage, discal or venous, and low complications rate. The main indications for KP or KP like devices are osteoporotic and non osteoporotic vertebral fractures, such as primary and secondary vertebral tumors, vertebral traumatic fracture Magerl A1 type and selected Magerl A2 and A3 type, according to his classification. Refresher Lecture 3b.3 VALUE IMAGING PRIOR TO SPINE INTERVENTION Pia Sundgren Head of the department of Diagnostic Radiology, Clinical Sciences, Lund, Lund University, Lund, Sweden Less invasive spine intervention such as percutaneous vertebroplasty (PV) for treatment of chronic vertebral pain after compression factures secondary to osteoporosis or malignancy, nerve root and facet blocks due to focal facet joint or nerve root pain and oxygen-ozone therapy to treat low back pain have been increasing have become more and more popular as treatment options to the more invasive surgical therapy. However prior to any therapy the correct and proper imaging need to be performed to evaluate the vertebral bodies, the spinal canal, the discs and facet for evaluation and guidance. Imaging has become more and more important to evaluate for back pain. Depending on the clinical question different radiological methods are available. CT of the spine is very useful for evaluating the bony structures of the spine. CT-meylogram can be used to better evaluate the impingement on spinal cord, dural sack and nerve root impingement. Magnetic resonance (MR) imaging of the lumbar spine is the most common imaging modality to evaluate for degenerative disk disease. MR imaging can readily demonstrate disk pathology, degenerative endplate changes, facet and ligamentous hypertrophic changes, and the sequelae of instability. But also the role of preintervention bone single photon emission computed tomography-computed tomography (SPECT-CT) are under investigation for pre invasive work up and possible management of patients prior to PV, in terms of patient selection, treatment planning and prediction of response to PV. In the present lecture different imaging modalities and there use in the pre intervention work-up, management, patient selection, treatment planning and prediction of results will be discussed. Refresher Lecture 3b.4 NEW OPPORTUNITIES FOR TREATING LOW BACK PAIN Giuseppe Bonaldi Director of Neuroradiology Dept. Ospedali Riuniti, largo Barozzi 1 - 24128 Bergamo - Italy

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Dynamic stabilization (nonfusion or motion preservation technologies) aims to provide stabilization while maintaining the mobility and function of the SUs, favoring realignment; preventing extremes of flexion and extension; and unloading, through modification of distribution of loads, painful areas within the SU, especially disc or facets. Dynamic unloading of the overall SU is not possible (it is equivalent to a rigid fusion). Often pain, however, is not from an increase of quantity of motion but from abnormal distribution of loads across sensitive areas of the SU. Changes in the location of the ICR change the deformation of local areas of tissue, moving the distribution of loading away from painful areas. Dynamic stabilization has the potential to relieve stress peaks in facets and anterior and posterior annulus, provided adequate spacer design and size are chosen. Thus, dynamic stabilization may provide pain relief by altering the transmission of abnormal loads across the degenerated structures. Indications remain poorly defined, however, and largely reflect individual surgeon bias. The main issue is that current diagnostic techniques are not sufficient to identify the exact source of pain, and understanding of pain etiology is poor. The same issue underlies fusion surgery, however, which is considered the gold standard for treatment of instability. The dynamic stabilization techniques discussed in this article limit their therapeutic possibilities to lower grades of instability, thus representing a first, lowinvasiveness tool in the armamentarium of the spine surgeon. Dynamic, minimally invasive implants should be used to avoid or delay more aggressive procedures, and their use as intermediate solutions is justified as long as the iatrogenic trauma during implantation is small. Low grades of instability are early ones and from a speculative and prospective point of view it is possible that an early correction of the problem, by means of minimally invasive, dynamic devices, could not only stop but also reverse degeneration of the components of the SU. Thus, patients suffer from instability; at the same time, there is a lack of diagnostic and therapeutic certainty. Far from being a limitation, this is the main advantage of dynamic stabilization systems, because they are minimally invasive, customizable, and easily reversible; maintain motion and spinal alignment; and are cheaper and safer than instrumented fusion procedures. And they do not burn down any bridges for further therapeutic options. Most problems are still open and many questions are not yet answered. Further studies are required to determine optimal implants design. This is the beginning of a new era of surgery for the degenerated spine, requiring open minds and absence of biases. Radiologists are the best trained and culturally equipped for correct use and application of percutaneous or minimally invasive, often x-ray guided surgical

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techniques and devices. Many of these have been proposed and developed by radiologists. At the same time orthopedists and neurosurgeons share a long tradition of invasive treatments of the degenerated spine. The two worlds are getting closer, and an open and unbiased cooperation of the different communities should represent good news for our patients. PLENARY SESSION 3 Plenary Lecture 6 WHITE DOTS AND BLACK SPOTS IN THE BRAIN Anne Osborn Department of Radiology, University of Utah, USA The differential diagnosis of multifocal parenchymal brain lesions is broad and often difficult to narrow down. In this lecture we review the spectrum of diseases that can result in “white spots” (hyperdensities on CT, hyperintensities on T1WI and T2/FLAIR MR) and “black dots” (hypointensities on T2* GRE/SWI) scans. The clinical manifestations, anatomy, underlying pathology, and imaging appearances are presented in a paradigm that helps the radiologist discriminate between different disorders that may appear quite similar. SESSION 2A: NEUROIMAGING BIOMARKERS OF PRE-DEMENTIA ALZHEIMER'S DISEASE: ORGANISED BY THE COMMITTEE OF THE EUROPEAN ASSOCIATION OF NUCLEAR MEDICINE (EANM) Lecture 2a.1 PRESENTATION OF THE SYMPOSIUM Flavio Nobili¹, Silvia Morbelli² ¹Dept. of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy ²Nuclear Medicine Unit, Dept. of Internal Medicine, University of Genoa, Genoa, Italy MRI is the cornerstone of neuroimaging in the diagnosis of Alzheimer (AD). Despite a somewhat lower sensitivity than functional imaging biomarkers, MRI has the advantage of being widely available. Recently introduced tools for automatic analysis of grey matter loss and the increasing availability of highfield equipments (i.e., 3 T) have improved its accuracy. Diffusion tensor imaging and BOLD fMRI are areas of active research and promising results are already available. FDGPET is an established biomarker for AD in the pre-dementia stage, detects functional impairment mainly at synaptic level and correlates with severity of cognitive symptoms. Topographic hypometabolism in prodromal AD is focused on posterior cingulate cortex, precuneus, posterior temporo-parietal

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associative cortex, and medial temporal lobe. This topographic pattern is highly specific and proven to be effective in differential diagnosis with frontotemporal dementia. Amyloid-PET with [11 C]-PIB has shown the feasibility to detect brain amyloidosis in vivo. Fluorurate amyloid ligands will be traded soon. Amyloid-PET ligands are specific for amyloid fibril deposition, both in forms of classical and diffuse plaques. Brain amyloidosis has been found in virtually all patients with AD, in most patients with DLB, and in a small but not trivial part of 'healthy' control subjects, whose meaning remains to be established in longitudinal studies. The availability of the two PET tools has raised the question on how and when using them avoiding unnecessary costs and radiation exposure while picking-up the pathophysiological and diagnostic information at best. This Symposium, proposed by the Neuroimaging Committee of the EANM, deals with these issues and recent advances in the field. Lecture 2a.2 NEW FRONTIERS IN MORPHOLOGICAL AND FUNCTIONAL MRI Wiesje Van der Flier VU University Medical Center, Amsterdam, The Netherlands With the advent of the new diagnostic criteria, hippocampal volume loss is considered a supportive biomarker for (predementia stage of) Alzheimer disease (AD). It is increasingly recognized however, that brain changes are not restricted to local, structural changes. Voxel-based approaches take into account the entire brain, allowing the identification of patterns of atrophy. Arterial spin labeling (ASL) provides the possibility to measure whole brain cerebral blood flow in a quantitative way. Finally, brain connectivity is a potentially powerful marker which may be studied using resting-state functional MRI. Using voxel-based morphometry in a large set of patients and controls, we found specific patterns of atrophy in older AD patients (relatively focused on hippocampus) compared to younger patients (much more widespread). In a direct comparison, younger patients showed more severe precuneus atrophy, illustrating that a focus on hippocampus only does not do justice to the heterogeneity in manifestation of the disease. With ASL we found that posterior brain regions, especially precuneus and posterior cingulate, were most strongly hypoperfused in patients with AD and MCI. The association between blood flow and cognition confirms the clinical relevance of this functional marker. A close connection between cerebral perfusion and functional connectivity is suggested as we found lower resting-state functional connectivity in AD compared to controls within the default mode network in the precuneus and posterior cingulate.

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In conclusion, new developments in MRI hold promise for a future of more specific, in depth diagnosis and as such may contribute to an individually tailored treatment strategy. Lecture 2a.3 FDG PET AS A BIOMARKER FOR DIAGNOSIS, PROGNOSIS AND OUTCOME IN AD Karl Herholz University of Manchester, Manchester, UK Positron emission tomography (PET) with the glucose analogue FDG, which is being widely used in clinical oncology, also provides regional measurements of cerebral glucose metabolism, which is an indicator of synaptic activity. Synaptic impairment associated with reductions in glucose metabolism in AD mainly affects temporoparietal association cortices, including the precuneus and posterior cingulate gyrus. These areas have close reciprocal connections with the mesial temporal cortex, where atrophic tissue changes are most prominent on MR scans. They are closely associated with dementia symptoms and severity. The regional distribution of metabolic impairment provides diagnostic clues for the differentiation of AD from frontotemporal dementia. It can also identify those patients with mild cognitive impairment who are at high risk for developing dementia within the next 1 or 2 years, and it can be used to monitor disease progression. Advanced image processing tools for FDG PET have been validated in multicenter databases to quantify changes objectively with high accuracy and to compare individual subjects to normative databases. Thus, FDG PET also has the potential to be used as an imaging biomarker for identification of patients at risk for dementia and as a surrogate outcome parameter. Acknowledgement: Supported in part by Alzheimer Research UK Lecture 2a.4 AMYLOID-PET: AN UPCOMING REVOLUTION IN DIAGNOSIS OF DEMENTIA? Koen Van Laere University Hospitals Leuven, Leuven, Belgium Efforts by industry and academia have resulted in a boost of specific and clinically applicable 18 F-labeled radiotracers for beta-amyloid, led by clinical demand as well as the commercial drive for a biomarker for objective quantitative assessment of disease burden in anti-amyloid trials. Early 2012, at least five 18 F-labeled amyloid ligands are in phase II or III clinical trials, and three are expected to obtain FDA approval in the course of 2012-2013. These ligands allow

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excellent separation of amyloid positive scans versus controls. Ongoing efforts show that amyloid imaging in MCI has a very high negative and also high positive predictive value for AD conversion. The significance of a positive scan in healthy subjects needs further longitudinal investigation. Amyloid PET is highly discriminating in frontotemporal dementia, while elevated tracer binding is observed in many patients with Lewy body dementia. Large scale availability will contribute to drug development and especially allow widespread clinical application in the very near future. Lecture 2a.5 FDG-PET VERSUS AMYLOID-PET: ANTAGONISTS OR ALLIES? Alexander Drzezga Technische Universität München, Munich, Germany Different pathological processes are known to be involved in the generation of neurodegenerative disorders. Among those are neuronal dysfunction, synaptic loss, inflammation and pathological protein aggregation, e.g. of beta-amyloid and tau-protein in Alzheimer's disease. According to current disease models the protein aggregation pathologies are regarded to be an initial event potentially causally responsible for other downstream pathologies such as neuronal dysfunction and atrophy. Modern imaging procedures allow the in vivo assessment of these pathological processes, The available methods include FDG-PET imaging of neuronal/synaptic dysfunction and recently different tracers for imaging amyloid-pathology. The scientific application of these imaging tools opens the opportunity to identify the interaction of different brain pathologies and also the order of their appearance. This may not only improve the understanding of disease mechanisms but also have relevant impact on the diagnostic value of these imaging biomarkers. FDG-PET can be regarded a well-established tracer for reliable early and differential diagnosis of dementing disorders. AmyloidImaging is recently entering the clinical arena and may be highly valuable for diagnosing neurodegenerative disorders on the basis of their underlying pathology rather than on their symptomatic appearance. It is a matter of current discussion if these two imaging tools are of complementary value, which tracer should be selected for which type of diagnostic question and if a combination of both may be required in some cases. Theses issues will be discussed in this presentation according to present knowledge.

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ORAL ABSTRACTS PARALLEL SESSION 1A – SCIENTIFIC PAPERS 1A.1 O1A-1.1 MICRO-EMBOLIC SIGNALS AND PLAQUE HAEMORRHAGE INDEPENDENTLY PREDICT RECURRENCE IN PATIENTS WITH CAROTID ARTERY DISEASE Nishath Altaf1 ,2, Neghal Kandiyil1 ,2, Akram A. Hosseini1, Shane T. MacSweeney0 ,2, Dorothee P. Auer1 1 Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, UK, 2Department of Vascular Surgery, Nottingham University Hospital, Nottingham, UK INTRODUCTION Carotid plaque haemorrhage as detected by MRI (PH) and microembolic signals (MES) detected by transcranial Doppler (TCD) are known risk factors for recurrent cerebrovascular events in patients with carotid disease. We previously found an association between them, but it is unclear whether they allow independent and potentially additive risk prediction. This study assessed whether MES and PH independently predict recurrent cerebrovascular events in symptomatic carotid artery disease. METHODS 98 prospectively recruited patients (mean age 73 years, 36 % female) with symptomatic severe (60-99 %) carotid stenosis underwent TCD and blood nulled, water selective T1 weighted MRI of the carotid arteries. Patients were followed up until carotid endarterectomy, recurrent cerebral event, death or study end. Event-free survival analysis was done using backward conditional Cox regression analysis. RESULTS 5 patients had no acoustic window. Of the remainder 93 patients, 59 demonstrated PH and 39 had MES. 29 events were observed over 24 weeks: 27 showed PH and 17 MES. PH (HR012.4; 95 % CI: 2.8-53.2) and to a lesser degree MES (HR02.2; 95 % CI: 1.0-4.9) predicted recurrence, while degree of stenosis and time from symptom did not. The combined score shows a graded risk increase for presence of one (HR010.6; 95%CI: 11.4-81.4, p00.024) and both risk factors (HR029.8; 95%CI: 3.8-231, p00.001). CONCLUSION The presence of microembolic signals and carotid plaque haemorrhage are independent predictors of recurrent cerebrovascular events in patients with symptomatic severe carotid stenosis.

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O1A-1.2 HOW USEFUL IS ROUTINE 24 HOUR CT HEAD SCAN AFTER THROMBOLYSIS FOR HYPERACUTE CEREBRAL INFARCTION? Permesh Singh Dhillon1, Huey K. Tan2, Wayne Sunman2, Dorothee P. Auer1 1 Division of Radiological & Imaging Sciences, University of Nottingham, Nottingham, UK, 2Stroke Department, City Hospital Campus Nottingham University Hospitals NHS Trust, Nottingham, UK There is a 6 % incidence of clinically significant intracranial haemorrhage after thrombolysis for cerebral infarction and a several-fold higher incidence of sub-clinical haemorrhage or haemorrhagic transformation (HT). Opinion is divided on whether to carry out a routine CT head scan (CTH) 24 hours after thrombolysis. The advocates for it feel that the routine CTH informs their decision on antiplatelet therapy. This retrospective study aimed to determine how frequently in our tertiary care Stroke Centre, routine CTH within 2 days of thrombolysis led to change in patient management. Details of all patients thrombolysed were obtained from our database. The post-thrombolysis CTHs were reviewed by an experienced neuroradiologist. The case notes of all cases showing HT were examined to determine whether the CTH was routine or triggered by clinical deterioration, and whether and how management was modified. Of 3752 stroke admissions since 2006, 210 were thrombolysed, 6 were scanned late or not re-scanned. Of the remaining 204, 34 showed HT. In 10 patients CTH was not routine, leaving 24 asymptomatic HT (11.7 %). In 7 patients, this resulted in withholding antiplatelets, but one died regardless. Statistical analysis showed age and sex did not predict HT. Amongst HT patients, NIHSS baseline scores did not predict HT grade while HT grade significantly predicted treatment decision (p<0.05). In conclusion, routine post thrombolysis CTH detected 12 % AHT and in our clinical service, this informed potentially beneficial management changes in only 3 % (6/204 patients). It is however unproven whether withholding or deferring antiplatelets truly improves clinical outcome. O1A-1.3 REORGANIZATION OF SENSORIMOTOR CORTEX IN ISCHEMIC STROKE DURING THE IMITATION O F WA L K I N G : F U N C T I O N A L M A G N E T I C RESONANCE (fMRI) STUDY Elena Kremneva, Lyudmila Chernikova, Rodion Konovalov, Marina Krotenkova Research Center of neurology, RAMS, Moscow, Russia

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PURPOSE to determine patterns of walking sensorimotor (SM) network reorganization depending on stroke periods and lesion localization using the passive motor fMRI paradigm. MATERIALS AND METHOD We examined 43 ischemic stroke patients with subcortical (SC, 20 patients) and cortical-subcortical (CSC, 23 patients) lesion in different periods: acute (AP) - 21 day, recovery (RP) 2-12 months, residual (RsP) - more than 1 year from the onset. fMRI was performed to all patients on 1.5 T scanner with original slow walking imitation blocked paradigm using the MR-comparable device. RESULTS For CSC, activation of primary and secondary SM cortex (SM1 and SM2) was almost absent. During RP activation of SM2 was revealed in unaffected hemisphere (UH); SM1 volume was 594 [432;2701] mm3 in affected hemisphere (AH) and 1404 [1053;5652,5] mm3 in UH. In RsP activation of SM was seen in both hemispheres, comparable with normal pattern. For CSC group, the negative correlation between volume of SM2 in UH and Fugl-Meyer /Perry score was revealed (r0-0,954, p00,00045 and r0- 0,66, p00,10, accordingly). For SC, in AP all the SM areas activation were seen, SM1 volume was comparable with the normal pattern. In RP and RsP there was an increase of SM1 volume. CONCLUSION In CSC there was a disintegration of SM system in acute period. Recovery of this group in further periods was associated with the less effective contralesional reorganization pattern. In SC even in acute period all SM network activation was preserved and further recovery was associated with more favourable pattern of ipsilesional reorganization. O1A-1.4 DIFFUSION-WEIGHTED IMAGING AND MRPERFUSION IN DIFFERENT ACUTE STROKE SUBTYPES Alexander Suslin, Marina Krotenkova, Marine Tanashyan, Dmitry Sergeev, Elena Kremneva Research Center of neurology, RAMS, Moscow, Russia PURPOSE to evaluate MR-diffusion and perfusion characteristics of the brain in different pathogenetic subtypes of acute ischemic stroke in the territory of middle cerebral artery. MATERIALS AND METHODS we examined 51 patients with acute ischemic stroke in middle cerebral artery territory [mean age 67 [59; 70] years; 28 males, 23 females) in the first 48 hours and then on 7-8 and 20-21 days from the onset. 22 patients had cardioembolic

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stroke subtype (CE), 18 - atherothrombotic (AT) and 11 lacunar (L) subtypes. In every examination time point MRI was performed on 1.5 T scanner in T2, T1, FLAIR, DWI (b0 0, 500, 1000), MR-perfusion regimens. RESULTS In AT subtype most extensive area of perfusion disturbances was revealed, with its maximum duration; in L subtype perfusion changes was minimal and its rapid regression (no later than on 21 day). In CE subtype the characteristic patterns were higher diffusion coefficient (ADC) during the whole acute period, the earliest reperfusion, more often (63 %) and the earliest (during the first 7 days) hemorrhagic transformation of ischemic tissue. CONCLUSION The most characteristic MRI patterns of different stroke subtypes in acute period were revealed. These data can be used for the most optimal MRI examination protocol and its time points in acute stroke patients, thus benefiting rapid treatment. O1A-1.5 FACTORS ASSOCIATED WITH NEGATIVE MRI SCAN IN MINOR STROKE Stephen Makin, Fergus Doubal, Martin Dennis, Joanna Wardlaw University of Edinburgh, Edinburgh, UK INTRODUCTION Diffusion weighted imaging (DWI) is increasingly used to diagnose minor stroke and TIA. In some stroke patients no appropriate DWI lesion is seen. Recent research has focused on anterior circulation strokes. We analysed factors associated with negative DWI in anterior and posterior circulation stroke. METHOD We recruited patients prospectively with lacunar, mild cortical or posterior circulation stroke. Patients had a clinical diagnosis of acute stroke made by an experienced stroke physician, confirmed by an expert panel. Prior to MRI stroke was classified as definite, probable or possible. All underwent MRI: DWI, T1, T2 and FLAIR sequences. We excluded all patients diagnosed clinically as non-stroke from this analysis. RESULTS Of 210 patients, 61 (29 %) had no DWI lesion. Patients without DWI lesions were less disabled (% Modified Rankin 0 or 1, 75 % v 55 %, p<0.05), presented later (median days to scan 4.38 v 2.0 p<0.05) yet more likely to have had a previous stroke (37 % v 12 % p<0.05), and less likely to have a clinically ‘definite' stroke prior to scan (10 % of ‘definite' strokes DWI negative v 41 % of possible stroke) There were no differences in the proportion with posterior circulation stroke, patient age, NIHSS, gender, or proportion with vascular risk factors.

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CONCLUSION The negative DWI rate (29 %) is similar in posterior and anterior circulation strokes and not explained by vascular risk factors or other stroke-related variables. MRI may aid stroke subtyping, but cannot be used to exclude stroke as 30 % of stroke patients do not have a DWI lesion.

responsible for increased vessel densities both in arteries and in veins. Increased creatinine leads to increased vessel densities only in arteries and increased CRP leads to an increased vessel density only in veins. This study can have an influence on clinical decisions and avoid unnecessary examinations especially in patients with ambivalent symptoms.

O1A-1.6 INFLUENCING FACTORS ON INCREASED CT DENSITY OF INTRACRANIAL BLOOD VESSELS

PARALLEL SESSION 1A - SCIENTIFIC PAPERS 1A.2

Astrid Grams1, Charlotte Rieck1, Regina Moritz2, Martin Obert1, Christian Tanislav3, Martin Berghoff3, Gabriele Krombach2, Elke Gizewski1 ,4, Thorsten Schmidt1 1 Department of Neuroradiology, University Hospital Giessen, Justus Liebig University, Giessen, Germany, 2Department of Radiology, University Hospital Giessen, Justus Liebig University, Giessen, Germany, 3Department of Neurology, University Hospital Giessen, Justus Liebig University, Giessen, Germany, 4Department of Neuroradiology, University Hospital Innsbruck, Medical University Innsbruck, Innsbruck, Austria INTRODUCTION Hyperdense intracranial blood vessels in patients with unspecific symptoms is a common problem which can lead to a false diagnosis of arterial thrombus or venous sinus thrombosis. As a possible cause for this phenomenon exsiccosis or increased haematocrit is commonly discussed but this has never been proved by a systematic evaluation of other possible influencing factors. In the present study different parameters such as age, vessel calcification status and laboratory values (erythrocytes, haemoglobine, haematocrit, MCH, MCV, MCHC, leukocytes, CRP, creatinine, potassium and sodium) were correlated with ROI density measurements of the intracranial arteries and veins of 200 patients (mean age 55 y ; 80 ♀, 122,♂) without suspected vessel thrombosis. RESULTS Significant correlations were found for both arteries and veins between increased densities and erythrocytes (p< 0.0001), haemoglobine (p<0.0001) and haematocrit (p< 0.0001). In addition significant correlations could be described between increased arterial vessel densities and creatinine (p 00.01) and between increased venous vessel densites and CRP (p00.02). For the other parameters no significant correlations were found. CONCLUSION With the present results the phenomenon of increased intracranial vessel density can be explained. High values of erythrocytes, haemoglobine and haematocrit are

O1A-2.1 [ 14 C]2-DEOXYGLUCOSE AUTORADIOGRAPHY C O N F I R M S M E TA B O L I S M W I T H I N T H E PENUMBRA; IDENTIFIED BY PFC ENHANCED DYNAMIC LACTATE METABOLIC MR IMAGING Graeme Deuchar1, I Mhairi Macrae1, David Brennan2, Jim Mullin1, William Holmes1, Celestine Santosh2 1 Glasgow Experimental MRI Centre, Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK, 2 Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK Accurate identification of the ischaemic penumbra is crucial for treatment decisions in acute stroke patients. We have published a novel technique that identifies penumbra using hyperoxia and lactate change imaging, which differentiates between anaerobic/aerobic metabolism. Our aim was to enhance this technique by including an oxygen-carrying Perfluorocarbon (PFC) emulsion and to measure glucose metabolism within tissues identified as penumbra using [14 C]2-deoxyglucose autoradiography. METHODS MRI scans were performed on a 7 T Bruker Biospec. The study had two parts. In part one, rats with induced stroke received 1.5 ml saline (n08) or 1.5 ml PFC i.v. (n07) with hyperoxia (100 % O2). The scanning protocol included: DWI, PWI and MRS lactate change to hyperoxia. In part two, 6 animals received 1.5 ml PFC, with MR spectroscopic imaging used to identify regions where changes in tissue lactate occurred in response to hyperoxia. This was correlated with [ 14 C]2-deoxyglucose autoradiography. RESULTS Part 1: Lactate was reduced in the penumbra voxel with ~10mins hyperoxia+PFC but not with saline+hyperoxia. Part 2: Regions showing a reduction in lactate to PFC+ hyperoxia had maintained glucose metabolism as compared to adjacent core tissue with very low glucose use. Regions

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of lactate change and DWI/PWI mismatch were not identical. CONCLUSION Dynamic lactate imaging to visualise the penumbra is improved with PFC and is based on metabolism. In the clinical management of stroke it is important to accurately identify patients with an ischaemic penumbra and this MR technique offers an improvement on current techniques by being primarily based on metabolism. O1A-2.2 TIMING PARAMETERS FROM ASL AND DSC-MRI REVEAL CEREBRAL PERFUSION TERRITORY BOUNDARIES Gerard Thompson, Laura Parkes, Alan Jackson University of Manchester, Manchester, UK INTRODUCTION Maps of cerebral perfusion territories relate to patterns of ischaemia and tissue injury seen in arterio-occlusive disease and hypoperfusion states, but are generally anatomically driven. Recent developments in selective arterial spin labelling (ASL) have provided functional maps for internal carotid and basilar arteries, but are technically demanding. Presented is a technique employing ASL and dynamic susceptibility contrast (DSC) timing parameters to define perfusion territories and produce a physiologically driven standard-space atlas. Such an atlas may benefit studies of neurovascular disease, or diseases with a suspected underlying neurovascular component. It has also been hypothesised that metastatic predilection for the grey-white matter junction is perfusion-related. METHODS 15 healthy volunteers underwent STAR-ASL and T2* DSCMRI at 3 T on two occasions. Normal circle of Willis anatomy and flow were determined by PCA and Q-flow. Timing parameter maps (arrival and transit) were derived, and nonlinear templates generated in MNI space. Skeletonisation was used to determine linear local maxima with regions of latest arrival or longest transit presumed likely to represent perfusion boundaries. RESULTS This technique described the major cerebral perfusion territories, in addition to perforator MCA and even cerebellar territories. The anterior and posterior cortical, and internal borderzones were identified. A further juxtacortical interface with prolonged transit was observed. DISCUSSION Using this technique, an MNI atlas of perfusion territories has been produced which includes MCA perforator and

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cerebellar regions. The juxtacortical perfusion interface may represent the manifestation of flow phenomena which predispose to deposition of blood-borne metastases at the superficial grey-white matter junction. O1A-2.3 DTI-BASED FUNCTIONAL DIFFUSION MAPS AND HISTOGRAM ANALYSIS TO EVALUATE STRUCTURAL CHANGES IN CEREBRAL GLIOMAS AFTER CHEMOTHERAPY Antonella Castellano1, Marina Donativi2, Giorgio De Nunzio2, Marco Riva3, Roberta Rudà4, Riccardo Soffietti4, Lorenzo Bello3, Andrea Falini1 1 Neuroradiology Unit and CERMAC, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy, 2 A.D.A.M., Advanced Data Analysis in Medicine, University of Salento, Lecce, Italy, 3Neurosurgery, Istituto Clinico Humanitas, University of Milano, Milan, Italy, 4Neuro-oncology, Department of Neuroscience and Oncology, University of Torino, Turin, Italy In infiltrating gliomas, changes in water diffusion patterns after chemotherapy, as measured by Diffusion Tensor Imaging (DTI), may occur before size variations on conventional MRI. To verify this hypothesis, we applied Functional Diffusion Map (fDM) analysis to compare voxel-by-voxel DTI metrics over time, and histogram analysis, to quantify changes of these metrics, in low-grade gliomas (LGGs) undergoing temozolomide (TMZ) chemotherapy. We analyzed 11 LGG patients who underwent 3 T-MR at baseline and after three and six TMZ cycles, with T1, T2, 3D-FLAIR and DTI sequences (b01000 s/mm2, 32 directions). Fractional anisotropy (FA), mean diffusivity (MD) and other DTI-derived maps (i.e. p and q) were obtained. fDM analysis was performed on coregistered post-chemio and baseline maps. Histogram parameters (i.e. mean, skewness) were calculated and their time evolution assessed. Changes in diffusion parameters were compared with volumetric response on FLAIR and with clinical response. Five patients had stable disease (SD) responses at conventional imaging, five had minor response, one had progressive disease; nonetheless, in four SD patients seizure frequency significantly decreased. In all patients, modifications of isotropy (MD,p) and anisotropy (FA,q) values were seen by fDMs, and correlated with clinical response. Diffusion changes on isotropy maps were mainly detected in peripheral tumor areas. Histogram analysis demonstrated significant mean and skewness changes in relation to volumetric changes at 6 months; nine patients

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with coherent histogram parameters changes on tensor maps had significant clinical improvement. In LGG patients, DTI changes may be early predictors for TMZ response, correlating with clinical response better than conventional MRI criteria. O1A-2.4 CEREBRAL BLOOD VOLUME CALCULATED BY D Y N A M I C S U S C E P T I B I L I T Y C O N T R A S TENHANCED PERFUSION MR IMAGING: PRELIMINARY CORRELATION STUDY WITH GENETIC PROFILES IN GLIOBLASTOMA

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CONCLUSION We found that glioblastomas with aggressive genetic alterations tended to have high rCBV in the present study. Thus, we believe that DSC-MRI can be a noninvasive radiophenotypic surrogate for genetic alterations which were crucial in predicting the prognosis and selecting the tailored treatment in glioblastoma patients. O1A-2.5 THE ROLE OF 1 H-MAGNETIC RESONANCE SPECTROSCOPY (MRS) AND VOLUMETRIC ANALYSIS IN THE DIAGNOSIS OF MULTIPLE SYSTEM ATROPHY (MSA)

Inseon Ryoo, Seung Hong Choi, Soo Chin Kim, Jeong A Yeom, Hwa Seon Shin, Seung Chai Jung Seoul National University Hospital, Seoul, Republic of Korea

Viren Kadodwala, Stuart Currie, Marios Hadjivassiliou, Nigel Hoggard University of Sheffield, Sheffield, UK

PURPOSE To evaluate the usefulness of dynamic susceptibility contrastenhanced perfusion MR imaging (DSC-MRI) in predicting major genetic alterations in glioblastomas. METHOD AND MATERIALS Twenty-five patients with pathologically proven glioblastoma who underwent DSC-MRI before the surgery were included. On DSC-MRI, normalized relative cerebral blood volume (rCBV) of the enhancing solid portion of each tumor was calculated by using a dedicated software (Nordic TumorEX, NordicNeuroLab, Bergen, Norway) which enabled semi-automatic segmentation for each tumor. Six major genetic alterations of glioblastomas (epidermal growth factor receptor(EGFR), phosphatase and tensin homologue (PTEN), Ki-67, phosphorylated form of histone H3(pHH3), O6-methylguanine-DNA methyltransferase(MGMT) and p53) were confirmed by immunohistochemistry and analyzed for correlation with the normalized rCBV of each tumor. Statistical analysis was performed using unpaired Student's t-test and Pearson correlation test. RESULTS Normalized rCBVs of MGMT methylation negative group (mean: 9.5±7.5 mL/100 mg) were significantly higher than those of MGMT methylation positive group (mean: 5.4± 1.8 mL/100 mg) (p0.046). In the analysis of EGFR expression positive group, normalized rCBVs of the subgroup with loss of PTEN expression gene (mean: 10.3±8.1 mL/100 mg) were also significantly higher than those of the subgroup without loss of PTEN expression gene (mean: 5.6 ± 2.3 mL/100 mg)(p 0.046). Ki-67 labeling index showed significant positive correlation with normalized rCBV of the tumor(p0.01).

OBJECTIVE To investigate if MR imaging and MRS at presentation in patients clinically suspected of having MSA-C aid the diagnosis. METHODS Retrospective analysis and comparison of imaging from 21 patients clinically suspected of having MSA-C, 21 patients with idiopathic sporadic ataxia (ISA) and 20 healthy controls. The scans at presentation were analysed. The metabolite levels of NAA/Cr and Cho/Cr were measured in the cerebellar hemisphere and vermis. The volumes of the brainstem, 4th ventricle (BS) and cerebellum were also measured. Voxel based morphometry (VBM), comparing MSA-C and ISA patients with the controls, was performed. RESULTS There was reduction in NAA/Cr levels in MSA-C patients when compared with the ISA patients (p<0.001) and controls (p<0.001) in both the hemisphere and vermis. There was a reduction of Cho/Cr in the vermis of MSA-C patients compared to the controls (p<0.001) and ISA patients (p<0.001). The BS volume was reduced in MSA-C patients compared to ISA patients (p<0.001) and controls (p<0.001). There was no difference in cerebellar volume in MSA-C and ISA patients (p00.066) but there was a difference between MSA-C and controls (p<0.001). VBM showed a more widespread loss of grey matter in the cerebellum of MSA-C patients compared to controls and ISA patients. CONCLUSION MSA-C patients have significantly greater reduction of NAA/ Cr and Cho/Cr in the cerebellum. They also have significant brainstem volume and more prominent grey matter loss on VBM compared to ISA patients. MRS and volumetric analysis can aid the diagnosis of MSA-C and differentiate it from ISA.

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O1A-2.6 HIGH-RESOLUTION 3D-PSIF DWI IN THE DIAGNOSIS OF CHOLESTEATOMAS ON 3 T MRI Takao Kodama, Takanori Yano, Shozo Tamura University of Miyazaki, Miyazaki, Japan INTRODUCTION Usefulness of diffusion weighted imaging (DWI) in the evaluation of cholesteatomas has been widely recognized. DWI using echo planar imaging (EPI-DWI), however, is vulnerable to susceptibility artifacts even with parallel imaging, especially at 3 T MRI. This study aimed to evaluate the utility of DWI using 3D-PSIF (reversed FISP) in the diagnosis of middle ear cholesteatomas. METHODS EPI-DWI and PSIF-DWI were retrospectively compared in 78 patients who had undergone middle ear surgery (62 cholesteatomas and 16 other middle ear pathologies). All studies were performed on a clinical 3 T MRI with a 32channel head coil. Voxel size of EPI-DWI and PSIF-DWI was 0.85 x 0.85 x 1.5 mm and 0.57 x 0.57 x 2 mm, respectively (with zero-fill interpolation). RESULTS Sensitivity, specificity and accuracy of PSIF-DWI (83.9 %, 75 % and 82.5 %) were slightly better than that of EPI-DWI (72.6 %, 75 %, and 73.1 %). Image quality of PSIF-DWI was superior to that of EPI-DWI in the most cases mainly because of less susceptibility effects and detailed anatomical information could be obtained on PSIF-DWI. One of drawbacks to PSIF-DWI was lack of quantitative evaluation such as ADC. CONCLUSION High-resolution 3D PSIF-DWI can be a robust sequence for diagnosing middle ear cholesteatomas. PARALLEL SESSION 1A - SCIENTIFIC PAPERS 1A.3 O1A-3.1 PATERNAL OCCUPATION IN CHILDHOOD PREDICTS RISK OF LATE-LIFE CEREBROVASCULAR DISEASE Alison Murray1, Christopher McNeil1, Roger Staff2, John Starr3, Ian Deary3, Lawrence Whalley1 1 University of Aberdeen, Aberdeen, UK, 2NHS Grampian, Aberdeen, UK, 3University of Edinburgh, Edinburgh, UK AIM Cerebrovascular disease (detected as white matter hyperintensities (WMH) on T2 weighted MRI), is common in older people, and is associated with poorer cognition. Although some risk factors for WMH are known (e.g.

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hypertension and diabetes) the cause for much variability in WMH abundance is unknown. Here we test the hypothesis that early life socio-economic environment influences late life cerebrovascular disease. METHODS 227 participants from the Aberdeen 1936 birth cohort (ABC36) underwent brain MRI aged 68, and WMH were assessed by an experienced rater using Scheltens' scale. Paternal occupation was graded according to the UK's Office of Population Statistics classification. Childhood intelligence, educational achievement, adult occupation and hypertension were assessed by questionnaire or measurement. A structural equation model (SEM) was constructed a priori and analysed using AMOS 18. This model investigated the influence of paternal occupation (a proxy for early life socio-economic environment) on WMH, accounting for potential confounders including childhood IQ, education, adult occupation and hypertension. RESULTS We found that greater paternal occupational achievement had a direct negative effect on WMH (p<0.001, standardised regression weight η00.22). This effect was independent of the significant (p<0.001; η00.25) WMH promoting effect of hypertension. Childhood IQ, occupation, and education did not affect WMH score. CONCLUSIONS The paternal occupation of ABC36 participants predicts their risk of cerebrovascular disease aged 68 years. The magnitude of this influence is similar to that of hypertension. The mechanism underlying this effect is unknown, but may act through fetal/early life programming of cerebrovascular disease. O1A-3.2 EVALUATION OF METABOLIC, PERFUSION AND MICROSTRUCTURAL CEREBRAL ALTERATIONS I N PAT I E N T S W I T H H E PAT I T I S C V I R A L I N F E C T I O N U S I N G M R S P E C T R O S C O P Y, PERFUSION AND DIFFUSION TENSOR IMAGING Anna Zimny, Joanna Bladowska, Anna Koltowska, Brygida Knysz, Jacek Gasiorowski, Michal Furdal, Marek Sasiadek Wroclaw Medical University, Wroclaw, Poland PURPOSE Aim of the study was to evaluate metabolic, perfusion and microstructural cerebral alterations in asymptomatic patients with hepatitis C viral (HCV) infection and normal appearing brain on plain MR using advanced techniques: MR spectroscopy (MRS), perfusion weighted and diffusion tensor imaging (PWI and DTI).

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MATERIAL AND METHODS Fifteen HCV patients (mean age 39.5 yrs) with normal appearing brain on plain MR and 18 age-matched control subjects underwent single voxel MRS, dynamic susceptibility contrast enhanced PWI and DTI in 25 directions on 1.5 T MR unit. Metabolite ratios (NAA/Cr, Cho/Cr, mI/Cr) were calculated from anterior and posterior cingulate gyrus as well as left frontal and parietal white matter and basal ganglia. Values of cerebral blood volume related to cerebellum (rCBV) were assessed from 8 regions including different cortical locations, basal ganglia and fronto-parietal white matter. Fractional anisotropy (FA) values were obtained from 14 white matter tracts including projection, commissural and association fibers. RESULTS Compared to controls, HCV patients showed significantly (p< 0.05) lower NAA/Cr ratios within frontal and parietal white matter, lower rCBV values within frontal and temporo-parietal cortex bilaterally and decreased FA values in both middle cerebellar peduncles, inferior longitudinal fascicles, inferior fronto-occipital fascicles and genu of corpus callosum. CONCLUSIONS The results of advanced MR techniques reflect neuronal loss within white matter, cortical hypoperfusion and disintegrity within several association and commissural tracts thus confirm neurotoxicity of HCV. MR techniques may be used as noninvasive neuroimaging biomarkers for assessing the severity of microstructural changes in patients with HCV infection. O1A-3.3 IMPAIRED PHYSICAL HEALTH MEDIATES THE RELATIONSHIP BETWEEN CEREBROVASCULAR DISEASE IN THE BASAL GANGLIA AND POSTERIOR FOSSA AND DEPRESSIVE SYMPTOMS Alison Murray1, Christopher McNeil1, Roger Staff2, John Starr3, Ian Deary3, Lawrence Whalley1 1 University of Aberdeen, Aberdeen, UK, 2NHS Grampian, Aberdeen, UK, 3University of Edinburgh, Edinburgh, UK BACKGROUND Depression is important in late life and is associated with increased morbidity and mortality. Cerebrovascular disease (white matter hyperintensities [WMH]) is associated with increased depressive symptoms. Here we investigate if WMH location determines their influence on depressed mood. METHODS 219 subjects from the Aberdeen 1936 birth cohort underwent brain MRI aged 68, and WMH were assessed using Scheltens' scale. Cognitive fability was determined using Raven's Progressive Matrices, Auditory Verbal Learning Test, Uses of Common Objects, Digit Symbol and National Adult Reading

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Test. Depressive symptoms were quantified using the Hospital Anxiety and Depression Scale. Hypertension was assessed by measurement or medical history. Physical health was determined by walk speed and lung function. A structural equation model was constructed and analysed using AMOS 18. This model investigated the influence of regional WMH on depressive symptoms, and the involvement of mediating factors such as cognitive ability, physical health and hypertension. RESULTS Results confirm the negative effect of whole brain hyperintensities on cognitive ability (b0-0.18- -0.23) and indicate that cognitive ability has a negative relationship with depressive symptoms (b0-0.14 - -0.17). However, in a model testing the influence of basal ganglia and infratentorial lesions, the effect of cognitive ability is overwhelmed by the much stronger effect, of impaired physical health on depressed mood (b0-0.27). CONCLUSION The mechanism by which WMH influence depressive symptoms is dependent on location. Lesions in the basal ganglia and infratentoral regions have the strongest effect and are mediated by impaired physical health. O1A-3.4 BRAIN MAGNETIC RESONANCE IN EPISODIC HEPATIC ENCEPHALOPATHY A Rovira1, L Chavarría1 ,2, J Alonso1 ,3, M Simon-Talero1, M Ventura1, R García-Martínez1, M Torrents1, J Córdoba1 ,2 1 Hospital Universitari Vall d'Hebron, Barcelona, Spain, 2 Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain, 3Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain BACKGROUND AND PURPOSE Brain MR has shown a series of metabolic and water distribution abnormalities that could be useful for the diagnosis of hepatic encephalopathy (HE). However, most MR studies have been performed in patients with minimal HE, while only few have assessed patients during an HE episode. The purpose of this study is to investigate the disturbances of brain water and metabolites in cirrhotic patients with episodic HE and relate them to the severity of HE. METHODS Cirrhotic patients with overt signs of HE (n018) (grade I-II: n06, grade III-IV: n012) and a control group (n08) underwent 3 T brain MR examination (1 H-MRS and DWI). In 14 patients the MR exam was repeated after resolution of HE.

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RESULTS Brain glutamine was higher at baseline in patients compare to controls (Gln/Cr: 2.40±0.78 vs. 0.22±0.08, p<0.001), decreased during follow-up (1.55 ± 0.55, p 00.028), and showed a positive correlation with the severity of HE (r00.62; p00.006) and with plasma ammonia concentration (r00.513, p00.006). During HE patients exhibited an increase in the ADC, which decreased when patients recovered from HE (corticospinal tract: from 780 ± 44 μm2/s to 758 ± 44 μm2/s, p 00.025; parietal white matter: from 884 ± 54 μm 2 /s to 842 ± 38 μm 2 /s, p 0 0.016). However, ADC values at baseline did not correlate with the severity of HE. CONCLUSIONS Brain glutamine assessed by 1 H-MRS could be a good biomarker for the assessment of HE. However, the increase of brain ADC in HE, likely reflecting a mild degree of vasogenic edema, does not seem to correlate with the degree of HE. O1A-3.5 MULTIMODAL APPROACH IN DIAGNOSIS AND MONITORING OF CEREBRAL CHANGES IN ASYMPTOMATIC PATIENTS WITH HIV INFECTION USING MR SPECTROSCOPY, PERFUSION AND DIFFUSION TENSOR IMAGING Joanna Bladowska, Anna Koltowska, Anna Zimny, Brygida Knysz, Jacek Gasiorowski, Michal Furdal, Marek Sasiadek Wroclaw Medical University, Wroclaw, Poland PURPOSE Aim of the study was to evaluate cerebral alterations in clinically asymptomatic cART-treated and non-treated patients with HIV infection and normal appearing brain on plain MR using advanced MR techniques: MR spectroscopy (MRS), perfusion weighted (PWI) and diffusion tensor imaging (DTI). MATERIAL AND METHODS Twenty one non-treated and 20 cART-treated asymptomatic HIV patients with normal appearing brain on plain MR and 18 age-matched control subjects underwent single voxel MRS, dynamic susceptibility contrast enhanced PWI and DTI in 25 directions on 1.5 T MR unit. Metabolite ratios (NAA/Cr, Cho/Cr, mI/Cr) were calculated from anterior and posterior cingulate gyrus as well as left frontal and parietal white matter and basal ganglia. Values of cerebral blood volume related to cerebellum (rCBV) were assessed from 8 regions including different cortical locations, basal ganglia and fronto-parietal white matter. Fractional anisotropy (FA) values were obtained from 14 white matter tracts including projection, commissural and association fibers.

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RESULTS Compared to controls, non-treated HIV patients showed significantly (p < 0.05) lower rCBV values in several cortical locations, decreased FA values in inferior longitudinal fascicles, inferior fronto-occipital fascicles and corpus callosum without changes in MRS. cARTtreated HIV-patients revealed lower NAA/Cr levels in cingulate gyrus and parietal white matter as well as more pronounced alterations in PWI and DTI compared to non-treated patients. CONCLUSIONS Advanced MR techniques may be useful in evaluation of severity of brain damage in patients with HIV infection. More pronounced changes in the group of cARTtreated patients may be explained by treatment and viral neurotoxicity. O1A-3.6 METABOLIC ALTERATIONS AND ATROPHY OF THE GRAY (GM) AND WHITE MATTER (WM) IN PAT I E N T S W I T H C L I N I C A L LY I S O L AT E D SYNDROME (CIS):1 H MRS AND MRI VOLUMETRIC STUDY Zinayida Rozhkova 1 , Oleksyi Omelchenko 1 , Tetyana Kobys'1 1 Medical Clinic BORIS, Kiev, Ukraine, 2Center of Multiple Sclerosis, Kiev, Ukraine PURPOSE On the basis of the analysis of 1 H MRS and volumetric data we propose quantitative approach for evaluation metabolic alterations and cerebral atrophy in patients with CIS. METHODS MRI and 1 H in vivo MRS were performed in 23 patients with CIS (16-43y, disease duration 3-6y) and in 10 volunteers (23-40y) with 1.5 T SIGNA EXCITE (GE). MRI data were obtained by T2/PD, FLAIR, T1SE(pre-contrast), 3D-SPGR(post-contrast), and T1-SE (post-contrast). 1 H spectra are recorded with the 2DCSISTEAM:TR/TE03000/144 ms. RESULTS From analysis of MRI in patients with CIS an increase of ventricular volume (+40 %, p00.005) and decrease of cerebral volume (-2 %) are obtain. Total brain atrophy was correlated with GM atrophy. From analysis of MR spectra the mean values of NAA/Cr, NAA/Cho, and Cho/Cr ratios are obtain. In the black holes localized in the WM the mean values of NAA/Cr01.47, and in the GM NAA/Cr01.76. In the black holes localized in the WM the mean values of Cho/Cr03.93, and in GM Cho/Cr02.46. In the black holes

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localized in the WM the mean values of NAA/Cho00.93, and in GM NAA/Cho00.84. We have found out correlation between Cho/Cr and NAA/Cho ratios with GM atrophy, and also correlation of NAA/Cr with WM atrophy. GM atrophy explains clinical disability better than WM atrophy. CONCLUSION Bringing together volumetric and MRS data confirms axonal damage and GM atrophy in patients with CIS. The volume of the black holes in WM predicted GM atrophy, which indicates that WM axonal damage is at least partially responsible for the GM atrophy in patients with CIS. O1A-3.7 MRI AND CLINICAL FOLLOW-UP IN ADULT-ONSET AUTOSOMAL DOMINANT LEUKODYSTROPHY (ADLD) WITH AUTONOMIC SYMPTOMS Johannes Finnsson1, Atle Melberg2, Raili Raininko1 1 Department of Radiology, Uppsala University, Uppsala, Sweden, 2Department of Neuroscience/Neurology, Uppsala University, Uppsala, Sweden PURPOSE Adult-onset ADLD with autonomic symptoms is a rare disease with a clinical course somewhat similar to primary progressive multiple sclerosis but with different imaging findings. Patients present in the fourth to sixth decade with autonomic symptoms and later develop symptoms from the pyramidal and cerebellar tracts. MR imaging findings are characteristic. We present MRI and clinical follow-up in this disease. METHODS 12 subjects, 5 females and 7 males, with proven genetic linkage to the disease were recruited to the study. They were from two non-related families. Four were asymptomatic and the rest had symptoms ranging from mild to severe when recruited at the ages of 29-58 years. Subjects were examined 2-5 times with standard MR imaging over a time of 113 years. They also underwent neurological clinical follow-up during the same period. RESULTS All subjects had pathological findings in the first MR examination. One asymptomatic subject had changes only in the pyramidal tracts, all the other subjects had changes also in the cerebellar peduncles. Cerebral white matter was first affected frontoparietally. White matter was always affected occipitally after the age of 45 and after the age of 50 most often also temporally. All subjects presenting motor symptoms had extensive cerebral white matter changes. Five subjects, all over 48, exhibited more than mild substance loss at the first investigation. Substance loss progressed in 3 subjects during follow-up. All subjects

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showed progress in radiological changes, though not all showed clinical progress. CONCLUSION Radiological changes preceded clinical symptoms and showed faster progress. PARALLEL SESSION 1B - SCIENTIFIC PAPERS 1B.1 O1B-1.1 UPDATE ON COIL USAGE FROM HELPS RCT Philip White2, Johann du Plessis1 1 Institute of Neurological Sciences, Glasgow, UK, 2University of Edinburgh, Edinburgh, UK AIM To compare coils used per aneurysm using hydrogel coated coils versus bare platinum coils by aneurysm size catgeory METHODS AND MATERIALS Using the HELPS database, 491 cases were identified in which adequate details were recorded (out of a total of 499 enrolled and 492 coiled). We determined the mean amount of coils used per case in the bare platinum coil arm (n0248) and mean amount of coils used per aneurysm in the HES coil arm for each of three different size categories (small, medium and large), determining also the mean mount of actual HES used in the HES arm. 8 cases were excluded from the study due to crossover and a single giant aneurysm was also excluded. RESULTS On average 0.89 more coils were used per aneurysm in the bare platinum arm of the trial than in the HES arm. The mean amount of coils per aneurysm in the bare platinum arm was 6.42(n0245) and in the HES arm 5.53(n0227). In the HES arm 69.25 % of coils used were actually HES coils (3.83 coils per aneurysm). The greatest difference was 1.2 fewer coils used in the medium sized aneurysm group and in fact on avergae 1.1 more coils were used in the large aneurysm group in the HES arm. CONCLUSIONS The findings of this analysis help explain the findings of the main HELPS trial where HES benefit was concentrated in ruptured aneurysms and medium sized aneurysms, particularly where HES target useage was met. O1B-1.2 DOUBLE LUMEN REMODELING BALLOONS ASCENT AND SCEPTER. NEW FAR BETTER TOOLS FOR BALLOON ASSISTED COILING TECHNIQUE Krzysztof Kadziolka, George Robin, Laurent Pierot Interventional Neuroradiology Departement, CHU Reims, Reims, France

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OBJECTIVE We describe our preliminary experience in use of two types new double lumen balloons Ascent and Sceptre for endovascular treatment of large neck and bifurcation aneurysms. METHOD 51 patients with large neck intracranial aneurysms were treated with use of new remodelling balloons in or institution 38 with Ascent and 13 with Scepter respectively. In 11 cases we performed direct coiling through inner catheter lumen with balloon inflated across the aneurysm neck simultaneously (Direct Balloon Catheter Coiling Technique). In 40 cases we used both balloon for sidewall aneurysms as a standard Balloon Assisted Technique. In 4 cases we deployed a stent Lvis Junior using balloon microcatheter internal lumen. RESULTS We achieved satisfactory anatomical occlusion of the aneurysms(Montreal scale:A or B). In one case we experienced sac perforation without clinical sequel. Our preliminary experience allow us to identify some advantages, differences as well as some drawbacks and limitations of the two types of double lumen balloons. We observed rigidity of the Ascent first generation balloon. From the other hand Scepter balloon represents better navigability characteristic but available model does not provide the mean for Direct Balloon Catheter Coiling Technique and we find it less stable. CONCLUSION Use of new double lumen balloon technology provides an improved alternative mean for the remodelling technique. Ascent balloon offers new application such as Direct Balloon Catheter Coiling. Inner diameter of both balloons is adapted for deployemen of low profile stent Lvis Junior. O1B-1.3 E N D O VA S C U L A R T R E AT M E N T O F M C A ANEURYSMS: CLINICAL AND RADIOLOGICAL OUTCOMES OF A LARGE SERIES Alex Mortimer, Kumar Abhinav, Peter Mews, Fionnan Williams, Richard Nelson, Marcus Bradley, Shelley Renowden Frenchay Hospital, Bristol, UK PURPOSE There is controversy as to the best mode of treating MCA aneurysms, with some believing that surgical clipping is the treatment of choice. We report the results of a large endovascular series treated at our centre.

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METHODS A retrospective review of case notes and the radiology system was used to acquire data on all patients with MCA aneurysms treated between January 1995 and June 2011. Clinical presentation, WFNS grade, aneurysm site, size and neck morphology were recorded, along with clinical and radiological outcome as assessed with Glasgow Outcome Score and MRA. RESULTS 270 patients with MCA aneurysms were treated. 68 % of cases in our series were ruptured aneurysms treated as emergencies. The WFNS grades were, 16 % grade 1, 24 % grade 2, 32 % grade 3 and 26 % grade 4. The majority were morphologically small, 72 % compared to medium/large 24.5 % and giant 3.5 %. The technical failure rate was 1.5 %, with four patients needing surgical clipping of the aneurysm. Nine patients (3.5 %) suffered thromboembolic or hemorrhagic complications in the immediate aftermath of the procedure, which resulted in death. One was unruptured, seven were grade 4 and one was grade 5 WFNS. The re-treatment rate overall was 7 %. Eighty-five percent had a Glasgow Outcome Score of 4-5. CONCLUSIONS Our experience demonstrates that endovascular treatment of MCA aneurysms is safe with low rates of technical failure, complications (in line with those of other intracranial aneurysms) and re-treatment. Therefore coiling is acceptable as the primary treatment for MCA aneurysms. O1B-1.4 ENDOVASCULAR TREATMENT OF CRANIAL A N E U RY S M S W I T H T H E P I P E L I N E F L O W DIVERTING STENTS: OUR INITIAL RESULTS Ismail Oran1, Celal Cinar1, Halil Bozkaya1, Erkin Ozgiray2 1 Ege University Medical School Department of Radiology, Izmir, Turkey, 2Ege University Medical School Department of Neurosurgery, Izmir, Turkey OBJECTIVE To present our initial experience with a new flow diverting device designed for aneurysm treatment. MATERIALS AND METHODS Forty-five consecutive patients underwent an endovascular treatment of 55 intracranial aneurysms or dissections using the flow diverting device (Pipeline, ev3) between November 2009 and December 2011. Pipeline was implanted without assistance of any other embolization materials. The targeted vessels were located in anterior circulation in 39 (87 %) and posterior circulation in 6

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(13 %) patints. Multiple devices were implanted in 9 lesions (%16). RESULTS A total of 55 aneurysms in 45 patients were treated. Twentyone aneurysms were asymptomatic, and 12 patients had mass-induced neurological deficit and headache. The aneurysm occlusion rate at 6-month was 94.8 % (37/39) and the overall occlusion rate at 12-month was 92.8 % (26/28). In cases previously untreated, the 6-month occlusion was 97.1 % (34/35). Three patients (6,6 %) had asymptomatic in-construct stenosis of less than 50 %. Acute aneurysmprovoked mass effect resolved or improved significantly in all cases. One major (fatal nonaneurysmal cerebellar hemorrhage) an one minor (TIA) clinical complications were encountered. There were 2 tecnical complications (acute stent thrombosis) without clinical consequences. CONCLUSIONS The Pipeline flow diverting stent represents an important advance in the endovascular therapy of cerebral aneurysms, targeting primary parent vessel reconstruction rather than endosaccular occlusion. Using Pipeline was safe and efficacious in difficult intracranial aneurysms with a high occlusion rate at 6-month. O1B-1.5 FLOW DIVERTER STENTS IN THE TREATMENT OF CHALLENGING INTRACRANIAL AND EXTRACRANIAL ANEURYSMS: EXPERIENCE IN AN IRISH INSTITUTION Mark McCusker, Jane Cunningham, Seamus Looby, Paul Brennan, Alan O'Hare, John Thornton Beaumont Hospital, Dublin, Ireland PURPOSE Flow diverter stents are a new treatment option for intracranial aneurysms considered difficult or impossible to treat with conventional methods. They may also have a role in aneurysms of the cervical internal carotid artery. We present our experience using flow diverter stents with findings at angiographic follow up. MATERIALS AND METHODS To date we have treated 17 aneurysms in 16 patients (aged 3-73 years) with flow diverter stents. 10 aneurysms were located in the anterior circulation, 3 in the posterior circulation, and 4 in the extracranial internal carotid artery. All were considered unsuitable for endovascular coiling and neurosurgical clipping. RESULTS Stents were deployed successfully in 16 of 17 cases.

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One procedure was complicated by embolus to a right middle cerebral artery branch, with resultant mild right hemiparesis. One patient had a retroperitoneal haematoma and two minor groin complications. When stents were successfully deployed, end of procedure angiogram showed immediate reduction in flow to the aneurysm in 14 out of 16. To date, angiographic follow-up has been performed in 13 cases. There has been complete occlusion of 6 aneurysms, progressive occlusion of 5, and no change in 2. The remainder are due follow up within 6 months. CONCLUSION Flow diverter stents can be deployed successfully with minimal immediate complications in the majority of cases. We have used them for both intracranial and extracranial aneurysms. While post-procedure angiography frequently showed reduction in aneurysm flow, complete occlusion occurred in less than half our treated aneurysms followed up within 12 months. O1B-1.6 INTRA-ANEURYSMAL FLOW DISRUPTION: PRELIMINARY CLINICAL EXPERIENCE OF A NEW APPROACH FOR THE ENDOVASCULAR TREATMENT OF INTRACRANIAL ANEURYSMS Laurent Pierot, Krzysztof Kadziolka CHU Reims, Reims, France PURPOSE Standard coiling is the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device not in the parent vessel but in the aneurysm sac. Preliminary clinical experience is presented. MATERIALS AND METHODS WEB (Sequent, Aliso Viejo, CA) is a self-expanding, oblate, braided nitinol mesh, deployed through microcatheters with an internal diameter>0.027”. Clinically, eight patients (7 females, 1 male; age: 45-65 years) harbouring unruptured aneurysms (basilar artery: 1, internal carotid artery: 1, anterior communicating artery: 2, and middle cerebral artery: 4) were treated between June 2011 and April 2012 using the intra-aneurysmal flow-disrupter WEB. RESULTS The device was successfully deployed in all cases. In two cases, a too small size of the device was selected and additional coiling was performed. No intraoperative

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complication was observed. Postoperatively two patients had mild, transient neurological deficit. At short or midterm follow-up, appropriate occlusion (total occlusion or neck remnant) was observed in all cases. CONCLUSION Intra-saccular flow disruption using WEB is a new way to treat some types of aneurysm, particularly wide-neck bifurcation aneurysms. This preliminary clinical experience shows the safety and efficacy of the device when used in appropriately selected cases. PARALLEL SESSION 1B – SCIENTIFIC PAPERS 1B.2 O1B-2.1 PREVALENCE OFANTERIOR INTERNAL AUDITORY CANAL "DIVERTICULUM" ON CT IN PATIENTS WITH OTOSCLEROSIS M.C. Hoeberigs, J.J Waterval, R.R. Stokroos, A.A.R.S. Stadler Maastricht University Hospital, Maastricht, The Netherlands PURPOSE In patients with otosclerosis an otosclerotic hypodense cavitating plaque at the medial margin of the otic capsule, seen as an indentation or "diverticulum" of the anterior margin of the internal auditory canal (IAC), might be present. We aimed to determine the prevalence of this easily identifiable anterior IAC indentation on CT in patients with otosclerosis. METHODS AND MATERIALS 222 consecutive high resolution CT scans (0.4-0.6 mm) of the mastoid bone in patients with conductive or mixed hearing loss from January 2008 to December 2010 were retrospectively reviewed by 2 neuroradiologists and 1 ENT surgeon. A total of 444 ears was scored for presence and severity of otosclerosis (graded according to the Symons/ Fanning classification: 1 fenestral; 2 patchy pericochlear; 3 extensive pericochlear) and for the presence of anterior IAC diverticulum/plaque (defined as an obvious notch in the anterior IAC margine, isodense to the IAC itself; a faint curvature of the wall was scored negative). RESULTS Anterior IAC diverticulum was observed in 9/92 ears (10 %) with only fenestral otosclerosis; in 9/35 (25 %) of grade 2 patchy cochlear otosclerosis and in 14/20 (70 %) with grade 3 otosclerosis. Only 1 patient without CT-signs of otosclerosis, but with clinical stapedial fixation, demonstrated bilateral IAC hypodensity (2/297 ears or 0.6 %). CONCLUSION Evaluation of the anterior IAC might aid in the detection of not only cochlear, but also in the more subtle fenestral otosclerosis.

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O1B-2.2 RADIOCHEMOTHERAPY INDUCED MODIFICATION OF LOCAL TUMOR BLOOD SUPPLY ESTIMATED BY DCE-CT AND FRACTAL ANALYSIS IN HEAD AND NECK TUMORS Andrij Abramyuk1, Nasreddin Abolmaali2, Volker Hietschold2, Steffen Appold3, Rudiger von Kummer1 1 University Hospital Carl Gustav Carus at the Technische Universität Dresden, Neuroradiology, Dresden, free state of Saxony, Germany, 2University Hospital Carl Gustav Carus at the Technische Universität Dresden, Radiology, Dresden, free state of Saxony, Germany, 3University Hospital Carl Gustav Carus at the Technische Universität Dresden, Radiology, Dresden, free state of Saxony, Germany PURPOSE Clinical/experimental observations suggest that radiochemotherapy (RChT), inhibits tumorangiogenesis in addition to a direct cytotoxic effect. Aim of study was to investigate RChT-induced changes of tumor blood volume (rTBV) and transfer coefficient (Ktrans) assessed by dynamic contrast enhanced CT (DCE-CT) and fractal analysis in Head and Neck Tumors (HNT). MATERIALS AND METHODS We performed DCE-CT in 15 patients with clinically inoperable HNT for RChT, after 20 Gy/2 cycles Cisplatin+1 cycle 5Fluorouracil and 50 Gy/5 cycles Cisplatin + 1 cycle 5Fluorouracil and assessed rTBV und Ktrans using pixel-based Software (VPCT). Lacunarity, slope of log(lacunarity) vs. log (box size), fractal dimension were determined from DCE-CT data. Dynamics of rTBVand Ktrans were compared with tumor volume changes during RChT and at 24 months follow-up. RESULTS An increase of rTBV and/or Ktrans after 20 Gy, followed by a decrease of both parameters after 50 Gy (p<0.05) was noted in n011 patients. Complete tumor response was determined in 10/11 except for one patient with local recurrence. Consecutive decrease of Ktrans and partial tumor response was detected in 3 patients. In 1 patient with elevation of both rTBV and Ktrans tumor progress was noted during follow-up. Slope of log(lacunarity) vs. log(box size), declined considerably under RChT, while reduction of other parameters was less pronounced. No correlation between any of these parameters and therapy outcome in 24 months follow-up was found. CONCLUSION Changes of absolute values of rTBV and Ktrans and their intratumoral heterogeneity may reflect RChT-induced altered oxygen distribution based on modified local tumor blood supply.

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O1B-2.3 PREDICTIVE MR IMAGING FEATURES IN VESTIBULAR SCHWANNOMA RADIOSURGERY Estanislao Arana1, Leoncio Arribas2 1 Dept. Radiology. Fundacion IVO, Valencia, Spain, 2Dept.Radiotherapy. Fundacion IVO, Valencia, Spain PURPOSE Determine if findings on magnetic resonance imaging (MRI) on pretreatment imaging are predictive of improved hearing preservation and outcomes after vestibular schwannoma stereotactical radiosurgery MATERIAL AND METHODS Seventy four patients diagnosed of vestibular schwannoma, (34 men, 40 women; 58.49±13.37 years) were treated with stereotactical radiosurgery. All patients had pretreatment MRI (including 3D T1 weighted images after gadolinium), complete preradiosurgery and posradiosurgery audiologic data and follow-up. Imaging features were blindly analyzed size, as fundal fluid status (absence, < 2 mm and >2 mm), cochlear signal intensity compared to contralateral side and type of tumor on T1-post contrast images (homogeneus, heterogeneous and cystic). Statistics were analyzed by SPSS 20 (IBM, NY, USA). RESULTS Cochlear signal hypointensity was predictive of no hearing recovery after treatment (c2, p<0.05) and shorter diseasefree interval (5±4 vs 34±32 months; ANOVA, p00.01). Larger tumors presented larger fundal fluid without statistical significance, although the biggest lesions were cystic (Kruskall-Wallis test, p<0.001). No relationship was found among fundal fluid and hearing recovery after radiotherapy or disease-free interval. Neither type of tumor enhancement nor size were statistically predictive for final outcomes or disease-free interval. CONCLUSSION The presence of cochlear signal hypointensity on pretreatment MRI is predictive of hearing outcomes and should be used in counseling patients who are considering radiosurgery as treatment of isolated vestibular schwannoma O1B-2.4 3T IN NEURORADIOLOGY, STATE OF THE ART Raffaele Agati, MD UOC Neuroradiologia, Ospedale Bellaria, IRCCS Istituto delle Scienze Neurologiche; Bologna, Italy A General Electric 3 Tesla Signa Excite system was installed in the Neuroradiology Unit of Bellaria Hospital,

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Bologna in February 2004. The system was upgraded to HDxt in May 2009. 3.0 T are becoming the new field strength of choice for Neuroradiological studies. Technical benefits and challenges exist performing MR studies at field strength greater than 1.5 T, because of increasing magnetic field strength several physical parameters change. One of the practical advantages of a 3.0 Tesla system is the possibility of acquiring routine morphological scans together with diffusion, perfusion and spectroscopic images at the same time, thereby achieving advanced neuroradiological diagnosis in a single session. We describe our findings on the impact of 3.0 Tesla imaging in neuroradiology, in particular in the presurgical evaluation of intraaxial tumours, epilepsy and vascular malformations. In our opinion the 3.0 Tesla MR devices enhance the diagnostic capabalities of MR studies in terms of sensitivity and specificity in clinical practice. For example one decisive result to emerge from our expeirence is the possibility to define more clearly the indications for or against neurosurgery, avoiding impossible or pointless operations. A clearer understanding of the risks and possible complications involved by neurosurgeon and patient alike will establish a more clear-cut relationship between the two when informed consent is given. O1B-2.5 INTRACRANIAL DURAL ECTASIAS: EMPTY MECKEL´S CAVE, EMPTY SELLA, OPTIC NERVE ECTASIA, IAC ECTASIA, ENCEFALOCELES AND ARACHNOID CYSTS. ARE THEY RELATED TO DURAL ANOMALIES OR ALTERED CSF DYNAMICS? Diana Quiñones-Tapia1, Antonio Mas-Bonet2, Javier Ibañez2, Maria José Picado2, Apolonia Moll2 1 RM Rosario, Madrid, Spain, 2Hospital Son Espases, Mallorca, Spain Small ectasias of Meckel´s cave are not uncommon on routine brain MRI. Greater expansions of Meckel´s cave can produce erosions of the petrous apex and are described as "petrous apex cephaloceles". We suggest the term "Empty Meckel´s Cave" (EMC) similar to "empty sella" to describe this condition. FINDINGS We have reviewed records from 60 patients with enlarged Meckel´s cave. We encountered 5 patterns of EMC, most associated to other dural anomalies: 1) isolated EMC with erosion of the sphenoid body or clivus. 2) EMC with multiple meningoceles, arachnoid cysts or displacement of internal carotid artery in the petrous canal. 3) EMC with

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empty sella and optic nerve dural ectasia, mostly related to Benign Intracranial Hypertension. 4) EMC with ectatic internal auditory canals. 5) EMC with distal thecal sac dural ectasia (increased AP diameter, vertebral scalloping and perineural cysts). CONCLUSION Enlargement of Meckel´s cave maybe not only an anatomic variant. The frequency of other associated dural anomalies and arachnoid cysts is increased, and should be observed on MRI studies. Empty Meckel´s cave may be a sign of dural pathology, or reflect altered cerebrospinal fluid dynamics.

subependymal location (NGC: 12; GC:6), and grey-white matter junction (NGC:14; GC:6) was predominantly involved. Uniform hyperdensity was present in 13/31(GC:7/7; NGC:6/24; P00.0007). Enhancement pattern varied by phenotype (homogeneous: GC:9/9; NGC: 9/24; inhomogeneous: GC:0/9; NGC: 15/24; P00.0014). CONCLUSION To the best of our knowledge, this study identifies for the first time, significant imaging characteristics differentiating phenotype in PCNSL, which may have relevance to clinical outcome.

PARALLEL SESSION 2A – SCIENTIFIC PAPERS 2A.1

O2A-1.2 BIMODAL HISTOGRAM ANALYSIS OF WASH-IN EMAX RATIO: DYNAMIC CONTRAST-ENHANCED PERFUSION MRI PARAMETER IN METASTATIC BRAIN TUMOR AFTER RADIOSURGERY

O2A-1.1 PR IMARY CENTRAL NERVO US SYSTEM LY M P H O M A : R A D I O L O G I C - PAT H O L O G I C CORRELATION A Neelakantan1, SL Bell2, E Murray3, R Muirhead3, A James3, R Jackson4, W Stewart2, K Forbes1 1 Department of Neuroradiology, Institute of Neurological Sciences, Glasgow, UK, 2Department of Neuropathology, Institute of Neurological Sciences, Glasgow, UK, 3Beatson West of Scotland Cancer Centre, Glasgow, UK, 4Department of Pathology, Glasgow Royal Infirmary, Glasgow, UK INTRODUCTION Primary CNS Lymphoma (PCNSL) accounts for 2-6 % of primary brain tumours, with the majority of diffuse large Bcell type (DLBCL). Immunophenotyping can subcategorise these into germinal center (GC) and nongerminal center (NGC), which in systemic DLBCL has prognostic significance and may be of similar relevance in PCNSL. The aim was to evaluate imaging appearances in DLBCL and to assess whether imaging could act as a biomarker of phenotype. METHODS Subjects with DLBCL were identified from the regional West of Scotland neuropathology database over a 10 year time period and pathologically categorised into GC and NGC phenotypes based on morphology and immunoprofile. Pre-treatment imaging was independently reviewed by two observers for lesion location and characteristics, including enhancement features. Relative CT density and/or T2 intensity were calculated, where digital images were available. Significance tested using Fischer's exact test. RESULTS A total of 50 subjects were identified, of which complete pathological, imaging and clinical data were available on 33 patients (NGC:24; GC:9). Solitary parenchymal lesion was more common than multifocal disease. Periventricular/

Young Jun Choi, Ho Sung Kim, Sang Joon Kim Asan Medical Center, Seoul, Republic of Korea PURPOSE To test the predictive value of the bimodal histogram parameters of wash-in - Emax ratio (WER) derived from dynamic contrast-enhanced (DCE) perfusion MR imaging for differentiating radiation necrosis from tumor recurrence in patients with metastatic brain tumor after radiosurgery. MATERIALS AND METHODS Our institutional review board approved this retrospective study. Thirty-eight lesions from twenty nine patients who showed enlarged, contrast-enhancing lesions after radiosurgery were assessed using conventional and DCE perfusion MR imaging. The bimodal histogram parameters of WER, which included mean WER at higher curve (mWERH), three cumulative histogram parameters (WER 50 , WER 75, and WER 90 ) and WER at mode (WERmode), were calculated with model-free DCE indices and was correlated with the final diagnosis. The best predictor for differentiating pseudoprogression from ETP was determined by receiver operating characteristic (ROC) curve analyses and unpaired t-test. RESULTS Thirty eight lesions were subsequently classified as radiation necrosis (n028, 73.7 %) or tumor recurrence (n010, 26.3 %). There were statistically significant differences of mWERH, WER50, WER75, WER90, and WERmode between the radiation necrosis group and the tumor recurrence (P<.001). The ROC curve analysis showed the WER75 to be the best single predictor of tumor recurrence, with a sensitivity of 80 % and a specificity of 96.2 %.

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CONCLUSION Bimodal histogram analysis of WER derived from modelfree DCE indices which do not require a complex modelbased approach, can be used as a potential, noninvasive imaging biomarker for monitoring early treatment response in patients with brain metastasis after radiosurgery. O2A-1.3 MR PERFUSION AND PERMEABILITY IMAGINGS IN DIFFERENTIATION OF TRUE PROGRESSION FROM PSEUDOPROGRESSION IN PATIENTS WITH MALIGNANT GLIOMAS Kook-Jin Ahn1, Hyun-Seok Choi1, Bum-Soo Kim1, SoLyung Jung1, Sin-Soo Jeon2, Yong-Kil Hong2 1 Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea, 2 Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea PURPOSE Awareness of pseudoprogression has been increased since introduction of the temozolomide concurrent chemoradiation therapy in high grade glioma patients. The purpose of this study is to compare the usefulness of various MR perfusion imagings in distinguishing true progression from pseudoprogression in high-grade glioma patients. MATERIALS AND METHODS Dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhancement (DCE) perfusion imagings of 23 high-grade glioma patients with increased enhancement after completion of chemo-radiation therapy were evaluated. Highest values of relative cerebral volume (rCBV), relative cerebral blood flow (rCBF), and vascular permeability (Ktrans), respectively were measured in the abnormally enhancing regions, and normalized to the values from contralateral side. Patients were divided into as having true progression or pseudoprogression based on subsequent imagings and pathology results. RESULTS In DSC and DCE perfusion imagings, the patients with true progression showed significantly increased rCBV and Ktrans compared with those from pseudoprogression (DSC rCBV 3.66 vs 1.87 p00.034, DCE Ktrans 3.5 vs 1.74 p00.027, respectively). However, in ASL perfusion imagings, there was no significant rCBF difference (1.21 vs 2.32 p00.14). On ROC curve analysis, DCE Ktrans showed largest area under the curve (DSC rCBV 0.778, ASL rCBF 0.692 and DCE Ktrans 0.833) CONCLUSION Permeability MR perfusion imaging showed the most favorable results in distinguishing true progression from true

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progression. However, the result from ASL perfusion imaging is disappointing. Further study with more increased recruitment of patients should be necessary to validate the usefulness of these imaging techniques. O2A-1.4 THE IMPORTANCE OF CO-DELETIONS 1p36/19q13 IN TUMOR IMAGING DIAGNOSIS Joana Barata Tavares1, Sofia Reimão1, Ana Filipa Geraldo1, Jose Pimentel1, Sónia Santos2, Pedro Aguiar3, Jorge Campos1 1 North Lisbon Hospital Centre – Santa Maria´s Hospital, Lisbon, Portugal, 2GenoMed - Institute of Molecular Medicine, Lisbon, Portugal, 3National School of Public Health – New University of Lisbon, Lisbon, Portugal INTRODUCTION Oligodendrogliomas (OLG) constitute 2-5 % of all primary brain tumors, being anaplastic in 20-54 % (A-OLG). The number of their histological diagnosis has increased in the past years, which is speculated that may not be due to higher incidence. Molecular studies of OLG revealed a loss of heterozygosity in the long arm of chromosome 19(19q) in 50-80 % and in the short arm of chromosome 1(1p) in 40-92 %; together these deletions have high specificity and are present in 69 %. OBJECTIVES Correlate tumor imaging findings with the presence of the co-deletions 1p36/19q13 in A-OLG. METHODS Retrospective recruitment of all A-OLG diagnosed at Santa Maria´s Hospital between 2008-2011 with review of their cytogenetic study for 1p36/19q13 deletions. Only cases with pre-surgical CT/MR in the Hospital´s PACS were included. Definition and study, in each tumor, of imaging markers: ring enhancement, perilesional edema, involvement of corpus callosum, involvement of contralateral hemisphere and intralesional calcifications. A statistical data analysis was performed. RESULTS 109 A-OLG with cytogenetic study in 79: 23 with both deletions (15 with pre-surgical CT/MR), 44 with none (27 with pre-surgical CT/MR) and 12 with just one. There was a statistically significant correlation (p<0,05) between both deletions and intralesional calcifications and between their absence and ring-enhancement/perilesional edema. CONCLUSION There are differences in imaging findings of A-OLG with and without 1p36/19q13 deletions and the findings of the AOLG without those deletions are typically associated to

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glioblastomas (GBM). The authors speculate that these tumors should be classified as "GBM with component of OLG" (WHO classification). O2A-1.5 ACCURACY IN DETECTION OF PITUITARY ADENOMA IN CUSHING DISEASE BASED ON PREOPERATIVE 3T MRI Tomas Belsan, Nora Profantova, Jiri Vrana, Vaclav Masopust, David Netuka Military University Hospital, Prague, Czech Republic AIM OF STUDY To demonstrate, that identification of pituitary adenoma on MR imaging in patients with Cushing disease can fail even in using 3 T MRI and dedicated pituitary imaging protocol. METHODS AND MATERIAL We performed 25 preoperative 3 T MRI in 22 patients. These patients were refered to neurosurgery with hormonally proved Cushing disease for surgery. MRI was performed with standard protocol for pituitary gland imaging with gadolinium contrast media administration. All patients underwent intranasal transsphenoidal adenoma resection. Intraoperative, early postoperative and 3 months follow-up MRI was performed in all patients. In 3 patients re-operation was necessary within 13 years after the initial operation because of persistent ACTH oversecretion. New preoperative MRI was performed in these cases with identical scanning protocol. RESULTS Based on preoperativen 3 T MR images in only 11 patients (44 %) pituitary adenoma was clearly identified. In 14 patients (56 %) the identification of pituitary adenoma based on MR images failed. In all 25 operations some pituitary adenoma tissue was resected surgically (proved by histology). In 22 patients there was significant improvement of initial ACTH oversecretion. Intraoperative MRI was not helpful for residual tumor identification in cases with preopratively undetected adenoma. CONCLUSION Identification of pituitary adenoma in patients with Cushing disease failed in up to 56 % of cases despite using good quality 3 T MR imaging. Diagnosis must be based on clinical and laboratory finding in these cases. Supported by grant IGA MZ NT 13631

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INTRODUCTION orbital tumors include multiple histological types, which have similar X-ray characteristics including contrast enhancement. Diagnosis is complicated by artifacts from eye movements, bone structures. PURPOSE we propose a new minimally invasive method of CT perfusion for assessing of the hemodynamics and differential diagnosis of orbital tumors. MATERIALS AND METHODS CT perfusion studies were performed in 54 patients on multislice CT: 12-meningeoma, 8-cavernous hemangioma, 7-low grade glioma, 6-pilocytic astrocytoma, 5-neurinoma, 4-metastasis, 4-chondrosarcoma, 3-hemangiopericytoma, 3neurofibroma, 2-lymphoma. CT perfusion included 4 slices with thickness 5 mm (160 images), acquisition time-40s, radiation dose-2,2 mSv. Pathomorphological verification was carried out in all patients. RESULTS orbital tumors of the same histological types were characterized by similar hemodynamic parameters (CBV,CBF, MTT). Values of these perfusion parameters for various histological types of orbital tumors presented in Table 1. Low differenciated gliomas, meningeomas, hemangiopericytomas, lymphomas had high CBV and CBF values in comparison with brain white matter. MTT values of the listed tumors was also increased. The highest CBV values were noticed in gliomas. Meningeomas and hemangiopericytoma had high CBF values. Cavernous hemangiomas, chondrosarcomas, neurinomas, neurofibromas had typically high MTT value, so for neurofibromas MTT was 3 times higher than that of brain white matter. CONCLUSION CTP is an effective method in diagnosis of various orbital tumors which allows to assess tumors hemodynamic, its vascularization and to make more specific differential diagnosis. It may help to decrease the number of patients undergoing preoperative biopsy and plan optimal surgical approach. PARALLEL SESSION 2A – SCIENTIFIC PAPERS 2A.2 O2A-2.1 PSEUDOTUMOUR CEREBRI (PTC): A REVIEW OF THE FINDINGS ON MRI

O2A-1.6 ORBITAL TUMORS: DIFFERENTIAL DIAGNOSIS USING CT PERFUSION

Edel Kelliher, Alison Corr, Sarah Power, Joanna Pearly-Ti, Paul Brennan, John Thornton, Seamus Looby Beaumont Hospital, Dublin 9, Ireland

Irina Schcurova, Ludmila Fadeeva, Igor Pronin, Valeri Kornienko Burdenko Neurosurgical Instute, RAMS, Moscow, Russia

PURPOSE To clearly illustrate the MR findings associated with pseudotumour cerebri.

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MATERIALS AND METHODS A review of the literature was performed to outline the current MR findings associated with pseudotumour cerebri. MR images available from previous cases in our institution were used to illustrate these findings. RESULTS Several MR findings are associated with pseudotumour cerebri. These include empty sella, tortuosity of the optic nerve, flattening of the globe, an enlarged optic nerve sheath, protrusion and enhancement of the optic nerve head. Recently, an association with sinovenous stenosis was identified. Some advocate the addition of MR venogram if PTC is a possible diagnosis. It is not clear yet if sinovenous stenosis is a cause or a result of the intracranial hypertension. If the clinical picture suggests PTC, then addition of imaging of the orbits is recommended to add evaluation for optic nerve sheath enlargement. CONCLUSION Pseudotumour cerebri is an entity of unknown cause in which the patient has raised intracranial pressure. Previously, the principal use of MRI was to exclude a secondary cause of this raised intracranial pressure. However, now with the realisation of the associated MR findings, this condition can be diagnosed based on the MR findings. O2A-2.2 ALCOHOLIC CEREBELLAR DEGENERATION: NOT ALL DOWN TO ALCOHOL? Stuart Currie, Marios Hadjivassiliou, Matthew Clark, Iain Wilkinson, Paul Griffiths, Nigel Hoggard University of Sheffield, Sheffield, UK PURPOSE To characterize and compare the MR imaging features of patients with gluten ataxia and alcoholic ataxia. METHODS Retrospective analysis of 3 T-MR imaging in patients with gluten ataxia (GA, n017) and alcoholic ataxia (AA, n029) was performed. Patients with AA had raised MCV/gamma GT. All patients were screened for other causes of ataxia, were HLA typed and had antigliadin antibody levels measured. RESULTS 59 % and 45 % of patients with GA and AA respectively had HLA-DQ2/DQ8 genotype (compared to 30 % in healthy local blood donors). HLA DQ2 is associated with autoimmune diseases such as celiac disease. 34 % of AA had antigliadin antibodies (compared to 12 % in the healthy local population and 10 % in patients with genetically confirmed ataxias). This allowed subdivision of the AA group into those with antigliadin antibodies (AA+) and those without (AA-). Voxel based morphometry (VBM) of the GA group compared to age- and sex-matched controls showed severe pancerebellar

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grey matter loss with no supratentorial involvement. Conversely, VBM of the AA group showed grey matter loss localized to the superior aspect of the cerebellum with additional atrophy of the cingulate gyrus. This pattern of disease was no different in the AA group when antigliadin antibody status was taken into account. CONCLUSION Patients with AA have an abnormally high incidence of HLA-DQ2 and antigliadin antibodies but show a different pattern of grey matter loss to what is seen in GA. This raises the possibility that alcohol excess in genetically susceptible individuals (HLA-DQ2) may induce sensitization to gluten. O2A-2.3 PERFUSION CT IN THE DIFFERENTIAL DIAGNOSIS BETWEEN BRAIN TUMORS AND NONNEOPLASTIC LESIONS Davide Gadda, Paolo Simonelli, Graziella Villa, Vania Scardigli, Diana Petacchi, Cesare Pandolfo, Marco Moretti, Andrea Ginestroni, Gian Paolo Giordano Careggi University Hospital, Firenze, Italy BACKGROUND AND PURPOSE PCT provide useful information for brain tumor assessment. We hypothesised that PCT may differentiate tumors from nonneoplastic conditions. MATERIALS AND METHODS We retrospectively examined 67 adult patients who underwent PCT before biopsy or treatment of a new intra-axial lesion suspicious for tumor. Final diagnoses were 53 tumors, 14 benign lesions. Mean±SD or Median PCT values of neoplasms and non-tumors were compared by using Student or nonparametric Mann-Whitney tests. ROC analyses were also done for each PCT parameter. Finally, we determined the performance values of a possible diagnostic algorithm with PCT on the basis of 2x2 tables. RESULTS Significant differences between neoplastic and benign lesions were found for rCBV (Mean±SD: tumors 5.78± 4.1, non-tumors 1.29±0.7, p<0.0001, AUC 0.955), rPS (Mean±SD: tumors 21.52±14.67, non-tumors 8.66±5.01, p<0.0001, AUC 0.788) and TTP [Median (95%CI) : tumors 0.6 (-0.19 to 1.8), non-tumors 9.4 (2.78 to 12.86), p0.0001, AUC 0.855]. For the diagnosis of tumor, rCBV >1.86, rPS> 8.16 and TTP<5.8 had 90.57 %, 81.13 % and 93.48 % sensitivity, 78.57 %, 64.29 % and 69.23 % specificity respectively. A strategy with diagnosis of tumor in all lesions with rCBV>2.56, and in those with 1.06£rCBV£2.56 and rPS>19.63 or 1.06£rCBV£2.56, rPS£19.63 and TTP£2.4, had an accuracy of 97.01 %, with 98.11 % sensitivity, 92.86 % specificity.

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CONCLUSION PCT is useful in differentiating brain neoplasms from other lesions. High rCBV and rPS, low TTP best predicted tumors. A PCT diagnostic algorithm primarily based on rCBV can be suggested for baseline neuroimaging when an intra-axial suspected tumor is found. O2A-2.4 D I F F E R E N T I AT I N G G L I O B L A S T O M A MULTIFORME AND CEREBRAL METASTASES BASED ON MAXIMUM 2D AXIAL MEASUREMENTS OF TUMOUR CORE DIAMETER, PERI-LESIONAL SIGNAL DIAMETER AND RATIO OF TUMOUR CORE DIAMETER TO PERI-LESIONAL SIGNAL DIAMETER Richa Sinha2, Calvin Soh1, Samantha Mills1 1 Salford Royal Foundation Hospital, Salford, Greater Manchester, UK, 2University of Manchester, Manchester, UK BACKGROUND It is a clinical empiricism that extensive surrounding oedema reliably predicts brain tumour type of metastasis over glioblastoma (GBM) but the scientific evidence for this is scant. The objective was to assess simple two-dimensional lesion-based measurements from conventional imaging as predictors of tumour type. METHODS 81 histologically confirmed GBMs and 83 confirmed metastases were analysed. Maximum diameter measurements were made from the post contrast T1-weighted imaging for maximum trans-axial solid enhancing component (core measurement) and from the T2-weighted imaging for the maximum peri-lesional signal abnormality (oedema measurement). Core: oedema ratio was calculated. An independent t-test was used to identify significant differences in core diameter, core oedema, core:oedema and patient age between the two groups. A canonical discriminant analysis was performed to assess the potential each measure had as a diagnostic discriminator between histology. RESULTS Metastases had smaller core (p<0.0001), smaller oedema diameter (p<0.0001) and smaller core:oedema ratio (indicatingly larger proportional oedema, p<0.0001) than GBMs. A discriminant analysis showed that the maximum axial diameter of the tumour had the greatest weight in classifying histological type with a canonical correlation of 0.877. However, using all 3 measures only correctly classified tumours as either GBM or metastases in 71.3 % of cases. CONCLUSION Our findings support the textbooks by demonstrating metastases have a greater amount of proportional

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oedema than GBMs, but found that overall axial core diameter is a better predictor of histology than the core: oedema ratio.

O2A-2.5 ROLE OF MULTI-TRACT TRACTOGRAPHY IN THE PRE-SURGICAL SELECTION AND PLANNING OF ELOQUENT INTRA-AXIAL LESIONS Giuseppe Kenneth Ricciardi1, Pasquale Mirtuono2 ,4, Roberto Foroni2, Stefania Montemezzi3, Francesco Sala2, Andrea Sbarbati4, Giampietro Pinna2, Alberto Beltramello1 1 Neuroradiology, University of Verona, Verona, Italy, 2 Neurosurgery, University of Verona, Verona, Italy, 3Radiology, Verona City Hospital, Borgo Trento, Verona, Italy, 4Institute of Neurological, Neuropschological, Morphological and Movement Sciences, Verona, Italy INTRODUCTION The aim of this study was to evaluate the possible role of Diffusion Tensor Imaging (DTI) based tractography of multiple fiber tracts in the selection and pre- and intra-surgical planning of intra-axial lesions. MATERIALS AND METHODS The authors included 28 patients with gliomas or cavernous angiomas located near the course of the CST, Arcuate and IFO. Freely available software was used both to calculate diffusion tensors and fiber tracts (Trackvis) and to obtain high-resolution anatomical registration, 2D and 3D display and fiber fusion in a versatile visualization framework (3D-Slicer). The authors evaluated the impact of DTI on patient selection, on the pre-sulgical modification of the approach to the lesion and on the definition of the resection margins. The last was obtained with the aid of the results evidenced using intraoperative subcortical motor mapping. RESULTS Of the 28 lesions 17 were located in the rolandic region, 8 in the temporal region and 3 in the insular region. In 6 cases (21 %) tractography significantly contributed to consider the patient not eligible for surgery because of high clinical deficit risk, in 7 cases (25 %) it determined a modification of a priory surgical approach and in 9 cases (32 %) it aided in reducing the time spent in performing intraoperative subcortical motor mapping to determine definition of the resection margins. CONCLUSIONS Multi-tract MR-tractography, even if performed only preoperatively, without the aid of intra-operative MRI, can have a significant impact on different stages of eloquent intraaxial lesions surgical management.

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O2A-2.6 USEFULNESS OF 11 C-METHIONIN-PET IN NONINVASIV GRADING OF BRAIN TUMORS Bernadett Szucs1, Zsolt Hascsi1, Jozsef Dobai2, Laszlo Novak2, Peter Molnar3, Ildiko Garai1 1 ScanoMed Nuclear Medicine Centers, Debrecen, Hungary, 2 Neurosurgery Department University of, Debrecen, Hungary, 3 Department of Pathology University of Debrecen, Debrecen, Hungary BACKGROUND 11 C-methionine ( MET-PET ) has been shown to detect brain tumors with a high sensitivity and specificity. While 18 F-FDG-PET is suggested for choice for tumor grading. Static MET- PET does not allow differentiation of high versus low grade gliomas. The aim of our study was to investigate the efficiency of dynamic MET-PET in nonivasive tumor grading. METHODS 16 patients were investigated. Dynamic study was performed 10-15 min post injection (0,15 mCi/kg) for 20 min. Free hand ROIs were drawn around the tumors.A reference ROI was placed on the contralateral cortex.The maximum and the mean activity of lesion/background ratio were evaluated as predictors of tumor grade. To analyze the tracer kinetics, the time course of the mean activity was determined. RESULTS Data were compared to the histopathological results, according to the WHO system. Applying Mann-Whitney U test, no significant relation could be observed between the maximum tumor/ background ratio ( p value: 0,11 ), the mean tumor/ background ratio ( p value: 0,27 ),the tracer washout (p value : 0,97) and the histopathological findings. CONCLUSION Our findings suggest that the maximum, mean 11 Cmethionine uptake and the tracer kinetics of low-grade gliomas did not differ significantly from high-grade gliomas. METPET and 18 F-FDG-PET should be performed in combination for noninvasive tumor grading. PARALLEL SESSION 2B – SCIENTIFIC PAPERS 2B.1 O2B-1.1 UPDATE ON THE PRAGMATIC ISCHAEMIC STROKE THROMBECTOMY EVALUATION: PISTE TRIAL Philip White1, Keith Muir2 1 University of Edinburgh, Edinburgh, UK, 2University of Glasgow, Glasgow, UK

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AIM To determine if endovascular thrombectomy in addition to IV thrombolysis improves the proportion of patients with favourable functional 3 month outcome (defined by modified Rankin 0-2) in patients with acute ischaemic stroke due to occlusion of the middle cerebral or intracranial internal carotid artery METHODS Prospective, randomised, controlled, parallel group study with blinded outcome evaluation (PROBE). Approrpriate imaging and clinical secondary endpoints including procedural safety will be determined. Trial is confined to UK at present. RESULTS this is a trial in progress and is in the start up phase. Inclusion/exclusion criteria and the rationale behind them will be presented. An update on progress to date and future plans will be presented.

O2B-1.2 THRACE: RANDOMIZED TRIAL AND COST EFFECTIVENESS EVALUATION ON INTRAARTERIALTHROMBECTOMY IN ACUTE ISCHEMIC STROKE Serge Bracard1 ,3, Xavier Ducrocq1 ,3, Francis Guillemein1 ,2, Kossar Hosseini1 ,2, Thrace investigators0 1 Université de Lorraine, Nancy, France, 2CIC INSERM, Nancy, France, 3CHU, Nancy, France Thrombectomy is currently conducted on non-controlled conditions and with varying indications. THRACE is a controlled, multicenter (31 hospital centers in France) and randomized parallel group study, with a costeffectiveness analysis. OBJECTIVES The primary objective is to determine whether a combined approach intravenous (IV) thrombolysis and mechanical thrombectomy, is superior to the reference treatment with IV thrombolysis alone. The second objective is to determine the cost-effectiveness of this new procedure compared to the standard. METHODS All patients aged between 18 and 80 years with an acute ischemic stroke occurred within 4 hours are eligible for the study. Inclusion criteria are an occlusion of the intracranial carotid artery, the M1 portion of the middle cerebral artery or the upper third of the basilar and with a NIHSS score between 10 and 25. All the patients are treated with the reference IV treatment (0,9 mg/kg of rTpa). In the thrombectomy arm, thrombectomy is performed at the end of IV perfusion, with one of the thrombectomy device available.

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The modified Rankin Score at 3 month after treatment is the primary outcome. Secondary outcomes are the Barthel score at 3 month and the Quality of Life with Euroqol EQ-5D generic questionnaire at 3 and 12 months after treatment. The sample size was estimated at 480 patients. 160 are already included and the intermediate analysis is planned in september 2012. The results will be presented during the WSO meeting. GRANT French Ministry of Health. STIC program 2009 O2B-1.3 MECHANICAL THROMBECTOMY IN ACUTE STROKE: EVALUATION OF THE SOLITAIRE FRTM DEVICE WHILE UNDER CONSCIOUS SEDATION Sébastien Soize1, Krzysztof Kadziolka1, Laurent Estrade1, Isabelle Serre2, Serge Backchine2, Laurent Pierot1 1 Department of Radiology, Maison Blanche Hospital, University of Reims, Reims, France, 2Department of Neurology, Maison Blanche Hospital, University of Reims, Reims, France BACKGROUND AND PURPOSE To evaluate the feasibility, safety, and efficacy of mechanical thrombectomy under conscious sedation in acute ischemic stroke (AIS) patients, using the Solitaire FRTM device. METHODS Consecutive patients with AIS due to a large artery occlusion were retrospectively included within 6 hours of symptom onset for the anterior circulation, and 24 hours for the posterior circulation. After intravenous thrombolysis (when no contraindications), thrombectomy was performed with the SolitaireTM device in patients under conscious sedation. Primary efficacy and safety endpoints were good functional outcome (modified Rankin Scale [mRS]≤2) at 3 months and mortality at 3 months. Secondary endpoints were recanalization (TICI≥2) and treatment failure rate. RESULTS From May 2010 to January 2012, 47 patients were treated. Median baseline NIHSS was 18. The occlusion site was the MCA in 28 patients (59.6 %), ICA-MCA tandem occlusion in 11 patients (23.4 %), terminal ICA in 3 patients (6.4 %), and basilar artery in 5 patients (10.6 %). 32 patients (68.1 %) received intravenous thrombolysis before treatment. Superselective catheterization of the occluded vessel was not feasible in 5/47 cases (10.6 %). Successful revascularization was achieved in 38/47 patients (80.8 %). After 3 months, 27 patients (57.4 %) showed good functional outcome (mRS≤2) and the median NIHSS score was 10. Overall mortality rate at 3 months was 21.3 % (10/36). CONCLUSIONS In AIS, mechanical thrombectomy while under conscious sedation is feasible in a large percentage of cases (89.4 %)

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and is associated with a short procedure delay and a high percentage of good functional outcomes at 3 months (57.4 %). O2B-1.4 STROKE ENDOVASCULAR INTERVENTION AT KING'S Marius Poitelea, Tim Hampton, Naga Kandasamy, John Hart, Jozef Jarosz, Neil Deasy Kings College Hospital, London, UK We present our experience with endovascular intervention in stroke since its introdution in our institution (32 cases to date). We look at out protocol including indications, patient selection, techniques, clinical outcomes and complications. We have seen several changes in practice since its initial introduction and there are small interoperator differences in the details of what is still a largely evidence-free technique in terms of what is considered to be "best practice". We compare our results to those of similar instiutions and hope to stimulate discussions with regards to observation that what would help create a protocol ready to be tested in a future multi-institutional clinical trial in terms of patient selection and techniques. O2B-1.5 Abstract withdrawn O2B-1.6 INTRA-ARTERIAL INTERVENTION FOR ACUTE ISCHAEMIC STROKE: THE IRISH EXPERIENCE FOLLOWING INTRODUCTION OF A 24/7 THROMBECTOMY SERVICE Sarah Power1, Jane Cunningham1, Stephanie Robinson1, Joanna Ti1, Seamus Looby1, Alan O'Hare1, Joan Moroney1, David Williams1, Peter Kelly2, Killian O'Rourke2, Eamon Dolan3, Paul Brennan1, John Thornton1 1 Beaumont Hospital, Dublin, Ireland, 2Mater Misericordiae Hospital, Dublin, Ireland, 3Connolly Hospital Blanchardstown, Dublin, Ireland Patients with large artery occlusive stroke respond poorly to recanalisation with intravenous thrombolysis (IVT), and can benefit from intra-arterial intervention (IAI). This study aims to evaluate our experience with intra-arterial treatement of acute ischaemic stroke. As standard protocol patients presenting with acute stroke within the 4.5 hr thrombolysis window undergo CT brain and CT angiography. All patients who

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underwent IAI from 01/01/2010 to 31/12/2011 were retrospectively identified. Thrombolysis-in-cerebral-infarction (TICI) score was assigned to assess recanalisation. Modified-Rankin score (mRS) was used to assess clinical outcome. 26 patients underwent IAI (M:F 15:11, mean age 59 yrs, mean NIHSS score 15.3). All had large artery occlusion, 25 anterior-circulation, 1 posterior-circulation. Nineteen patients received IVT with poor clinical response, IVT was contraindicated in the remainder. IA techniques included mechanical thrombectomy (n021) and wire/microcatheter disruption (n01). Three patients underwent carotid stenting only. In total nine patients had carotid stents placed. Eleven patients received intraarterial tPA. Recanalisation (TICI 2a-3) was achieved in 22/26 (85 %). The four cases of failed recanalisation (TICI 0) all had internal carotid artery occlusion. In the recanalised group 30 day mRS ≤2 was achieved in 15/22, and one patient with mRS of 3 was just one point above his baseline, giving a good outcome rate of 72 %. Thirty day mortality rate was lower with successful compared to unsuccessful recanalisation (18 % versus 50 %). Symptomatic haemorrhage occurred in four patients. We demonstrate high rates of vessel recanalisation and good functional outcome which compares well with international literature. In patients where successful revascularisation is achieved there is propsect for full functional recovery. O2B-1.7 ENDOVASCULAR TREATMENT OF CAROTID STENOSIS : 103 PROCEDURES Daehyun Hwang1, Insoo Kim0 ,2, Choonwoong Huh0 ,2, Dalsoo Kim0 ,2 1 Hallym University ,Hangang Sacred Heart Hospital, Seoul, Republic of Korea, 2Myunggi Saint Mary Hospital, Seoul, Republic of Korea INTRODUCTION Ischemic stroke is a major cause of adult disability and the 3rd leading cause of death. Approximately 15-30 % of ischemic strokes are caused by obstructive carotid atherosclerosis involving the carotid bifurcation The purpose of this study is to determine safety, short and mid-term outcomes of CAS (Carotid Artery Stenting) MATERIALS AND METHODS Between January 2006 and December 2010, 101 successful CAS out of 103 attempted procedures in 89 patients were included in this study. . There were 70 men and 19 women and their age range was 5079 years (mean 71.1). One hundred one stents (50 Protégé, 37 Precise stent, 12 Wallstent, and 2 Acculink)

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and distal filters (89 Spider Rx, 9 Filter-wire, 3 Emboshield) were used. RESULTS There were one death (huge ICH), 4 minor strokes (4.2 %), 9 bradycardia (9.4 %), and 3 groin hematoma as peri-procedural complications. Follow-up angiography was done in 58 patients (61 %) for 6-58 months (mean 17.3), there was only one restenosis (1 %). Clinical follow-up was done for 84 patients (88 %) for 660 months (mean 32), there were two deaths (2.3 %, one myocardial infarction, one rectal cancer), one major stroke (basilar artery, 21 months), and one minor stroke (cerebellum, 10 months). CONCLUSION CAS is and effective treatment modality and as safe as CEA for carefully selected patients. Judicious selection of the procedure is made on a case-by-case after considering the patient (physiological), lesion, and access (anatomical) factors that increase the risk of CAS and CEA in that particular patient PARALLEL SESSION 2B – SCIENTIFIC PAPERS 2B.2 O2B-2.1 SPINAL EPENDYMOMAS - RADIOLOGICAL/ PATHOLOGICAL CORRELATION OF RECURRENCE RATE AND CLINICAL OUTCOME POST RESECTION Alison Corr, Edel Kelliher, Sarah Power, Joanna Pearly-Ti, Paul Brennan, John Thornton, Michael Farrell, Seamus Looby Beaumont Hospital, Dublin, Ireland PURPOSE Ependymomas are rare primary central nervous system (CNS) tumours constituting 8 % of pediatric and 4 % of adult CNS tumours, occurring most commonly in the spinal cord. Histopathologic evaluation is critical in differentiating WHO grade 1 to grade 111 tumours as treatment decisions and predictive outcome of surgical resection depend on grade. The relative rarity of spinal ependymomas has resulted in a paucity of large scale studies determining the factors most influential in predicting recurrence rate following resection. The purpose of this study was to ascertain patient and tumour factors that influence clinical recurrence risk. MATERIALS AND METHODS 60 pathologically proven cases of spinal ependymoma, from 1999-2011 were retrospectively reviewed. The initial preoperative MR imaging was reviewed looking at tumour size, location and MR characteristics. Patient demographics; age at presentation and sex were documented and histopathological subtype and grade, capsule integrity and tumour

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resection margins were all correlated with post operative follow-up imaging and MR detectable tumour recurrence. RESULTS Tumour recurrence risk is multifactorial in the case of spinal ependymomas. Patient age, tumour location and size, and histopathological subtype are important determinants of clinical outcome and should be considered when evaluating individual cases. Depending on these factors, adjuvant radiotherapy is considered. CONCLUSION The radiological evaluation of pre-operative imaging of spinal ependymomas plays a role in predicting clinical outcome and in determining the most appropriate therapeutic strategy. O2B-2.2 COMPARISON BETWEEN RADIOFREQUENCY TARGETED VERTEBRAL AUGMENTATION, BALLOON KYPHOPLASTYAND VERTEBROPLASTY USING HIGH VISCOSITY CEMENT IN TREATMENT OF VERTEBRAL COMPRESSION FRACTURES Bassem Georgy University of California, San Diego, San Diego, USA PURPOSE Both vertebroplasty and balloon kyphoplasty have been described for treatment of vertebral compression fractures. This study compares the incidences and patterns of cement leakage in cases treated with high–viscosity cement vertebroplasty (HVC-VP), standard balloon kyphoplasty (BKP) and a novel procedure, Radiofrequency Targeted Vertebral Augmentation (RF-TVA) that allows targeted delivery of Radiofrequency activated (high–viscosity) cement after creating multiple channels using a midline osteotome. MATERIALS AND METHODS Retrospective analysis of postoperative radiographs of patients treated with the three techniques was analyzed for the incidence and location of cement leakage. 112 consecutive patients with 159 treated levels were included. There were 66 levels in HVC–VP, 46 levels in BKP, and 47 levels in RF–TVA groups treated. RESULTS In the HVC–VP group, 33 leakages were reported (17 discal, 11 venous, 4 paravaertebral and 1 epidural). In the BKP group, 31 leakages were reported (15 discal, 11 venous, 3 paravaertebral and 2 epidural). In the RF–TVA group, a total of 16 leakages were reported, (8 discal, 5 venous, 3 paravaertebral and non epidural).

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CONCLUSIONS These findings show that cement augmentation using RF– TVA technique may provide approximately 50 % reduction in leakage rate when compared to conventional VP using high viscosity cement and standard BKP. This may be related to the combination of controlled delivery of radiofrequency activated (high viscosity) cement at a fixed low rate of injection into site–specific channels created using a navigational osteotome. RFK allows uni–pedicular access and remotely controlled cement delivery to decrease procedural invasiveness and physician radiation exposure, respectively. O2B-2.3 EVALUATION OF DUAL ENERGY MYELOGRAPHY CT AFTER LUMBAR OSTEOSYNTHESIS Astrid Grams1, Jonas Sender1, Regina Moritz2, Martin Obert1, Marco Stein3, Matthias Oertel3, Gabriele Krombach2, Elke Gizewski1 ,4, Thorsten Schmidt1 1 Department of Neuroradiology, University Hospital Giessen, Justus Liebig University, Giessen, Germany, 2Department of Radiology, University Hospital Giessen, Justus Liebig University, Giessen, Germany, 3Department of Neurosurgery, University Hospital Giessen, Justus Liebig University, Giessen, Germany, 4Department of Neuroradiology, University Hospital Innsbruck, Medical University Innbruck, Innsbruck, Austria INTRODUCTION The purpose of this study was to evaluate benefits of dual energy (DE) CT myelography in patients with previous lumbar osteosynthesis. MATERIALS AND METHODS 30 patients were included. After intrathecal injection of iodine contrast agent a DE-CT scan with tube voltages of 80 kV and 140 kV was performed and a virtual series of 120 kV was generated. In the different series impact of metal artifacts on the visualisation of the spinal canal and the spinal foramina were evaluated. VRT series of the dural sac were generated using commercially available software and compared to conventional myelography data in concerns of the amount of visualized of nerve roots. RESULTS With tube voltages of 140 kV artifacts were least pronounced with only slightly limited evaluation of the spinal canal as well as the spinal foramina. With 80 kV and the virtual 120 kV artifacts limited the evaluation moderately. As no overlay disturbance was present VRT visualization of

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the nerve roots was more reliable than conventional myelography in oblique and a-p views, which is considered the "gold standard". CONCLUSION In patients after osteosynthesis DE-CT provides minimal artifact disturbance using 140 kV tube voltage. It also provides the possibility of "virtual myelography", which seems to be superior to conventional myelography for the evaluation of nerve roots. This could reduce the need of additional conventional radiography after the injection of contrast agent and may shorten unnecessary painful movements for the patients, the entire examination time, and the radiation exposure for patient and radiologist or radiographer.

patients (79 %) degenerative disk disease; and 2 patients (10 %) posterior ligament ossification. Surgical intervention was required in 10 patients (53 %). At the time of discharge only 4 patients (21 %) had improved the ASIA grade scale. CONCLUSION SCIWORA contributes to 14 % of cases of spinal cord injury in adults. MRI is crucial for diagnosis and prognostic outcome and helps in detecting surgically treatable abnormalities.

O2B-2.4 MR IMAGING IN ADULT SPINAL CORD INJURY WITHOUT RADIOGRAPHIC ABNORMALITIES

Estanislao Arana 1 , Silvia Ruiz-España 2 , Francisco M Kovacs3, David Moratal2 1 Fundacion IVO, Valencia, Spain, 2Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain, 3Fundación Kovacs, Palma de Mallorca, Spain

Laura Frascheri1, Lluisa Montesinos0 ,2, Carolina Ramos0 ,2, Tatiana Biedermann0 ,2, Silvana Sarria1, Raquel Mitjana1, Sahyly Siurana1, Carla Vert1, Cristina Auger1, Alex Rovira1 1 departament Of Radiology. Universitary Hospital Vall D´ Hebron, Barcelona, Spain, 2spinal Cord Injury Unit.Universitary Hospital Vall D´Hebron, Barcelona, Spain BACKGROUND AND PURPOSE Spinal cord injury without radiographic abnormalities (SCIWORA) has been mainly described in children. The purpose of the present study is to describe the incidence, MR imaging features and clinical outcome of SCIWORA in adult population and to assess the prognostic value of MR imaging in this condition. PATIENTS AND METHODS Between January 2010 to December 2011, 134 patients with spinal traumatic injury were admitted in our hospital. In 19 (14 %) of these patients (17 men, mean-age 52 years, age range 20-83) a diagnostic of SCIWORA was established RESULTS The causes of spinal injuries were a fall from height in 53 %, road traffic accidents in 26 %; sport accidents in 16 % and work accidents in 5 %. According to ASIA scale, 53 % of patients were grade D; 32 % were grade C; and 15 % were grade A, B or E. MR imaging was obtained within the first 72 hours in 17 patients (89 %). MRI showed significant abnormalities in 89 % of patients, including spinal cord changes (either cord edema or haemorrhage in 16 patients (84 %) and degenerative spinal abnormalities: 13 patients (68 %) cervical spine stenosis; 15

O2B-2.5 COMPUTER-ASSISTED DIAGNOSIS OF DEGENERATIVE LUMBAR SPINE MR IMAGING

PURPOSE To evaluate reliability of computer assisted diagnosis for the interpretation of lumbar 1.5-T magnetic resonance (MR) images. MATERIALS AND METHODS A semiautomatic computer assisted diagnosis (CAD) software was developed in MATLAB (The Mathworks, Inc. Natick, MA, USA). Definitions of disk degeneration, disk contour, spinal stenosis (categorical and quantitative) were implemented according to the definitions of Combined Task Force criteria, endorsed by European Society of Neuroradiology. Algorithm was trained in 52 lumbar intervertebrals discs. Afterwards, it was twice tested lumbar in 233 intervertebral discs from 53 patients with low back pain, 28 women and 25 men (mean age, 48 years±13.3 [SD]). An engineer, unaware of MR reports, performed the computerized examination with one month interval between assessments. The k statistic was used to assess reliability, categorized as almost perfect (0.81-1.00), substantial (0.610.80), moderate (0.41-0.60), fair (0.21-0.40), slight (0.00-0.20), or poor (< 0.00). Quantitative percentage stenosis was analyzed by intraclass coefficient correlation (ICC) test. Bootstrap estimation of 95 % confidence limits were calculated using 1000 resamples. Statistical Package for Social Sciences, SPSS, version 20 (IBM, Somers, NY, USA) was used for data analysis.

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RESULTS Pfirmann disc degeneration showed k00.81 (CI95% 0.750.88), disk contour depicted k00.94 (CI95% 0.87-1) and categorical spinal stenosis, k00.94 (CI95% 0.90-0.98). Quantitative stenosis depicted an ICC00.98 (CI95% 0.97-0.98). CONCLUSION Almost perfect reliability was achieved. These results provide support for enhanced reproducibility of MR imaging reports, as in clinical practice, only moderate agreement among radiologists can realistically be expected.

and interdigitation of the cement. The system is particularly helpful in augmentation of sclerotic bone due to the sharp stiff nature of the nitinol wire and in the treatment of cases with intra-vertebral clefts where the created channels can bridge the cleft with the normal surrounding bone.

O2B-2.6 VERTEBRAL AUGMENTATION WITH TARGETED CEMENT DEPO SITION AFTER C HANNELS CREATION USING A NITINOLWIRE, THE "BLAZER" SYSTEM

O3A-1.1 DIFFUSION TENSOR IMAGING AND TRACTOGRAPHY IN JOUBERT SYNDROME: UNRAVELING BRAIN STEM FIBRE TRACTS

Bassem Georgy0 ,1, Sean Tutton0 ,2, M Davidson0 ,2, F Facchini0 ,2, N Nguyen0 ,2, C Nutting0 ,2, P Patel0 ,2 1 University of California, San Diego, San Diego, USA, 2 Medical Colleage of Wisconsin, Milwaukee, USA BACKGROUND AND OBJECTIVE We are reporting our early experience with a new vertebral augmentation system that preserves cancellous bone architecture by using a percutaneously introduced nitinol wire designed to create channels within the vertebral body. The channels created are intended to direct the flow of bone cement in a targeted fashion. METHODS Retrospective multicenter analysis of 46 patients was included in the study. All patients were treated using the “Blazer” vertebral augmentation system (Benvenue Medical, Santa Clara, CA) using unipedicular access in 44 patients. The nitinol wire is used to create channels inside the cancellous bone, which can cross the midline to the contra-lateral side or bridge through bone clefts before cement delivery. Visual Analog Scores (VAS) was obtained before and within 2-4 weeks after the procedure. RESULTS Creation of strategic channels enhances targeted cement delivery and enables bone cement to interdigitate. The system is particularly useful in creating channels to connect clefts with normal adjacent bone (9 patients) and creating channels in hard sclerotic bones (6 patients). No significant leakage was identified. Patients had statistically significant reduction of VAS after the procedure. DISCUSSION AND CONCLUSION The Blazer system allows a unipedicular access with creation of channels resulting in a uniform distribution

SATURDAY 22nd SEPTEMBER PARALLEL SESSION 3A – SCIENTIFIC PAPERS 3A.1

Sandeep Bhuta, Charlie Hsu, Gigi Kwan Griffith University, School of Medicine, Department of Medical Imaging, Gold Coast Hospital, Southport, 4215, Gold Coast, QLD, Australia PURPOSE To illustrate abnormal white matter tract findings in Joubert syndrome using Diffusion Tensor Imaging and Tractography. MATERIALS AND METHODS Four patients with clinical and genetic diagnosis of Joubert syndrome underwent MR imaging on a 1.5 T MRI system (SIEMENS MAGNETOM SymphonyTim MR B18). Multiplanar T2- and T1-weighted isotropic volume images, diffusion tensor imaging (DTI). Apparent diffusion coefficient (ADC), color-coded fractional anisotropy (FA) maps were obtained. Color vector maps of FA were used to place a seed point for fibre tracking. Healthy age and sex matched volunteers were used as control subjects. Though sample size is small Joubert syndrome is rare with incidence of 1:100.000. RESULTS MR imaging performed showed typical Molar Tooth Sign. In normal subjects color coded FA texture maps show a ” red dot” at the level of the inferior colliculi of the midbrain due to decussation of the superior cerebellar peduncles. In JS, the absence of “red dot” on color-coded FA-maps within the midbrain confirms the failure of the superior cerebellar peduncles to decussate. Also seen was horizontal orientation of superior cerebellar peduncles (SCP). In all patients deep nuclei in cerebellum were more laterally located. Ventral and dorsal pontine tracts were separately identified as red bands in normal subjects whereas in patients with JS the dorsal pontine tract was missing. This finding has not been reported to date.

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CONCLUSION In Joubert syndrome, DTI and Tractography adds a different dimension in understanding of complex fibre tract abnormality and certainly is a step beyond “Molar Tooth Sign” O3A-1.2 PERFUSION PARAMETERS OF PILOCYTIC ASTROCYTOMAS: ADDITIONAL ODDITIES OF THESE TUMORS Matia Martucci, Raffaella Colantonio, Chiara Schiarelli, Simona Gaudino, Giuseppe Di Lella, Cesare Colosimo Policlinico "A. Gemelli"-Dipartimento di Bio-Immagini e Scienze Radiologiche, Rome, Italy PURPOSE We analyze perfusion data of pediatric pilocytic astrocytomas (PA) comparing these data with those of low grade gliomas (LGG), high grade gliomas (HGG) and metastases (Met). We discuss their clinical relevance. MATERIAL-METHODS We reviewed conventional, diffusion and perfusion (DSC-GRE EPI) MRI of 8 pathologically proven PA. Maximum rCBV within enhancing and non-enhancing tumor, minimum and mean percentage of signal recovery (PSR) were obtained. PSR-Tmax was calculated as the percentage of signal intensity recovered at the end of acquisition (time-maximum), relative to baseline. The increasing of the curve was defined as the difference between PSR-Tmax and PSR. Results were compared with those from 8 histologically proven HGG, LGG and Mets. Data were presented as mean value±SD, using student's t and Mann-Whitney tests for statistical comparisons (p<0,05 significant). RESULTS rCBV of PA was 1,44±0,27, without significant differences between enhancing and non-enhancing regions, resulting lower than HGG (3,96±1,76) and Mets (4,31± 0,88), slightly higher than LGG (1,2±0,35). PSR was higher than 80 % in PA and LGG. Mets showed lowest PSR (PSRmean 61,07 ± 11,17). At Tmax PA showed highest PSR (>90 %), and in 5cases the curve overshot the baseline. PA demonstrated increasing of the curve closer to HGG than LGG. CONCLUSION PWI parameters should be considered additional oddities of PA: some perfusion behavior resulted peculiar (curve crossing the baseline), other dissimilar to LGG (higher rCBV), other similar to HGG (curves increasing in time).

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These characteristics may be explained by the histological tumoral vascularity and the increased blood-brainbarrier permeability due to intralesional inflammatory/degenerative changes. O3A-1.3 PERSISTING CEREBELLAR EFFERENT PATHWAY DEGRADATION FOLLOWING POSTOPERATIVE CEREBELLAR MUTISM Rob Dineen1, Chris Clarke2, Daniel Rodriguez Gutierrez1 ,3, Sophie Wilne3, David Walker3, Richard Grundy3, Dotohee Auer1 ,3 1 Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, UK, 2Department of Radiology, Nottingham University Hospital, Nottingham, UK, 3Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK Acute injury to the dentate nucleus and dentatothalamic pathways is implicated in the pathogenesis of cerebellar mutism (CM) following posterior fossa tumour surgery. We use longitudinal diffusion tensor imaging (DTI) to study integrity of the decussation of the superior cerebellar peduncles (DSCP), a readily-identifiable component of the dentatothalamic pathways, in 22 individuals (median age 9.8 years; 11 medulloblastoma, 8 pilocytic astrocytoma, 3 ependymoma) with (CM+, n08) and without (CM-, n014) post-operative CM. Ninety-one DTI (Philips 3 T Achieva or 1.5 T Intera) datasets were analysed. After post-processing using FSL, the DSCP was manually outlined on colour-coded principle eigenvector maps overlaid onto an anatomical reference image, and fractional anisotropy (FA) of the DSCP was derived. Where the DSCP could not be identified a value of ‘0' was assigned. Individual's scans were grouped into perioperative (pre-op to 5 days post-op), early (6-90 days), intermediate (91 to 280 days) and late (beyond 280 days) post-operative clusters. DSCP FA was compared between CM + and CM- groups for each time cluster using the Independent-Samples Median Test. No baseline group difference was found in DSCP FA between CM+and CM- (median FA 0.36 v 0.46, p0.183), but significantly lower DSCP FA was found in the CM+group at the intermediate (0 v 0.42, p0.018) and late (0 v 0.45, p0.026) post-operative time clusters, largely attributable to frequent non-visualisation of the DSCP in the CM group. We conclude that reduction of integrity of the dentatothalamic pathways measured at the DSCP is a persistent feature following CM.

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O3A-1.4 READY TO BE BORN: FETAL NEURAL NETWORKS JUST BEFORE BIRTH Renzo Manara1 ,2, Laura Milanese2, Valentina Citton1, Mauro Dam1, Paolo Santonastaso3, Alessandro Salvalaggio2, Francesco Di Salle4 ,5 1 I.R.C.C.S., S.Camillo Hospital, Lido/Venice, Italy, 2Neuroradiologic Unit, University Hospital of Padova, Padua, Italy, 3 Psychiatric Clinic, Department of Neurosciences, University of Padova, Padua, Italy, 4Department of Medicine and Surgery, University of Salerno, Salerno, Italy, 5Department of Cognitive Neuroscience, Maastricht University, Maastricht, Italy Human brain development is mesmerizing though difficult to explore in prenatal phases. Functional MRI performed at rest can investigate non-invasively the intrinsic connectivity of developing neural networks in utero. We evaluated resting state fMRI of ten fetuses at the 37th-38th gestational week, with normal neurological status at one year of age. Shortly before birth, fetal neural networks appeared fragmented (sensorimotor), side-to-side split (auditory) or relatively well established (visual), in line with well-known myelination milestones. The degree of neural network maturation probably hierarchically reflects functions needed to have fetuses ready for life. At the 37th-38th gestational week, neural networks appear relatively immature compared with preterm infants of the same postmenstrual age, unveiling the authoritative effect of external stimuli in inducing neural network maturation. By drawing the natural course of neural networks maturation, fetal functional MRI provides an unexplored tool to clarify the pathogenesis of diseases which may root from early brain damage. O3A-1.5 VENOUS EMBRYOGENESIS USING 3D AND ANGIOGRAPHIC RENDERING AT THE EARLY POST-EMBRYONIC STAGES IN HUMAN Romain Tonnelet3 ,4, Emilien Micart4, Marc Labrousse2 ,4, Romain Cendre4, Vincent Delmas5, Serge Bracard3 ,4, Marc Braun1 ,3 1 Anatomy department, Faculty of medicine, Université de Lorraine, Nancy, France, 2Anatomy department, Faculty of medicine, Université de Champagne, Reims, France, 3Neuroradiology department, CHU, Nancy, France, 4IADI, Inserm U947, Nancy, France, 5 Anatomy department, Faculty od medicine, Université Paris Descartes, Paris, France

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INTRODUCTION Since the mid 1950’s, very little work has been done to contribute to a better understanding of venous vasculature developpement during embryogenesis. We present a new analysis method with multiplanar reformation process based on microscopic sections. This presentation focus on the brain stem arachnoïdo-pial venous anastomoses evolutive morphology. MATERIAL AND METHODS High résolution numerised microscopic continuous sections (10 to 20 microns) from Carnegie stage XIX to XXIII human embryo were used. Specific image treatment was the following : binarisation- thresholding-labellisation, rigid shifting, median filtration (cubic matrix) (resolution 10 microns/ pixel) ; DICOM format images are exported for post-treatment process. Angiographic rendering was obtained thanks to the Eosine/hematoxylin red cells fixation within the vessels. RESULTS At first step, we confirmed the embryonic status relatively to the Carnegie classification in assessing the cochlear canal orientation. The evolutive morphology of the brain stem primitive venous network is presented ; at stage XIX, the initial longitudinal veins are separated from the caudal plexus. During the next stages, they connect to transverse pial anastomoses. The next period (i.e the early and late post-embryonic periods) show these intrinsic pial veins lying between the arteries and the brain surface leading to a progressive simplication pattern. During the stages XX to XXIII, we also present the changing morphology of the trijeminal ganglion venous plexus. These organisations are compared to the Padget and Streeter works. CONCLUSION We present a preliminary work of the brain stem venous embryogenesis using 3D and angiographic rendering at the early post-embryonic stages. O3A-1.6 CHARACTERISTIC BRAIN MRI FINDINGS IN CHILDREN WITH EAST SYNDROME AND CONFIRMED POTASSIUM CHANNEL KCNJ10 RECESSIVE MUTATIONS Roxana Gunny1 ,2, Kling Chong1 ,2, Helen Cross1 ,2, Ruchi Arora1 ,2, RA Heckemann3, Torsten Baldeweg1 ,2, Robert Kleta1 ,2, Alexander Hammers3 ,4, Detlef Bockenhauer1 ,2 1 Great Ormond Street Hospital, London, UK, 2UCL Insitute of Child Health, London, UK, 3The Neurodis Foundation, Lyons, France, 4Imperial College, London, UK INTRODUCTION EAST syndrome is a recently recognised constellation of findings comprising Epilepsy, Ataxia, Sensorineural Deafness, and

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Tubulopathy. It is associated with recessive mutations in the potassium channel gene KCNJ10. The brain imaging findings have not previously been described. METHODS Two paediatric neuroradiologists performed visual assessment of standard MRI scans in 6 (age range 9-18 years, 5 boys) of 9 children referred to Great Ormond Street Hospital with the following characteristics: seizures first occurring between 2-6 months of life; congenital, non-progressive, cerebellar ataxia; early motor and cognitive delay; sensorineural hearing loss; recessive KCNJ10 mutations. Volumetric analysis of 83 anatomical brain regions on T1-weighted MR images was performed in 4 subjects and 8 age- and gender matched healthy control subjects. The underlying image segmentation was performed automatically using MAPER (multi-atlas propagation with enhanced registration). RESULTS All patients' brain MRIs showed symmetrical cerebellar dentate nuclei signal abnormalities and cerebellar hypoplasia. 4 of 6 patients had associated mild pontine hypoplasia and small corpus callosum; 3 of these also had a thin spinal cord. Two patients had mild kyphoscoliosis, 3 had a fatty filum terminale, but a normally positioned conus medullaris. Children who had a second brain MRI (n02) after 8 and 10 years, respectively, showed no evidence of progression. Volumetry showed some regional differences between patients and controls, with reduced volumes of temporal lobe cortex and thalamus. CONCLUSION EAST syndrome involves consistent, subtle structural brain abnormalities that may aid diagnosis. O3A-1.7 CLIPPERS: 3.0 T MR INVESTIGATION AND ROLE OF SUSCEPTIBILITY WEIGHTED IMAGES Mario Sabato1, Ilaria Pesaresi2, Ilaria Desideri1, Silvia Canovetti1, Michele Puglioli2, Mirco Cosottini2 ,3, Carlo Bartolozzi1 1 University of Pisa, Department of Radiology, Pisa, Italy, 2 AOUP, Unit of Neuroradiology, Pisa, Italy, 3University of Pisa, Department of Neuroscience, Pisa, Italy We report the case of a 39 years-old man who underwent to our observation for subacute onset of ataxia and nystagmus. MRI performed at 1.5 T showed multiple areas of T2 hyperintensity and punctuate-curvilinear enhancement mainly in the brainstem and cerebellum, but also in the basal ganglia, thalamus and subcortical emispheric white matter. Sierological and Liquor examination and X-Ray Imaging excluded infective and neoplastic diseases. In the hypothesis of an inflammatory disease he started steroid therapy, with clinical improvement and reduction of MRI lesions. After the therapy

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interruption, symptoms recurred and MRI showed progression of the lesions. Typical imaging findings, symptoms and steroid responsiveness and exclusion of the main differential diagnoses suggested diagnosis of Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). The patient went back to the previous therapy, with newly clinical improvement. 3.0 T MRI was for the first time performed showing, as clinically expected, decrease of the focal enhancement lesions. We acquired Susceptibility Weighted Images (SWI), which revealed multiple punctate hypo-intense alterations in cerebellum, pons, mesencephalon and basal ganglia. Corresponding changes were not found on T2* images. On the bases of animal models we suppose that these signal alterations are expression of perivenous cellular infiltration, according to the physiopathology of the disease. SWI, particularly in High Field acquisition, can be a further criteria for the diagnosis of CLIPPERS, helping physicians in not invasive evaluation and management of these patients. O3A-1.8 USEFULNESS OF ICTAL ELECTROENCEPHALOGRAPHY-FUNCTIONAL MRI IN LOCALIZATION OF EPILEPTOGENIC ARE A IN PATIEN TS WITH REFR ACTORY NEOCORTICAL FOCAL EPILEPSY Nuria Bargalló1 ,2, Alba Sierra1, Iratxe Maestro0 ,3, Carlos Falcon2, Antonio Donaire1, Mar Carreño1 1 Hospital Clinic i Provincial de Barcelona, Barcelona, Spain, 2IDIBAPS, Barcelona, Spain, 3Hospital Universitario Cruces, Bilbao, Spain PURPOSE To evaluate the usefulness of EEG-combined functional magnetic resonance imaging (EEG-fMRI) in localizing epileptogenic zone in refractory neocortical focal epilepsy. METHODS From the EEG-fMRI database of our institution including a total of 62 adult patients, fourteen (age 18-46 years) experienced some clinical or electrographic ictal event during the test. Regions of activations were compared to results from the different techniques performed during presurgical evaluation , SPECT coregisted to MRI (SISCOM), PET and invasive subdural EEG monitoring if available. Lobe and hemisphere of seizure onset were compared among the different techniques available for each patient. RESULTS Regarding the structural MRI findings, five exams were considered normal, 5 had malformations of cortical

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development (MCD), 3 presented a porencephalic cyst, and one patient showed a cavernous angioma. From the total of 9 lesional patients, 8 presented the BOLD area of activation in the same area than the lesion. SISCOM studies were performed in 11 patients; 3 were partially concordant with the increase in BOLD signal and 6 were localized in the same lobe activated in fMRI. Eleven patients underwent PET studies, being concordant within the same hemisphere or lobe in 8 patients. Finally, 3 patients were subject to invasive EEGevaluation with subdural electrodes and all of them presented the seizure onset in the electrodes surrounding the initial area of ictal BOLD activation. CONCLUSION This study support the integration of EEG-fMRI in the multidisciplinary presurgical workup in some patients with refractory neocortical focal epilepsy. O3A-1.9 THE USE OF DIFFUSION TENSOR TRACTOGRAPHY TO ANALYSE CHANGES IN LARGE-SCALE BRAIN NETWORKS IN TEMPORAL LOBE EPILEPSY Julie Chandra1, Tim van Hartevelt2 ,3, Gerardine Quaghebeur1, Alex Green4, Tipu Aziz4, Morten Kringelbach2 ,3 1 Oxford University Hospitals NHS Trust, Oxford, UK, 2 Department of Psychiatry, University of Oxford, Oxford, UK, 3Aarhus University, Aarhus, Denmark, 4Nuffield Department of Surgery, University of Oxford, Oxford, UK Connectivity is fundamental in understanding how the brain functions. Structural networks of the human brain can be constructed using diffusion MRI tractography and analysed using graph theoretical analysis. With this approach, the human brain has been shown to have a “small world” topology characterised by a high degree of local interconnections and small path lengths linking individual network nodes. We describe the technique of network construction using diffusion tensor imaging (DTI) To determine the nodes of the brain network the cerebral cortex is parcellated into 90 non-anatomical regions of interest. Diffusor tensor imaging is then used to calculate the edges of the network by performing whole brain fibre tracking and using the fibre number and fractional anisotropy the weight of each edge is established. In this pilot study, we analyse 6 patients with temporal lobe epilepsy (TLE) and 6 age- and sex-matched healthy controls with DTI to create structural connectivity networks. Previous studies have demonstrated widespread structural and

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functional changes in both hippocampal and extrahippocampal regions in patients with TLE. We hypothesise that analysis of the structural connectivity networks in patients with TLE will demonstrate loss of the optimal topological organisation compared with controls, such as abnormal nodal topological characteristics in important hub regions and areas of the default mode network.

PARALLEL SESSION 3A – SCIENTIFIC PAPERS 3A.2 O3A-2.1 CT ANGIOGRAPHY IN ACUTE ISCHAEMIC STROKE: LOOKING BEYOND THE THROMBUS TO OPTIMISE PATIENT OUTCOME Sarah Power1, Jane Cunningham1, Joanna Ti1, Stephanie Robinson1, Seamus Looby1, Alan O'Hare1, Joan Moroney1, David Williams 1 , Peter Kelly 2 , Eamon Dolan 3 , Paul Brennan1, John Thornton1 1 Beaumont Hospital, Dublin, Ireland, 2Mater Misericordiae Hospital, Dublin, Ireland, 3Connolly Hospital Blanchardstown, Dublin, Ireland Large artery occlusive strokes have poor recanalisation rates with intravenous thrombolysis, and benefit from intra-arterial intervention. We perform CT angiography (CTA) in all patients presenting within the thrombolysis window to identify large vessel occlusion. We reviewed CTA studies from our intra-arterial thrombectomy patient cohort with a view to identifying pattern of occlusion, tandem extra-cranial disease, assessing collaterals, identifying learning points, and comparing CTA to intraprocedural findings. 34 patients with large artery occlusive stroke underwent intra-arterial intervention from January 2010 to April 2012. All patients had pre-procedural CTA, except one patient who had MRA. CTA and intra-procedural DSA were reviewed for each patient. The most commonly occluded single vessel was the MCA (n015), followed by ICA (n04). The remaining 15 patients had multiple sites of occlusion, the most common pattern was ICA, carotid T, and M1±A1 occlusion (n06). Collateralisation to the affected territory was graded, with good pial collaterals present in 13 patients. Tandem ipsilateral carotid stenosis was identified in 2 patients. Contralateral ICA occlusion/stenosis was identified in 4 patients, 2 of whom also had vertebral artery occlusion. We identifed a number of significant learning points, which will be discussed. CTA findings correlated well with intra-procedural findings.

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CTA is an invaluable imaging tool in the acute stroke patient. It rapidly identifes and localises proximal vessel occlusion, gives an indication of thrombus load, and acts as a roadmap for intra-arterial intervention, allowing indepth insight into the vascular imaging characteristics of large vessel occlusive stroke which have not previously been well evaluated. O3A-2.2 DSA-BASED, DYNAMIC 2D WHOLE BRAIN PERFUSION EVALUATION IN STENO-OCCLUSIVE CEREBROVASCULAR DISEASE

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CONCLUSION The DSA-based, dynamic 2D brain perfusion study is feasible for evaluation of both ischemic and congestive perfusion anomalies of the brain. With promising initial results, the technique may become a viable option to study cerebral perfusion in patients, who undergo a catheter-angiography for diagnostic or therapeutic purposes. O3A-2.3 QUANTIFICATION OF CT PERFUSION PARAMETERS AND PENUMBRA BASED ON ASPECTS

Zsolt Kulcsar 1, Hans Aerts 2 , Drazenko Babic 2, Isabel Wanke1, Daniel Rufenacht1 1 Department of Neuroradiology, Swiss Neuro Institute, Hirslanden Clinic, Zurich, Switzerland, 2Philips Healthcare, Best, The Netherlands

Ayelet Eran1, Boaz Gilboa0 ,2, Gregory Telman1, Yaaqov Amsalem1 1 Rambam Health Care Campus, Haifa, Israel, 2Shaare Zedek Medial Center, Jerusalem, Israel

BACKGROUND AND PURPOSE The purpose of this study was to determine the feasibility of DSA-based, dynamic 2D brain perfusion studies in the evaluation of arterial steno-occlusive and venous congestive cerebrovascular pathologies. MATERIALS AND METHODS Twenty consecutive patients underwent DSA-based 2D dynamic perfusion studies on a Philips Allura XPer FD 20/20 flat detector neuroangiographic system, due to arterial steno-occlusive or venous congestive vascular disease. Demographic and clinical informations were collected for all participants. Brain tissue perfusion parameters were calculated for both hemispheres, including arrival time (AT), mean transit time (MTT), time to peak (TTP), cerebral blood flow (CBF) and cerebral blood volume (CBV). The data of the affected versus non-affected sides were compared. In cases where an intervention was also performed, the postinterventional results were calculated and compared to the pretreatment results. RESULTS Eleven patients presented with chronic stenosis or occlusion of a cerebral artery; there were four acute ischemic stroke patients, and one patient with vasospasm after subarachnoid hemorrhage. Four patients were evaluated due to sino-venous occlusion and/or dural arteriovenous fistula. The 2D dynamic brain perfusion evaluation was informative, quantifiable and clinically correlated in all arterial steno-occlusive pathologies of the anterior circulation, and in all pathologies of the sinovenous system.

PURPOSE Evaluation of brain perfusion prior to angiographic interventions has been suggested as a possible selection criterion for treatment. ASPECTS (Alberta Stroke Program Early CT Score), is a quantitative method that has been developed to measure stroke in MCA territory. We hypothesized that the ASPECTS can be applied to CT Perfusion (CTP) maps to quantify core and penumbra. METHOD AND MATERIALS 411 patients underwent CTP due to clinical suspicion of acute stroke between April 2007 and August 2011. We identified 88 patients that had acute stroke in the MCA territory as shown by CTP and follow-up CT. We scored MTT (Mean Transit Time), CBF (Cerebral Blood Flow) and CBV (Cerebral Blood Volume) in the ischemic region using ASPECTS. Additionally, volumetric quantification of the infarcted region was also obtained using vendor software. Penumbra percent was calculated by the equation - (MTT size minus CBV size X 100)/MTT size. Pearson correlation was used to correlate the measurements based on ASPECTS and the volumetric measurements. RESULTS Significant correlation (p<0.01) was found between volumetric measurements of perfusion parameters and ASPECTS . Pearson's correlation coefficients were -0.89, 0.75, -0.75 and 0.64 for CBV, MTT, CBF and penumbra percent respectively. We further investigated the correlation by dividing the patients into 3 groups based on penumbra percent (050 %, 50-85 % and 85-100 %) and found similar correlation in all groups.

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CONCLUSION ASPECTS may be used as a quantification tool of perfusion parameters and penumbra percent in clinical practice and research. O3A-2.4 COMPUTED TOMOGRAPHIC ANGIOGRAPHY AN D V ENO G RA PHY FO R PATIEN TS WITH S P O N TA N E O U S A C U T E I N T R A C E R E B R A L HAEMORRHAGE: REPORT OF A CLINICAL SERIES AND META-ANALYSIS George Kwok Chu Wong, Deyond Siu, Anil Ahuja, Wai Sang Poon Chinese University of Hong Kong, Hong Kong, Hong Kong BACKGROUND With the advancing technology of multi-slice computed tomography (MDCT), we explored the effectiveness of using computed tomographic angiography and venography (CTAV) in place of DSA in patients with spontaneous acute intracerebral haemorrhage. METHODS In a regional neurosurgical center in Hong Kong, we prospectively recruited 109 patients with non-hypertensive spontaneous intracerebral haemorrhage for this comparative study. All patients had CTAV in a single procedure using a MDCT with 64 detectors. They would then schedule to have catheter angiography the next day. Radiological data were collected for blinded analysis. We also performed a computerized PubMed Search of the literature from 1st Jan 1990 to 12th Feb 2010 for reports of similar comparative studies and performed a meta-analysis on diagnostic accuracy. RESULTS Vascular pathologies causing haemorrhage were identified 37(33 %) patients, which included cerebral arteriovenous malformation in 22 patients. The positive predictive value and negative predictive value of CTAV for vascular pathologies causing haemorrhage were 97.3 % (95%CI: 88.3 % to 99.9 %) and 100 % (95%CI: 95.9 % to 100 %) respectively. Cohen's Kappa coefficient for Spetzler-Martin grading was 0.93 (p< 0.001), which indicated excellent intermodality agreements. The high positive and negative predictive values were confirmed with meta-analysis. CONCLUSIONS CTAV was able to identify all vascular lesions causing spontaneous acute intracerebral haemorrhage and could

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replace DSA as the initial vascular investigation for patients presented with spontaneous non-hypertensive intracerebral haemorrhage during the acute phase. O3A-2.5 COMPARISON OF COMMON CAROTID, INTERNAL CAROTID AND VERTEBRAL ARTERIAL COMPLIANCE IN YOUNG HEALTHY CONTROLS AND ELDERLY SUBJECTS MEASURED WITH 3D TIME OF FLIGHT MRA Frank Mihlon, Kerry Hildreth, Kerrie Moreau, Robert Schwartz, Robert Bert University of Colorado Denver, Colorado, USA INTRODUCTION Proximal arterial compliance can decrease with aging and possibly affect CNS perfusion. Ultrasound can measure common carotid artery (CCA) compliance but interference from bony structures and vessel tortuosity limit measurement of internal carotid arteries (ICA) and vertebral arteries (VA). METHODS We have directly measured CCA, ICA and VA compliance with cardiac-gated 3D time of flight (CG3DToF) MRI (1.5 Tesla; systolic and diastolic gates, delay and interval set from phase contrast (PC) max velocity curves) in 8 healthy young men and 3 older men. Separated systolic and diastolic vascular image sets allowed calculation of ΔV. Oscillometric blood pressure (BP) measurements (5 each arm) were averaged to calculate ΔP. Comparison ultrasound compliance measurements of the CCA provided controls. RESULTS CCA vascular distension from MRI and ultrasound were reasonably correlated (MRI 0.158 ± 0.049, US 0.125 ± 0.034 ); R200.41. MRI compliance measurements of CCA, ICA and VA showed pronounced differences between CCA (0.175±0.04) and ICA (0.028±0.011)≈VA (0.031±0.009) in young healthy controls. The pattern was the same, but differences smaller, in the three older subjects: CCA (0.110± 0.04), ICA (0.034± 0.013), VA (0.041 ± 0.008). Older subject PC velocity curves showed broadening in CCA compared to younger subjects but similar ICA and vertebral curves. CONCLUSIONS ICA and VA are significantly less compliant than CCA in both young healthy controls and aged subjects. CCA v. ICA-VA compliance differences narrowed~threefold

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with aging and resulted from decreased CCA compliance alone. Correlating with flow curves, aging may result in loss of "pumping action" contributed by the CCAs.

O3A-2.7 H A E M O R R H A G I C T R A N S F O R M AT I O N I N DIFFERENT ISCHEMIC STROKE PATHOGENETIC SUBTYPES: MRI INVESTIGATION

O3A-2.6 CT BRAIN PERFUSION PATTERNS IN ACUTE S T R O K E W I T H AT H E R O S C L E R O S I S O F EXTRACRANIAL BLOOD VESSELS

Alexander Suslin, Marina Krotenkova, Marine Tanashyan, Rodion Konovalov, Dmitry Sergeev Research Center of neurology, RAMS, Moscow, Russia

Maija Radzina1 ,2, Gaida Krumina2, Karlis Kupcs1, Evija Miglane1 1 P.Stradina clinical univeristy hospital, Riga, Latvia, 2Riga Stradins university, Riga, Latvia AIM To describe the brain perfusion patterns, using multimodal imaging technique in acute stroke patients with atherosclerosis of extracranial blood vessels. MATERIALS AND METHODS A 64 row multislice CT system was used for the evaluation of 70 acute stroke patients 9 hours after ictus, using multimodal imaging (CT, CTA, CTP) and follow up CT within 24 hours. Atherosclerotic changes were evaluated by CTA. RESULTS Increased mean transit time (MTT) indicate delayed blood supply. This pattern was false-positive in hypoperfusion, e.g. severe extracranial carotid stenosis/occlusion. Our study data correlate with latter in 39 % cases of ICA occlusions. CBV maps are the best to estimate collateral flow. We found good collaterals on CTA imaging that correlated in 93 % of penumbra lesion. CBV also is the best predictor for final infarct volume, if the abnormal regions on CBV and CBF match - this represents completed infarct and correlates with our data with completed or partial necrosis in 93 % of all ICA occlusions. Penumbra zone in 4-6 hours correlate with extracranial vessel stenosis less than 50 % at the origin of the ICA in 53 % cases, suggesting of underlying hypoperfusion due to effective collateral blood supply. CONCLUSIONS Optimal image interpretation requires selection of appropriate thresholds and choice of most appropriate parameter for definition of penumbra and collaterals. Brain perfusion patterns correlate with vessel stenosis stage and localization. Long term brain hypoperfusion due to stenosis of extracranial vessels may increase possibility to have wider time window to treatment in acute stroke patients.

PURPOSE to evaluate haemorrhagic transformation (HT) in different ischemic stroke pathogenetic subtypes and influence of HT on neurological deficit. MATERIALS AND METHODS we examined 51 patients with acute ischemic stroke in middle cerebral artery territory [mean age 67 [59; 70] years; 28 males, 23 females) in the first 48 hours and then on 7-8 and 20-21 days from the onset. 22 patients had cardioembolic stroke (CE), 18 atherothrombotic (AT) and 11 - lacunar (L). In every examination time point MRI was performed on 1.5 T scanner in T2, T1, FLAIR, DWI (b00, 500, 1000), MR-perfusion regimens. RESULTS HT was revealed in 21 patients: in 38,9 % AT, in 63,6 % CE. No HT in L was seen. Both AT and CE had parenchymal haemorrhages (PH) and haemorrhagic infarction (HI) types of HT: PH occurred in the first 7 days from onset and was almost equally presented in AT and CE; most HI also occurred in the first 7 days from onset, but only in CE; after 7 days HI occurred predominantly in AT. Neurological deficit assessment in patients with HT showed clinical improvement in 11 (52,4 %) patients on 20-21 days, stable state in 9 (42,8 %) patients and there was worsening only in 1 (4,8 %) patient. CONCLUSION HT revealed during MR examination was clinically asymptomic, so it can be considered as a reperfusion marker and as one of the ischemic stroke progress stages. HI is more common in CE stroke subtype in the first 7 from the onset. O3A-2.8 DIFFUSION-WEIGHTED IMAGING IN TIA PATIENTS Miriam Brazzelli, Francesca Chappell, Joanna Wardlaw University of Edinburgh, Edinburgh, UK BACKGROUND Patients with TIA are at high risk of early recurrent stroke. Accurate diagnosis and recognition of ischaemic

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causes of neurological symptoms are essential for effective management and stroke prevention. Demonstration of an ischaemic lesion on DWI has been associated with an increase risk of stroke in TIA patients. We aimed to assess the frequency of DWI visible lesions in TIA patients. METHODS We searched MEDLINE, EMBASE from 1995 to 2011 for all published studies assessing TIA patients with DWI irrespective of the study design and setting. We performed a random effect meta-analysis to combine results between included studies. RESULTS We identified 49 studies with a total of 9222 TIA patients. Frequency of positive DWI findings ranged from 9 % to 67 % across studies. Studies varied in terms of time interval between symptoms onset and DWI, symptoms duration, aetiology, selection criteria, and setting. Overall the proportion of TIA patients with a DWI abnormality was 34.7 % (95 % CI 31.0 %-38.6 %). CONCLUSIONS In clinical practice DWI can be useful to establish an acute ischaemic cause in a third of TIA patients, but a considerable proportion (two thirds) of definite TIA patients have negative DWI. Absence of an ischaemic lesion on DWI is the commonest finding in patients with definite TIA and should not preclude effective secondary prevention. It remains to be demonstrated whether an ischaemic DWI lesion is an independent risk factor for stroke. O3A-2.9 DWI/PWI- COMBINED DETERMINANT OF ENDOVASCULAR REPERFUSION THERAPY IN ACUTE STROKE PATIENTS WITHIN 4.5 HOURS OF ONSET DUE TO THE CAROTID ARTERY OCCLUSION Takahisa Mori, Tomonori Iwata, Yuichi Miyazaki, Masahito Nakazaki, Kouji Mizogami, Yoichiro Takahashi, Syunichiro Inagaki, Gen Sihashi Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan PURPOSE The aim of our retrospective study was to find a useful DWI/ PWI-combined determinant of endovascular reperfusion therapy (ERT) in stroke patients admitted within 4.5 hours due to acute carotid artery occlusion. SUBJECTS AND METHODS Included were patients 1) who were admitted within 4.5 hours between Jan 2006 and January 2011, 2) who presented NIHSS score of 6 or more on admission, and 3) who underwent emergency MR imaging, suggesting the affected carotid artery occlusion. PWI- based Time-

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Intensity Curve (TIC) were generated on region of interests set at symmetrical positions of the bilateral MCA territories, and graded according to the time to peak (TP) and the reduction value of the peak signal (PS) (grade 1 to 4; Figure). We assessed which combination of TIC grade and ASPECTS of 4 or more was a useful determinant of ERT RESULT Eighty-seven patients were included for retrospective analysis. TICs were generated easily. NIHSS adm (median) was 20, ASPECTS was 6, there were 36 in TIC grade1, 39 in grade2, 12 in grade3, and 0 in grade 4, 39 patients (44.8 %: 39/87) underwent reperfusion therapy, 7-day NIHSS was 20. Forty-five patients improved in 7-day NIHSS. Among three types of combination, patients with ASPECTS of 4 or more and TIC grade of 2 improved neurologically on the 7th day after ERT compared to patients without ERT (p<0.05). CONCLUSION ASPECTS of 4 or more and TIC grade of 2 was a useful determinant of endovascular reperfusion therapy.

PARALLEL SESSION 3B – SCIENTIFIC PAPERS 3B.1 O3B-1.1 MRI PATTERNS IN NATALIZUMAB-ASSOCIATED PROGRESSIVE MULTIFOCAL L E U K O E N C E P H A L O PAT H Y ( P M L ) I N M S PATIENTS: UPDATED RECOMMENDATIONS Tarek A. Yousry1, Daniel Pelletier2, Diego Cadavid3, Achim Gass4, Nancy D. Richert3, Ernst-Wilhelm Radue5, Massimo Filippi6 1 UCL Institute of Neurology, London, UK, 2Yale University School of Medicine, New Haven, CT, USA, 3Biogen Idec, Cambridge, MA, USA, 4University Hospital Mannheim, Mannheim, Germany, 5University Hospital Basel, Basel, Switzerland, 6Vita-Salute San Raffaele University, Milan, Italy OBJECTIVE To update recommendations for diagnosis of progressive multifocal leukoencephalopathy (PML) with magnetic resonance imaging (MRI) based on common characteristics of PML and PML-related immune reconstitution inflammatory syndrome (IRIS) in natalizumab-treated multiple sclerosis (MS) patients. BACKGROUND Natalizumab is an efficient MS treatment that is associated with a risk of PML. Recommendations were published in 2006 to improve early diagnosis of PML using MRI. However, the imaging criteria were primarily derived from PML lesions in HIV patients and from the first 2 cases of PML in

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natalizumab-treated MS patients. Therefore, there is a need to update the existing recommendations accordingly based upon reported cases of natalizumab-associated PML. METHODS Of the first 40 cases of PML identified in natalizumabtreated MS patients, 22 (7 with IRIS) fulfilled inclusion criteria for this analysis. The MR images were analyzed according to predefined criteria by 5 independent readers. RESULTS Among patients with early PML, the most common pattern was that of large (>3 cm, 15/18), subcortical (18/18), T2 or FLAIR hyperintense (18/18), T1 hypointense (17/18), and diffusion hyperintense (15/15) lesions. Borders were sharp toward the grey matter and ill-defined toward the white matter (18/18) on T2 weighted images. We detected contrast enhancement in 41 % (7/17) of cases on the first scan at clinical presentation. CONCLUSION For screening and early diagnosis of PML in MS patients treated with natalizumab, attention to characteristic MRI patterns, especially the presence of frequent, punctate/rimlike contrast enhancement and the subcortical location, is critical.

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cerebral hemisphere regions of interest (ROIs), placed in Normal Appearing White Matter (NAWM) and Normal Deep Gray Matter (NDGM) structures. The same hemodynamic parameters were also measured in thirty healthy controls. RESULTS Both CIS and RR-MS patients showed significantly impaired scores on verbal working memory and secondary verbal memory. All measured CBV and MTT values were significantly elevated in CIS as compared to healthy controls and to RR-MS patients. In CIS patients, memory performance correlated inversely with CBV values in the left frontal NAWM, right thalamus, right caudate and CC, whereas in the RR-MS patients these memory indices correlated positively with CBV values in the right frontal, left parietal and periventricular NAWM, and in the caudate. CONCLUSION Impaired verbal memory in CIS patients correlated inversely with elevated regional CBV values thought to reflect disease-induced inflammation in brain structures normally involved in memory functions. Hence, the cognitive disturbances observed in CIS patients may relate to widespread brain inflammatory processes that prevail in early MS.

O3B-1.2 COGNITIVE DEFICITS IN EARLY MULTIPLE SCLEROSIS CORRELATE WITH INFLAMMATORY HEMODYNAMIC CHANGES

O3B-1.3 BASELINE BRAIN INFLAMMATION AND ITS RELATIONSHIP WITH GREY, WHITE AND BRAIN VOLUME CHANGES DURING THE FIRST YEAR OF NATALIZUMAB THERAPY IN RELAPSINGREMITTING MULTIPLE SCLEROSIS PATIENTS

Efrosini Papadaki1, Panagiotis Simos0 ,1, Theodora Panou1, Vasileios Mastorodemos1, Emmanouil Amanakis1, Thomas Maris1, Andreas Plaitakis1 1 University Hospital, Heraklion, Crete, Greece, 2University of Crete, Rethymnon, Crete, Greece

Alex Rovira, Anka Vidal-Jordana, Jaume Sastre-Garriga, Raquel Mitjana, Mar Tintoré, Jordi Rio, Xavier Montalban Hospital Vall d'Hebron, Barcelona, Spain

PURPOSE To explore whether CNS hemodynamic disturbances, detected in patients with Clinically Isolated Syndrome (CIS) and Relapsing Remitting- Multiple Sclerosis (RRMS), correlate with memory function. METHODS Thirty CIS and early stage RR-MS patients matched for age, gender, education level, and IQ, were administered tests of short-term and working memory for digits, passage and design memory. Regional cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) values were estimated using Dynamic Susceptibility Contrastenhanced T2*-weighted MRI (DSC-MRI) in 20 left and right

BACKGROUND AND PURPOSE Clinical trials have demonstrated an increased rate of volume loss in natalizumab treated multiple sclerosis (MS) patients compared to placebo during the first year of therapy, which may be interpreted as a pseudoatrophy effect. The aim of this study is to assess the evolution of brain atrophy during the first year of natalizumab therapy, and on the relationship between pre-existing inflammation and subsequent global and regional brain volume loss. METHODS Thirty-nine relapsing-remitting MS patients on natalizumab therapy were selected for the study. All patients underwent T2- and pre- and post-contrast T1-weighted sequences at

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baseline and after one year of treatment. SIENA and SPM5 software with lesion mask maps were used for the volumetric analysis and measures of percentage brain volume change (BVC), brain parenchymal fraction (BPF), grey and white matter fraction (GMF and WMF) for the first year of treatment. RESULTS Mean percentage brain volume changes during the first year of treatment were: BVC -1.10 %, BPF -0.04 %, GMF 1.15 % and WMF -1.72 %. Mean number of contrast-enhancing lesions (CEL) at baseline was 4.4 (SD 7.7). Higher numbers of CEL at baseline correlated with greater global atrophy accrual rates during the first year (Rho0-0.41; p00.009 for BVC. There was a trend to a more marked WMF reduction in those patients having baseline CEL (p00.071). CONCLUSION Early brain volume loss during natalizumab therapy seems to be related to baseline inflammatory activity and to be mainly due to WMF changes. These findings would support the pseudoatrophy effect theory. O3B-1.4 BRAIN MEDULLARY VEINS VISIBILITY WITH SUSCEPTIBILITY-WEIGHTED MR IMAGING IN CLINICALLY ISOLATED SYNDROMES AND RELAPSING REMITTING MULTIPLE SCLEROSIS Alex Rovira1, Francesc Xavier Aymerich1 ,2, Cristina Auger1, Raquel Mitjana1, Mar Tintoré1, Xavier Montalban1 1 Hospital Universitari Vall d’Hebron, Barcelona, Spain, 2 Department of Automatic Control (ESAII) Universitat Politècnica de Catalunya, Barcelona, Spain BACKGROUND AND PURPOSE Susceptibility-weighted imaging (SWI) is a novel MR technique that allows visualizing veins in the brain due to an inverse BOLD effect. Previous studies have described that relapsing-remitting multiple sclerosis (RRMS) patients show in SWI images a significantly reduced visibility of periventricular white matter veins compared to healthy controls (HC), with a negative correlation with T2 lesion load. In this work we propose to extend these studies to patients presenting with clinically isolated syndrome (CIS), who represent the earliest stage of possible multiple sclerosis (MS). METHODOLOGY 101 subjects (17 HC; 48 CIS; 36 RRMS) were examined with 3 T MRI (T2 and SWI). SWI images were acquired using a 3 mm-slice thickness transverse GE sequence (TR/TE032 ms/ 24.6 ms). A home-developed algorithm was used to detect vein pixels in eight rectangular supraventricular white matter ROIs.

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RESULTS Twenty-eight (58 %) CIS patients had subclinical brain lesions (pCIS), whereas twenty (42 %) had not (nPCIS). There were significant differences in the number of vein pixels among HC, RRMS and CIS groups (p00.047). Dunnett's test only showed significant difference comparing RRMS vs. HC (p00.033). However, pCIS showed a significant lower number of vein pixels than nPCIS (p00.028). CONCLUSIONS CIS and RRMS patients showed in supraventricular white matter regions a decrease in the number of vein pixels, which is associated with the presence of T2 lesions. This finding likely reflects a decrease in the inverse BOLD effect (decrease in deoxihemoglobin) and supports the concept of a widespread hypometabolic process in MS. O3B-1.5 GREY MATTER IN MULTIPLE SCLEROSIS SHOWS 'NORMAL AGING' Jean Lee, Rebecca Quest, Lesley Honeyfield, Mark Radon, Paolo Muraro, Adam Waldman Imperial College, London, UK PURPOSE To investigate the effect of age and disease duration on: (1) Grey matter lesion burden (2) The rate of grey matter volume loss, in patients with relapsing-remitting or secondary progressive multiple sclerosis (MS) with similar disease duration, stratified into younger and older age groups. METHODS Analysis of volumetric T1 and volumetric T2 FLAIR MRI images of patients with relapsing-remitting or secondary progressive multiple sclerosis (n 020 ‘younger ‘; 2630 years; and n020 ‘older' 45-60 years) and healthy controls (n 010) using a semi-automated thresholding technique, based on fuzzy C-mean algorithm and integrated in Xinapse, which was subsequently verified on visual inspection. Grey matter volume and lesion volume were quantified through segmentation from FSL SIENAX. Data were analysed with multivariate regression and Mann-Whitney U Test. RESULTS There is no significant difference in grey matter lesion volumes in patients with MS between age groups. Grey matter volume is reduced in patients with MS compared with healthy controls. In patients with MS, grey matter volume is significantly lower in the older compared with the ‘younger'age group (p00.008).

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The rate of loss of grey matter volume between ' younger' and ‘older' age groups in MS (-5.3 %) is similar to healthy controls (-4.3 %). CONCLUSION Patients with relapsing-remitting and secondary progressive multiple sclerosis have grey matter volume loss compared with healthy controls, but show "normal aging", i.e. lose volume at a similar rate to healthy controls. Older age and disease duration does not affect the radiological progression of grey matter disease. O3B-1.6 C O RT I C A L - J U X TA C O RT I C A L L E S I O N S I N C L I N I C A L LY I S O L AT E D S Y N D R O M E S : DISTRIBUTION, AND DIAGNOSTIC VALUE Cristina Auger, Deborah Pareto, Albert Pla, Raquel Mitjana, Juan F Corral, Àlex Rovira Hospital Vall d'Hebron, Barcelona, Spain PURPOSE To evaluate the presence, the spatial distribution of corticaljuxtacortical lesions in patients with a clinical isolated syndrome (CIS) by using MRI-based lesion probability maps, and to determine its impact to diagnose lesion dissemination in space (DIS) according to the 2010 McDonald criteria for multiple sclerosis (MS). METHODS 71 CIS patients aged between 18 and 50 years old (mean 34 years) with underwent brain and spinal cord 3 T MRI within the first five months after symptoms onset. The following sequences were obtained: 1) PD and T2weighted; 2) T2-fast FLAIR; 3) Un-enhanced and contrastenhanced T1-weigthed; and 4) 3D double inversionrecovery. Cortical-juxtacortical lesions in each patient, were identified, manually outlined and segmented into a binarized mask. A cortical-juxtacortical MRI-based lesion probability map was obtained. RESULTS Cortical-juxtacortical lesions were identified in 31 patients (44 %). Frontal lobe was the most affected area with an incidence of 48 % of the lesions. Temporal and parietal lobes had also a significant incidence (20 % and 29 %). According to the MS 2010 McDonald diagnostic criteria, identification of cortico-juxtacortical lesion contributed to demonstrate lesions disseminated in space (DIS) in 27 %. CONCLUSIONS Cortical-juxtacortical lesions are a common MRI finding in patients with a CIS, predominantly involving the

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frontal, parietal and temporal lobes. Its demonstration has a high relevance for demonstrating dissemination in space according to the MS 2010 McDonald diagnostic criteria. O3B-1.7 U S E F U L N E S S O F A P PA R E N T D I F F U S I O N COEFFICIENT MEASUREMENTS WITHIN NORMAL APPEARING WHITE AND GREY MATTER IN THE DIFFERENTIAL DIAGNOSIS OF PATIENTS WITH MULTIPLE SCLEROSIS AND CEREBRAL SMALL VESSEL DISEASE Joanna Bladowska, Anna Zimny, Anna Zacharzewska, Tomasz Maciej Gondek, Anna Pokryszko-Dragan, Maciej Guzinski, Ryszard Podemski, Marek Sasiadek Wroclaw Medical University, Wroclaw, Poland BACKGROUND The purpose was to assess the usefulness of apparent diffusion coefficient (ADC) measurements of normal appearing white (NAWM) and grey matters (NAGM) in the differential diagnosis of patients with multiple sclerosis (MS) and cerebral vascular lesions (VA). MATERIAL AND METHODS Ninety-two patients: 35 with MS, 27 with VA lesions and 30 age- and sex-matched control subjects (CG) underwent plain MR followed by diffusion weighted imaging (DWI) on a 1.5 T MR unit. Among MS patients there were 16 nontreated and 19 treated subjects in the early stage of disease with up to 40 brain lesions. In DWI the ADC measurements were performed in 11 regions of interest (ROIs) within NAWM and NAGM: bilaterally in the cerebellar white matter (WM), thalami, basal ganglia, frontal WM, frontoparietal WM and pons. ADC values were correlated with lesion load and the clinical Expanded Disability Status Scale (EDSS). RESULTS Compared to CG and VA subjects, non-treated MS patients showed significantly higher ADC values in all locations, which correlated with lesion load. Treated MS patients revealed higher ADC values in cerebellar WM, frontal and frontoparietal WM compared to CG and VA subjects. In treated MS patients ADC values were decreased in pons and right basal ganglia compared to non-treated. There were no significant differences in ADC values between VA and CG subjects. CONCLUSIONS Assessment of ADC values of NAWM and NAGM in particular brain regions seems to be very useful method in

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differential diagnosis of inconclusive MS and VA cases and treatment monitoring in MS. O3B-1.8 BRAIN INVOLVEMENT IN ALSTRÖM SYNDROME Valentina Citton1, Angela Favaro2, Vera Bettini3, Joseph Gabrieli4, Jan Marshall5, Gabriela Milan3, Francesca Favaretto3, Pietro Maffei3, Alessandro Salvalaggio4, Chiara Briani2, Jürgen K. Naggert5, Giuseppe Rolma4, Renzo Manara1 1 Neuroradiologic Unit, Ospedale San Camillo, Lido/Venice, Italy, 2Department of Neurosciences, University of Padua, Padua, Italy, 3Internal Medicine 3, Dept. of Medicine, University Hospital of Padua, Padua, Italy, 4Neuroradiologic Unit, University Hospital of Padua, Padua, Italy, 5The Jackson Laboratory, Bar Harbor,Maine, USA BACKGROUND Alström Syndrome (AS) is a rare ciliopathy characterized by cone-rod retinal dystrophy, sensorineural hearing loss, obesity, type 2 diabetes mellitus and cardiomyopathy. Most patients do not present with neurological issues and demonstrate normal intelligence, although delayed psychomotor development and psychiatric disorders have been reported. To date, brain Magnetic Resonance Imaging (MRI) abnormalities in AS have not been explored. METHODS We investigated structural brain changes in 12 genetically proven AS patients (mean-age 22 years; range: 6-45, 6 females) and 19 matched healthy and positive controls (mean-age 23 years; range: 6-43; 12 females) using conventional MRI, Voxel-Based Morphometry (VBM) and Diffusion Tensor Imaging (DTI). RESULTS 6/12 AS patients presented with brain abnormalities such as ventricular enlargement (4/12), periventricular white matter abnormalities (3/12) and lacune-like lesions (1/12); all patients older than 30 years had vascular-like lesions. VBM detected grey and white matter volume reduction in AS patients, especially in the posterior regions. DTI revealed significant fractional anisotropy decrease and radial diffusivity increase in the supratentorial white matter, also diffusely involving those regions that appeared normal on conventional imaging. On the contrary, axial and mean diffusivity did not differ from controls except in the fornix. CONCLUSIONS Brain involvement in Alström syndrome is not uncommon. Early vascular-like lesions, gray and white matter atrophy, mostly involving the posterior regions, and diffuse supratentorial white matter derangement suggest a role of cilia in endothelial cell and oligodendrocyte function.

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O3B-1.9 IS THE AIRWAY COLLAPSIBILITY ON SLEEP CINE MRI R ELATED TO SMALL VESSEL DISEASE ON BRAIN MRI IN OBSTRUCTIVE SLEEP APNEA? Hyobin Seo, Hua Sun Kim, Se-Yeong Chung Seoul National University hospital healthcare system Gangnam center, Seoul, Republic of Korea Obstructive sleep apnea (OSA) is associated with stroke and hypertension. However, a connection between OSA and small vessel disease (SVD) is uncertain. Sleep magnetic resonance imaging (MRI) is the advanced imaging tool to evaluate upper airway collapse during sleep. The aim of this study is to evaluate an association of OSA and SVD with cine MRI. From April 2009 through February 2012, 74 patients with OSA were evaluated with sleep cine MRI and brain MRI. A balanced fast field-echo sequence was used for cine MRI. The upper airway was classified into two (retropalatal and retroglossal) levels. We measured the airway diameters on pre-sedation and post-sedation axial images. On brain MRI, SVD including white matter hyperintensity or microbleed, lacunar or large artery infarction were evaluated. We also obtained medical history, medication, laboratory finding, endoscopic result and Watch-PAT result from electronic medical record. Airway collapse was observed at both retropalatal and retroglossal levels during sleep (p<0.01). There were 26 patients with grade 1 SVD, 5 patients with grade 2 SVD and 3 patients with infarction. Prevalence of SVD in our study was 41.9 %. Decrease of airway diameter was more significant in patients with cerebral ischemic lesions than in patients without cerebral lesions (p < 0.05). However, patients with cerebral ischemic lesions including SVD had a significant association with retroglossal anterior-posterior collapsibility after the confounding effect was eliminated by statistical analysis (p <0.05). Airway collapsibility of OSA patients on sleep cine MRI is related to cerebral ischemic lesions including SVD.

PARALLEL SESSION 3B – SCIENTIFIC PAPERS 3B.2 O3B-2.1 CAROTID-CAVERNOUS FISTULA- THE OXFORD EXPERIENCE Neil Rane, Julie Chandra, Martino Cellerini, Iris Grunwald, Rufus Corkill, Wilhelm Kuker, James Byrne Oxford University Hospitals, Oxford, UK

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A carotid-cavernous fistula (CCF) is an aberrant communication between the carotid artery and the cavernous sinus. It involves the internal carotid artery itself and can be distinguished from dural arteriovenous fistulae of the cavernous sinus. CCFs are most commonly post traumatic but the presentation can be delayed, with development of chemosis, proptosis, diplopia, bruit and visual loss. The arteriovenous shunt that subsequently develops leads to symptoms due to altered venous dynamics and raised pressure; commonly in the orbital compartment leading to proptosis and chemosis. The raised venous pressure may translate into intraoccular pressure that threatens vision. CT or MRI are typically used as the initial investigation, with the classic signs of enlargement of the superior opthalmic vein, extra-ocular muscles and proptosis strongly suggestive of the diagnosis. Endovascular treatment (EVT) has become the mainstay of management. Strategies vary but ultimately the aim is to occlude the shunt, most commonly with coils, via a venous, arterial, or combined approach. This is a retrospective review of nine cases of CCF treated by EVT at a single institution between 2005 and 2012. The presentation, initial imaging, and technical aspects are all reviewed. Outcomes including complications and potential pitfalls are also discussed. O3B-2.2 INTEREST OF USING A SPHERICAL CONVEX ANAMORPHOSIS FOR A BETTER UNDERSTANDING OF THE ANGIO-ARCHITECTURE OF BRAIN AVMS Frédéric Clarençon1, Franck Maizeroi-Eugène2, Benjamin Gory3, Nader Sourour1, Nicolas Menjot de Champfleur4, Jacques Chiras1, Charbel Mounayer3 1 Department of Interventional Neuroradiology. Pitié-Salpêtrière Hospital, Paris, France, 2Segmentix Society, Limoges, France, 3Department of Interventional Neuroradiology. Limoges University Hospital, Limoges, France, 4Derpartment of Neuroradiology. Montpellier University Hospital, Montpellier, France PURPOSE To elaborate an algorithm of convex spherical anamorphosis that could be applied on 3D rotational angiography (3DRA) acquisitions for the understanding of brain arteriovenous malformations (bAVMs). MATERIALS AND METHODS The algorithm was elaborated on Matlab software (version R2009b). The data from 3D-RA of 12 patients (6 males, 6 females; 10 supratentorial bAVMs; 2 infratentorial bAVMs) were used to elaborate the algorithm.

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The convex spherical anarmophosis is a barrel distorsion that consists to apply a part of a plane surface on a convex hemisphere. This deformation may help to "spread" the nidus and the vessels close to the nidus. Two independent observers applied this algorithm on the volumes ( nidus, arteries and veins) derived from the segmentation of bAVMs and semi-quantitatively evaluated its quality (poor, fair and good). The number of arterial feeders to the nidus showed by this barrel distorsion was compared with the images obtained from 6 f/s DSA in AP, lateral and oblique projections. RESULTS The application of the convex spherical anamorphosis was possible in all cases. The quality of the deformation provided was evaluated as good by both observers in most cases. In mean, convex spherical anamorphosis could depict one more arterial feeder than the 6 f/s DSA. CONCLUSION The algorithm of convex spherical anamorphosis elaborated is a promising tool for a better understanding of complex bAVMs. O3B-2.3 E L A B O R AT I O N O F A S E M I - A U T O M AT E D ALGORITHM FOR BRAIN ARTERIOVENOUS MALFORMATIONS SEGMENTATION: INITIAL RESULTS Frédéric Clarençon1, Franck Maizeroi-Eugène2, Benjamin Gory3, Nader Sourour1, Damien Bresson4, Jacques Chiras1, Charbel Mounayer3 1 Department of interventional neuroradiology. Pitié-Salpêtrière Hospital, Paris, France, 2Segmentix Society, Limoges, France, 3Department of interventional neuroradiology. Limoges University Hospital, Limoges, France, 4 Depatment of Neurosurgery. Lariboisière Hospital, Paris, France PURPOSE The purpose of our study was to elaborate a semi-automated segmentation algorithm in order to distinguish, on 3D rotational acquisition (3D-RA) volume, the different components of the bAVM (arterial feeders, nidus and draining veins). MATERIALS AND METHODS The semi-automated algorithm was elaborated on Matlab software (version R2009b). The data from 6 frames rate images from AP, lateral and oblique views acquired from the DSA and 3D-RA of 12 patients (6 males, 6 females; 10 supratentorial bAVMs; 2 infratentorial bAVMs) were used to elaborate the algorithm. The nidus was individualized on axial slice from the 3DRA. Then, the upper and lower edges of the nidus were

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specified. The nidus segmentation was finally obtained using a region growing algorithm with propagation from discrimination criteria. Tagging of the vessels (artery or veins) was determined using a stereoscopic matching algorithm based on the 4 views from the 6 f/s acquisitions respectively on arterial phase for arteries and venous phase for veins. Then, the arteries and veins were segmented using a propagation algorithm. Reliability of the algorithm was checked on the concordance between the segmented 3D-RA volume and the acquisitions at 6 f/s. RESULTS Segmentation was satisfying in all the cases. Only mild errors were depicted that were related to crossing between veins and arteries. These errors could be easily corrected by additional tagging of the vessels. Mean duration for the bAVM segmentation was about 25 min. CONCLUSION This segmentation algorithm is a promising tool for the understanding of the angio-architecture of the bAVMs.

RESULTS A total of 74 FAs were found in these 46 patients (mean age: 44 yrs). Forty-six patients (57 %) had only one FA, multiple FAs in 20 patients (43 %). All 74 FAs were smaller than 9 mm; and 68 FAs (96 %) were smaller than 5 mm. No significant morphologic change of FAs after total obliteration of BAVMs in 41 FAs (55 %), while 33 FAs fed by distal branches of parent artery vicinity of BAVM disappeared or decreased in aneurysm size in angiographic follow up (mean: 39 months). No event of FA rupture was found in the clinical follow up (mean: 42 months). CONCLUSION Almost all FAs were small. FAs near the nidus of BAVM may undergo regression or disappearance after gradual obliteration of BAVM by radiosurgery, while those locating in the will's circle may remain stable and unchanged in morphology. There was no event of FAs rupture in the mid-term follow up.

O3B-2.4 NATURE COURSE AND MORPHOLOGICAL CHANGE OF FLOW-RELATED ANEURYSM IN BRAIN ARTERIOVENOUS MALFORMATION AFTER RADIOSURGERY

Alex Mortimer, Suzanne O'Leary, Andrew Mallick, Marcus Bradley, Shelley Renowden Frenchay Hospital, Bristol, UK

Chao-Bao Luo1 ,2, Wan-Yuo Guo1 ,2, Michael MH Teng1 ,2, Feng-Chi Chang1 ,2, Chung-Jung Lin1 ,2, Hsiu-Mei Wu1 ,2, Wen-Yuh Chung1 ,3 1 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, 2Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, 3 Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan BACKGROUND The purpose of this study is to evaluate the nature course, demography and morphologic change of flow-related aneurysm (FA) of brain arteriovenous malformation (BAVM) after radiosurgery. PATIENT AND METHODS In the past 10 years, a total of 552 BAVMs had been treated primary by radiosurgery. Seventy-seven patients (14 %) had associated with FAs. Of these 77 patients, 46 patients had conventional cerebral angiography before radiosurgery and at complete obliteration of the BAVMs. We retrospectively analyzed the demography, nature course of flow-related aneurysm (FAs) in BAVM as well as morphologic change of the FA during the latency of radiosurgery.

O3B-2.5 ENDOVASCULAR TREATMENT OF CEREBRAL VENOUS SINUS THROMBOSIS IN CHILDREN: A CASE SERIES

PURPOSE Cerebral venous sinus thrombosis (CVST) is a serious condition affecting 0.67 per 100,000 children per year. The clinical presentation is often non-specific and this can lead to a delay in diagnosis or it being missed altogether: adverse outcomes are common. The mainstay of acute treatment is anticoagulation with heparin. However, a proportion of patients remain in a severe clinical condition and escalation to endovascular therapy is a potential method of treatment. There is little published literature on the use of aggressive endovascular treatments in children with CVST. METHODS We undertook a retrospective case note and imaging review of a series of children treated using endovascular therapy following diagnosis of CVST. Clinical presentation, decision to escalate therapy, methods of recanalisation and clinical outcome were assessed. RESULTS Eight children were treated (age range 18 months-16 years). All had the diagnosis made by a neuroradiologist on CT, CTV, MR or MRV. Seven children were comatose; one child had signs of raised intracranial pressure with progressive cranial nerve palsies. Seven of the children had been treated with heparin without improvement. A variety of endovascular methods were used including local tPA, microwire and

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catheter disruption, balloon angioplasty and thromboaspiration using the Penumbra device. Seven children had good functional outcomes. One child died as a consequence of uncontrolled intracranial hypertension secondary to CVST. CONCLUSION Endovascular therapy appears to have a role in the treatment of CVST in children when medical therapy has failed and the patient is in a poor clinical condition. O3B-2.6 Abstract Withdrawn O3B-2.7 MR IMAGING FEATURES OF AMYLOID-RELATED IMAGING ABNORMALITIES (ARIA) IN PATIENTS TREATED WITH BAPINEUZUMAB Jerome Barakos1 ,2, Reisa Sperling3, Stephen Salloway4, Clifford Jack5, Achim Gass6, Jochen Fiebach7, Donatella Tampieri8, Denis Melancon8, Yves Miaux2, Gregory Rippon9, Ronald Black9, Yuan Lu10, H. Robert Brashear10, H. Michael Arrighi10, Kristen Morris10, Michael Grundman10 1 California Pacific Medical Center, San Francisco, CA, USA, 2Synarc, Newark, CA, USA, 3Brigham and Women’s Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 4Warren Alpert Medical School of Brown University, Providence, RI, USA, 5Mayo Clinic, Scottsdale, AZ, USA, 6University Hospital Mannheim, Heidelberg, Germany, 7Center for Stroke Research, Charité Berlin, Germany, 8NeuroRx Research, Montreal, Quebec, Canada, 9Pfizer Inc., Collegeville, PA, USA, 10Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, CA, USA OBJECTIVES Magnetic resonance (MR) imaging abnormalities referred to as ARIA (amyloid-related imaging abnormalities) have been reported in clinical studies of Alzheimer's disease (AD) with several agents that target cerebral β-amyloid (Ab). ARIA includes ARIA-E, or parenchymal or sulcal hyperintensities on FLAIR indicative of parenchymal edema or sulcal effusions; and ARIA-H, hypointense regions on GRE/T2* indicative of hemosiderin deposition classified as small (<10 mm; also known as microhemorrhages) and large (≥10 mm). ARIA identified during studies of bapineuzumab, a humanized monoclonal antibody against Ab, are described. METHODS Two neuroradiologists reviewed MRI scans from 210 bapineuzumab-treated patients from three phase 2 studies. ARIA-E and H were identified and a spectrum of findings is presented.

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RESULTS Thirty-six patients were identified with incident ARIA-E and 24 with incident small ARIA-H. The most commonly encountered MR feature of ARIA-E at detection consisted of a region of sulcal hyperintensity, occurring in 78 % (28/36) of cases; of these, 13 also had some degree of parenchymal hyperintensity on FLAIR. Parenchymal hyperintensity without sulcal hyperintensity on FLAIR was observed in 8 patients. Of the ARIA-E patients, 35 had acceptable GRE/T2* images for ARIA-H assessment; of these, 49 % (17/35) had incident small ARIA-H. Seven patients developed incident small ARIA H without ARIA-E. Two others with ARIA-E developed large ARIA-H during follow-up. CONCLUSIONS We describe the radiologic features of ARIA, as well as differentiations between ARIA and other pathological conditions. Familiarity with ARIA should permit radiologists and clinicians to recognize and communicate ARIA findings more reliably for optimal patient management. O3B-2.8 A N M R I R AT I N G S C A L E F O R A M Y L O I D RELATED IMAGING ABNORMALITIES (ARIA) Frederik Barkhof1, Marita Daams1, Michael Wattjes1, H. Robert Brashear2, H. Michael Arrighi2, Kristen Morris2, Philip Scheltens1 1 VU University Medical Center, Amsterdam, The Netherlands, 2Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco,CA, USA OBJECTIVES Amyloid-related imaging abnormalities (ARIA) have been reported in clinical trials of amyloid-lowering therapies for Alzheimer's disease. ARIA-E is the subgroup of ARIA characterized by parenchymal and sulcal hyperintensities on FLAIR images, believed to represent cerebral edema and sulcal effusions. ARIA-E is heterogeneous, with unclear correlation between clinical symptoms or outcomes. We propose and test a radiologic grading scale to accurately measure these findings. METHODS A scale was developed that measured sulcal and parenchymal hyperintensities and gyral swelling. Characteristics were graded in 12 regions using a 6-step scale according to spatial extent and lobe. Two blinded neuroradiologists applied the scale to serial MRIs from subjects (N020) in a phase 2 clinical trial of antiAβ immunotherapy (bapineuzumab). Ten cases were previously identified ARIA-E; 10 were non-ARIA-E. Agreement was calculated between raters using the intraclass correlation coefficient (ICC).

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RESULTS The ARIA-E grading process resulted in 100 % agreement on the interpretation of non-ARIA-E cases. High inter-rater agreement was observed for parenchymal (ICC0 0.831) and sulcal (ICC00.892) hyperintensities (combined ICC00.887). Scoring gyral swelling showed greatest variability between raters (ICC00.542), but appeared to add value with regard to radiologic severity by increasing the range of total scores. CONCLUSION We propose a simple visual grading scale for reporting ARIA-E findings. The scale demonstrated good interrater reliability and ease of use when tested in a blinded fashion. Following wider testing and training among neuroradiologists, this scale may make possible more precise description and categorization on MRI of the various manifestations of ARIA-E.

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(completeness 97 %), the five-year risk of a first haemorrhage was lower than the risk of recurrent haemorrhage (2.4 % [95 % confidence interval (CI) 0 % to 5.7 %] versus 29.5 % [95 % CI 4.1 % to 55 %], p<0.0001). The annual risk of recurrence of haemorrhage+/- focal neurological deficit declined from 19.8 % (95 % CI 6.1 to 33.4) in year one to 5.0 % (95 % CI 0.0 to 14.8) in year five. The risk of recurrence was higher for women than men (p00.01). Location (brainstem versus other) did not influence recurrence risk (p00.17). CONCLUSIONS CCMs incidentally diagnosed on MR imaging have a significantly lower risk of subsequent haemorrhage than those initially presenting with radiologically confirmed haemorrhage. For those presenting with haemorrhage, the risk of a recurrent bleed declines over five years. Also the risk of a recurrent event such as haemorrhage is greater in women than in men.

O3B-2.9 THE UNTREATED COURSE OF CEREBRAL CAVERNOUS MALFORMATIONS: RESULTS FROM THE FIRST PROSPECTIVE, POPULATION-BASED COHORT STUDY

PARALLEL SESSION 4A – SCIENTIFIC PAPERS 4A.1

JM Hall1 ,2, R Al–Shahi Salman2, MA Horne3, F Moultrie2, CB Josephson2, JJ Bhattacharya4, CE Counsell5, GD Murray3, V Papanastassiou4, V Ritchie6, RC Roberts7, RJ Sellar2, CP Warlow2, SAIVMS Collaborators2 1 Department of Clinical Radiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK, 2Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, 3 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK, 4Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK, 5Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK, 6Fauldhouse Health Centre, Fauldhouse, UK, 7Neurology Department, Ninewells Hospital and Medical School, Dundee, UK, 8www.saivms.scot.nhs.uk, Edinburgh, UK

Marit Herder1 ,2, Sigbjørn Rogne1 ,2, Gry Wikran1, Petter Eldevik1 ,2, Torgil Vangberg2 ,1, Ellisiv Mathiesen2 ,1, Henrik Schirmer1 ,2 1 University Hospital of Northern Norway, Tromsø, Norway, 2 University of Tromsø, Tromsø, Norway

INTRODUCTION MR imaging is the current gold standard for diagnosis of cerebral cavernous malformations (CCMs). It is also essential for the clarification of complications such as haemorrhage. Systematic review of the literature revealed a dearth of information on the risk of complications such as haemorrhage, focal neurological deficit and epilepsy. We report on five years of uninterrupted prospective follow-up from a populationbased study in Scotland (definite CCM diagnosis first made 1999-2003). RESULTS 139 adults had at least one definite CCM; 134 were alive at presentation. During 1,177 person-years of follow-up

O4A-1.1 ASSOCIATIONS BETWEEN WHITE MATTER HYPERINTENSITIES ON CEREBRAL MAGNETIC RESONANCE (MR) IMAGES, MARKERS OF ATHEROSCLEROSIS, AND COGNITIVE FUNCTION. THE TROMSØ DEMENTIA STUDY

BACKGROUND Lesions in cerebral white matter, depicted as white matter hyperintensities(WMH) on T2 weighted MR imaging is hypothesized to be related to decreased cognitive performance. We studied the associations between periventricular and deep WMH and markers of carotid atherosclerosis (intima media thickness (IMT)) and cognitive function in subjects with mild cognitive impairment (one person had MMS-verified dementia) and controls. METHODS Subjects were 225 stroke-free persons (157 cases, 68 controls) recruited from the population-based Tromsø Study. Cerebral MRI scans were obtained and the images graded by two experienced neuroradiologists according to Fazekas scale of WMH burden, and dichotomized into mild (category 0-1) or severe (category 2 and 3). Cognitive function was assessed by the Digit-Symbol Coding test (DSC), the Trail

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A and B tests, the Tapping test and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) tests. Associations between IMT, cognitive tests and WMH were assessed in logistic regression analysis. RESULTS Mean age was 73 years in cases and 71 years in controls (p00.03). The age-adjusted proportion with severe WMH lesions was 61 % in cases vs 35 % in controls (p00.03). In multivariate logistic regression analysis adjusted for age, sex and education, high IMT levels (p00.024), lower performance on the Trail A (p00.004) and B tests (p00.004) and higher performance on the DSC-test (p00.027) were associated with periventricular WMH, while the Trail B (p0 0.024) and the DSC-test (p<0.001) were associated with deep WMH. CONCLUSIONS WMH were associated with cognitive test performance and subclinical carotid atherosclerosis. O4A-1.2 PECULIARITIES OF THE BRAIN METABOLISM IN PATIENTS WITH PARKINSON'S DISEASE (PD) AND DIFFERENT LEVEL OF COGNITIVE IMPAIRMENT (CI): IN VIVO 1 H MRS STUDY Zinayida Rozhkova1, Irina Karaban'2, Nicolas Karaban'2 1 Medical Clinic BORIS, Kiev, Ukraine, 2Institute of Gerontology, Kiev, Ukraine PURPOSE On the basis analysis of MRS data we propose markers for the characteristics of the local metabolic state of the brain in patients with PD and different level of CI. METHODS Three groups of PD-patients with various cognitive statuses are studied by MRI and 1 H MRS with 1.5 T SIGNA EXCITE (GE). The 1st group (DPDG) consists of 13 PD-patients with dementia. The 2nd group (CIPDG) consists of 15 PD-patients with mild CI.The 3rd group (NPDG) includes 12 PD-patients with normal cognitive function. Spectra are recorded in both hemispheres in the frontal lobe (FL), and in the basal ganglia (BG) with the SVSSTEAM:TR/TE01500/144 ms. RESULTS From the spectra the content (in mM) of NAA, Cr, Cho, mIns, Glx 0Glu + Gln are obtained. In BG the values NAA/Cr ratios in DPDG and CIPDG are significantly lower than in the NPDG, and Cho/Cr ratios higher than in patients of NPDG. Concentration of NAA in BG:(6.81+1.8), (7.62+-1.4), (7.82+-1.3) in DPDG, CIPDG, and NPDG, and the ratios of NAA/Cr decrease with the grade of CI. Concentrations of mIns in FL: (4.23+-0.79), (3.69+-0.62), (3.43+-0.83) in DPDG, CIPDG, and NPDG, respectively. Concentrations of Glx in the FL is more pronounced,

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than other metabolites:(8.1+-1.9), (9.32+-1.6), (10.6+-1.8) in DPDG, CIPDG, and NPDG, and Glx/Cr decrease with the grade of CI. Concentration of Glx in the BG: (6.34 + -1.4), (7.93 + -0.9), (9.46 + -1.2) in DPDG, CIPDG, and NPDG. CONCLUSION Concentration of Glx in FL, and in BG is indicator of neuronal loss and dysfunction, and may be useful marker of CI in patients with PD. O4A-1.3 COMPARISON OF WHITE MATTER ABNORMALITY IN PARKINSON DISEASE WITH AND WITHOUT DEMENTIA: EVALUATION WITH DIFFUSION TENSOR IMAGING AND TRACT-BASED SPATIAL STATISTICS STUDY Sang Joon Kim1, Hengjun Kim2, Ho Sung Kim1, Choong Gon Choi1, Chong Sik Lee1, Namkuk Kim1 1 University of Ulsan, Asan Medical Center, Seoul, Republic of Korea, 2Korea Basic Science Institute, Ochangeup, Chungbuk, Republic of Korea PURPOSE White matter lesions (WML) are frequent comorbidity that may influence the clinical phenotype of Parkinson disease (PD) including cognitive impairment. Our purpose is to evaluate white matter abnormality in PD with and without dementia using diffusion tensor MR imaging and tractbased spatial statistics (TBSS). MATERIALS AND METHODS Diffusion tensor imaging (DTI) was obtained with a 3.0 T MR system in 74 patients with PD, 12 patients with PD with dementia (PDD) and 74 normal control (NC) subjects. Patients were selected on the basis of clinical criteria. Patients with prominent high signal in the white matter on T2-weighted images were excluded from the study. Fractional anisotropy (FA) and mean diffusivity (MD) maps were generated using FDT in the FMRIB's Software Library (FSL) package and processed to perform tract-based comparisons of FA and MD between the groups using TBSS in FSL. RESULTS In both PD and PDD groups, there were wide-spread white matter changes in MD maps compared to NC group in cerebral hemispheres involving bilateral frontal 2221and parietal lobes, corpus callosum, bilateral internal capsules, corona radiata, thalamic radiation, superior longitudinal fasciculus, and cingulum of the brain. Involvement was more widespread in PDD than in PD group in both FA and MD maps. Additionally, there was significant involvement in the occipital lobe in PDD group.

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CONCLUSION Diffusion tensor imaging with TBSS revealed wide spread abnormality of white matter in both PD and PDD groups compared to NC. Involvement was more wide-spread in PDD group than in PD. O4A-1.4 THE ROLE OF MAGNETIC RESONANCE IMAGING AND COMPUTED TOMOGRAPHY OF THE BRAIN IN FIRST EPISODE OF PSYCHOSIS. THE ROLE OF MAGNETIC RESONANCE IMAGING AND COMPUTED TOMOGRAPHY OF THE BRAIN IN FIRST EPISODE OF PSYCHOSIS Nader Khandanpour, Nigel Hoggard, Daniel Connolly Sheffield NHS, Sheffield, UK AIM Is imaging associated with early detection of organic causes for first episode of psychosis (FEP)? MATERIALS AND METHODS Individuals with FEP but no neurological signs referred for cerebral magnetic resonance imaging (MRI) or computer tomography (CT) to a tertiary centre were reviewed retrospectively. Two groups were evaluated with either CT or MR scan, were independent and no individual had both CT and MRI scan. RESULTS One hundred and twelve consecutive cerebral MR scans and 204 consecutive CT scans were identified. Three (2.7 %) individuals had brain lesions (brain tumour and HIV encephalopathy) potentially accountable for the psychosis on MRI scan. Seventy patients (62.5 %) had incidental brain lesions such as cerebral atrophy, small vessel ischaemic changes, unruptured Circle of Willis aneurysm, cavernoma and arachnoid cysts on MRI scan. Three patients (1.5 %) had focal brain lesions (primary or secondary tumours) potentially accountable for the psychosis on CT scan. One hundred and thirty three patients (65.2 %) had incidental brain lesions unrelated to the psychosis on CT scan. There was no significant difference between MR and CT imaging in detecting organic pathology potentially responsible For FEP(P<0.001). CONCLUSION Routine MR or CT imaging of the brain is unlikely to reveal pathology leading to significant change in management. MRI scan was comparable with CT scan in terms of diagnosis of both pathologic and incidental cerebral lesions. Therefore, routine brain structural imaging of FEP in patients without focal neurology may not be routinely required and if imaging is requested then CT may function equally as well as MRI as the first line investigation.

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O4A-1.5 NEUROPSYCHOLOGICAL EVALUATION AND CONVENTIONAL BRAIN MR IMAGING - AVOIDING AGE RELATED COGNITIVE DECLINE Joana Barata Tavares1, Sofia Reimão1, Carolina M. Santos1, Carolina Maruta2, Isabel Pavão Martins2, Pedro Aguiar3, Jorge Campos1 1 North Lisbon Hospital Centre – Santa Maria´s Hospital, Lisbon, Portugal, 2Department of Clinical Neurosciences, Institute of Molecular Medicine, Lisbon, Portugal, 3National School of Public Health – New University of Lisbon, Lisbon, Portugal INTRODUCTION Cognitive aging is not identical in all individuals and, in the past few years, the role of neuroradiology in its study has increased not only with advanced techniques but also with the development of imaging scales that try to stage brain aging and can be used in daily practice. OBJECTIVES Correlate demographic, vascular risk and cognitive performance, including neuropsychological tests, with brain imaging scales in a cohort of elderly subjects. METHODS Recruitment of 80 subjects in the Portuguese Primary Care System, aged more than 50 years. Clinical data was obtained from the participants' physicians and cognitive evaluations were performed. A conventional 3 T brain MR study was conducted and assessment included the following imaging scales: Fazekas, CHIPS (Cholinergic Pathways Hyperintensities Scale), MARS (Microbleed Anatomical Rating Scale), GCA (Global Cortical Atrophy) and MTA (Medial Temporal lobe Atrophy). A statistical data analysis was performed. RESULTS The median age of the population studied was 71 y.o, and median MMSE (Mini Mental State Exam) 29, Fazekas 1, CHIPS 6, MARS 0, GCA 1 and MTA 1. There was a statistically significant correlation (p<0,05) between Fazekas score and female sex and age(>65). There were no correlations between Fazekas and vascular risk factors (hypertension/diabetes/hyperlipidemia/smoking). There was a tendency for negative association between MMSE and Fazekas/CHIPS/GCA. CONCLUSIONS Cognitive decline is associated with brain alterations measurable on daily practice conventional brain MRI. Knowing and applying different imaging scales related to cognitive decline is important to neuroradiologists dealing with a progressively elderly population.

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O4A-1.6 MRI OF BRAIN HEMATOMA: WHAT DOES THE "SPOT SIGN" MEAN ? Stéphanie Condette-Auliac, Anne Boulin, Pierre Guedin, Oguzhan Coskun, Stéphanie Guieu, Georges Rodesch Hopital FOCH, Suresnes, France OBJECTIVE to precise the significance of a spot sign (SpS : a round non tubular contrast enhancement distinct from any vessel, within the hematoma ) on contrast enhanced MRI, and its potential criterion for secondary worsening MATERIAL AND METHODS We retrospectively studied 111 spontaneous hematomas explored by MRI within the first 3 days after occurrence. SpS were observed in 25 cases. We precised their number, size, localization (central or peripheral) and correlated them with the time elapsed since the clinical onset and the final diagnosis. We paid particular attention to the presence of any perihematoma (perihematoma zone of liquid signal). Two groups were distinguished: group 1 with a delay from clinical onset up to 4 ½ hours and group 2 with a delay above 4 ½ hours. RESULTS Group1: 27 patients, 17 with SpS (63 %), 6 clinicoradiological worsening (35 %). Group2: 84 patients, 8 with SpS (9.5 %), 1 clinico-radiologic worsening (12.5 %). According to CT findings, MRI SpS is considered to be an active bleeding, and is more frequently observed in the first hours after the onset of haemorrhage. In our series impairment was related to the number of SpS (1:none, 2 to 4:11 %, 5 or more:85 %), the location (central:14 %, peripheral:33 %, both:71.4 %), the association with a perihematoma (54 % vs 0.8 %). We also observed enlargements of hematomas when the SpS was associated with AVMs or amyloïd angiopathies. CONCLUSION SpS must be differenciated from pathologic enhancements and predict worsening in cases of multiplicity (>5), peripheral localization , or if associated with perihematoma. O4A-1.7 DIFFUSION MRI AND PLAQUE HAEMORRHAGE INDEPENDENTLY PREDICT RECURRENT EVENTS IN PATIENTS WITH CAROTID ARTERY DISEASE Nishath Altaf1 ,2, Akram A. Hosseini1, Neghal Kandiyil1 ,2, Philip M.W. Bath3, Shane T. MacSweeney2, Dorothee P. Auer1 1 Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, UK, 2Department of Vascular Surgery, Nottingham University Hospital, Nottingham, UK, 3 Division of Stroke Medicine, University of Nottingham, Nottingham, UK

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INTRODUCTION Carotid plaque haemorrhage as detected by MRI (PH+ve), and acute cerebral infarctions detected by diffusion (DWI+ve) are known risk factors for recurrent cerebrovascular events. However, both are not currently used for selection of patients for carotid endarterectomy. To assess the potential value of combining these risk scores, we assessed the independence of DWI and PH as predictors for recurrent events, and whether a combined score would improve risk prediction in patients with symptomatic carotid stenosis. METHODS 135 prospectively recruited patients (mean 74 years, 36 % female) with symptomatic carotid stenosis (≥50 %) underwent Diffusion weighted MRI of the brain, and blood nulled, water selective T1 weighted MRI of the carotid arteries. All patients were followed up until carotid endarterectomy, recurrent cerebral event, death or study end. Multivariate logistic regression analysis controlled for age, sex, degree of stenosis, hypertension and diabetes was used for event prediction. RESULTS 79/135 patients were PH + ve and 64/133 DWI + ve. 32 events were observed. Presence of DWI + ve (HR 02.7; 95%CI: 1.2-5.8, P 00.013), and more strongly PH + ve (HR08.12; 95%CI: 2.4-27.2, P00.001) predicted recurrent events, but none of the other factors. A simple linear combined score improved risk prediction showing a graded risk increase when one (HR 09.1; 95%CI: 1.1-70.3, P00.035) or both markers were positive (HR029.1; 95%CI: 3.8-220.6). CONCLUSION The presence of carotid plaque haemorrhage and DWI+ve lesions are independent predictors of recurrent cerebrovascular events in patients with symptomatic carotid disease. O4A-1.8 VERTEBROBASILAR INSUFFICIENCY SYNDROME TREATED WITH EXTRACRANIAL STENTING Ian Rennie, Paul Burns, Patricia Gordon, Michael Watt Royal Victoria Hospital, Belfast, UK INTRODUCTION Vertebro-basilar insufficiency syndrome is an increasingly recognised collection of symptoms relating to poor vascular supply to the posterior fossa structures. They include headache, visual disturbance, gait disturbance and vertigo. This series of three patients discusses issues of anatomy which have contributed to the condition and have influenced treatment. METHOD We present three patients with symptoms attributed to vertebro-basilar insufficiency treated with stent revascularisation. All patients remained significantly symptomatic despite maximal medical therapy. The three patients all have

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variant anatomy which is felt to be contributory to aetiology of the symptoms. All three patients underwent stent reconstruction of the stenotic vessel. RESULTS The three patients have all reported a very rapid resolution of their symptoms. The immediate post procedural angiography in all three cases demonstrates a significant increase in blood flow to the basilar artery. No procedural complications were observed. CONCLUSION Extra cranial stenting of hemodynamically significant stenosis in Vertebro-basilar insufficiency should be considered in patient's refractory to medical therapy

with risk factors and disease suggest that these are true tissue abnormalities and therefore should not be ignored.

O4A-1.9 MORPHOLOGICAL, DISTRIBUTIONAL, VOLUMETRIC AND INTENSITY CHARACTERISATION O F P E R I V E N T R I C U L A R W H I T E M AT T E R HYPERINTENSITIES

AIM To identify the incidence of both serious and incidental pathological findings on Brain CT identified using a GP requested proforma using retrospective request data. MATERIALS AND METHODS A Brain CT rapid access pathway using a pre-request proforma protocol produced 747 GP requests for CT brain imaging between 2010 to 2011. Average patient age was 51.5 years (range 17 to 95 years). A retrospective audit was carried out of the reason for requesting CT brain imaging and subsequent findngs for this period. RESULTS Reasons for CT request: 592 requests (79 %) were for headache: from this group 362 (61 %) were for new onset headache, 143 (24 %) for headache of altered nature in persons known to have headaches. Other indications included: 66 (8.8 %) progressive neurological deficit, 19 (2.5.%) cranial nerve palsy, 66 (8.8 %) recent onset double vision, 22 (2.9 %) new onset seizures, 95 (12.7 %) mental changes and 18 (2.4 %) unilateral sensorineural deafness. A history of malignancy was present in 29 (3.8 %) of requests. CT RESULTS 119 of total brain scans (15 %) reported some form of abnormality. 32 (4.2 %) had brain tumours, 3 (0.4 %) acute haemorrhages, 4 (0.5 %) acute/subacute ischaemia, 58 (7 %) sinus disease, 7 (0.9 %) CSF circulation issues and 15 (2 %) other findings (e.g. choleasteotama, impacted wax). CONCLUSION This data outlines that in general terms most GP rapid access CT neuro-imaging does not identify sinister pathology. Clinical indications for primary care imaging need improvement especially for headache if GP access is to be cost-effective and avoid patient anxiety and unnecessary radiation exposure.

Maria Valdes Hernandez, Rory Piper, Zoe Morris, Natalie Royle, Catherine Murray, Susana Munoz Maniega, Benjamin Aribisala, Mark Bastin, Ian Deary, Joanna Wardlaw University of Edinburgh, Edinburgh, UK White matter hyperintensities (WMH), identifiable on FLAIR and T2-weighted MRI, are typically separated into periventricular (PVWMH) or deep (DWMH). It is unclear whether the innermost segment of PVWMH is abnormal white matter or artefactual. We used FLAIR MRI from 665 non-demented subjects, mean age 72.7 years (SD00.7). We categorised the PVWMH into 4 categories visually: 1) thin white line, 2) penetrating towards DWM, 3) big caps and/or confluent with DWMH, and 4) dirty white matter. We measured the maximum intensity and the width of the PVWMH, obtained the 3D spatial mapping of the WMH, and investigated associations between each category and hypertension, stroke, diabetes, hypercholesterolaemia, cardiovascular disease and total WMH. The intensity patterns and morphological features were different for each PVWMH category. Both the widths (r 00.61; p< 0.0001) and intensities (r 00.51; p<0.0001) of PVWMH correlated with total WMH volume and with each other (r 00.55; p<0.0001), except for ‘dirty PVWMH', largely characterised by evidence of erratic, ill-defined and fragmented WMH (r 00.03; width: p 00.1119; intensity: p 00.947). The prevalence of hypertension, hypercholesterolaemia and neuroradiological evidence of stroke increased from PVWMH category 1) to 3). The mean PVWMH width was significantly larger in subjects with hypertension (mean difference00.5 mm; p00.0287) or evidence of stroke (mean difference01 mm; p<0.0001). Our analysis does not support the assumption that the PVWMH signal next to the ventricle is only artefact, as intensity levels, distribution measures and association

PARALLEL SESSION 4A - SCIENTIFIC PAPERS 4A.2 O4A-2.1 GP RAPID ACCESS TO CT BRAIN IMAGING: DOES IT INCREASE PATIENT OR DOCTOR ANXIETY? Husnain Ali, Changez Jadun, Brendan Davies University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, UK

O4A-2.2 C TA I N S U S P E C T E D A C U T E C E R E B R A L ISCHAEMIA - WHO ARE WE SCANNING? Stefanie Thust, Paul Smith, Jane Evanson Barts and The London NHS Trust, London, UK

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CT arteriography (CTA) of the intracranial and neck arteries is increasingly requested in suspected acute stroke, particularly in the setting of hyperacute stroke services. CTA allows quick and accurate evaluation for acute thromboembolic large vessel occlusion and flow-limiting stenosis requiring intervention. Presently, there are no widely agreed guidelines as to which presentations of suspected acute CVA/TIA form an appropriate indication for urgent CTA whilst in others this may be less valuable in aiding management. Theoretically, maximum imaging investigation would be desirable in all patients, but may exceed resources and bear radiation risks. We present recent retrospective data from a central London tertiary stroke referral centre, whereby 100 consecutive patients with suspected CVA/TIA who had received an acute plain CT plus CTA were analysed. 4 main categories were defined as indications for urgent CTA: thrombolysis candidate, high risk TIA, haemorrhage and suspected posterior circulation CVA. Referral details, CTA results in terms of flow-limiting luminal narrowing, other significant imaging findings, the mean effective dose and the impact of the scan result on clinical management were analysed. In addition to issues around clinical management, two main concerns emerged: Over a third (35 %) of patients were scanned with insufficient or inappropriate referral information calling for a more thorough selection and referral process. Relatively few (13 %) thrombolysis candidates subsequently received thrombolysis (intracranial bleeds excluded) suggesting that even under time pressure careful choice of thrombolysis candidates is required to avoid unnecessary scans, thus limiting CT waiting times and cost. O4A-2.3 DYNAMIC 4D MR ANGIOGRAPHY VERSUS TIME OF FLIGHT MR ANGIOGRAPHY IN THE EVALUATION OF CEREBRAL VASCULAR LESIONS Hung-Chieh Chen, Chen-Hao Wu, Wen-Hsien Chen, Clayton Chi-Chang Chen Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan PURPOSE Early diagnosis of cerebral vascular lesions such as arteriovenous malformation (AVM) and arteriovenous fistula (AVF) is important. Currently, digital subtraction angiography (DSA) is a gold standard diagnostic method. However, it is invasive and has radiation exposure. Time of flight magnetic resonance angiography (TOF MRA) is commonly used as initial screening and for following up treatment effect. The purpose of this study is to compare the 4D dynamic contrast-enhanced MRA (D-MRA) and TOF MRA to see their effect to evaluate cerebral vascular lesions.

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METHODS The samples consisted of 40 patients with AVM or AVF at their initial evaluation or for follow up after gamma knife radiosurgery. D-MRA and TOF examinations were performed simultaneously. The conventional angiography was used as a standard references. The kappa test was used to compare the diagnosis accuracy, lesion localization, arterial feeder and venous drainage identification between these two MRA methods. RESULTS Almost all vascular lesions were correctly detected using DMRA and TOF MRA, except two residual AVM after gamma knife radiosurgery with very slow flow were not detected using D-MRA. There is no statistically significance of the lesion diagnostic accuracy (p00.08), lesion localization (p 00.085) and venous drainage identification (p0 0.079) between D-MRA and TOF MRA. However, there is significant difference regarding identification of the arterial supply (p00.011), due to relative poor spatial resolution of D-MRA. CONCLUSION D-MRA could be used for a screening modality and follow up methods for cerebral vascular lesion with higher accuracy and consist with DSA. O4A-2.4 A SECOND OPINION BY A NEURORADIOLOGIST DOES IT CHANGE ANYTHING? Elizabeth Ryan, Kevin Pennycooke, Sarah Power, Joanna Pearly-Ti, Paul Brennan, John Thornton, Seamus Looby Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland PURPOSE A second opinion by a consultant neuroradiologist on neuroimaging is sometimes requested by the initial reporting radiologist or referring clinician. We examined neuroradiology second opinions produced since the introduction of a PACS system, to assess their impact. MATERIALS METHODS Using a recently implemented PACS system, all outside institution CT, MRI and other neurodiagnostic imaging modalities submitted to our institution for a formal consultant neuroradiologist second opinion were retrieved. The second report was compared to the original report and using the RADPEER scoring system, a RADPEER score, as follows, was given to each original report; 1. Concur with interpretation; 2. Difficult diagnosis, not ordinarily expected to be made; 3. Diagnosis should be made most of the time; 4. Diagnosis should be made almost every time-misinterpretation of findings. Cases with a RADPEER score of 2 or greater were

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divided into major and minor discrepancies, based upon whether a change in patient management resulted. RESULTS From August 2011 to February 2012, 59 formal second opinion reports were issued by 4 consultant neuroradiologists. RADPEER scores were recorded as follows; 1: 32 (55 %), 2: 14 (24 %), 3: 13 (21 %) and 4: none (0 %). Of the 27 cases involving a difference of radiological opinion, 10 were major and changed patient management and 17 were minor with no significant change to patient management. CONCLUSION With increasing complexity, volume and subspecialisation within radiology, our study shows that a second opinion on neuroimaging by a consultant neuroradiologist can beneficially impact on patient management. O4A-2.5 DIFFUSION TENSOR MRI MEASURES OF THE S U B S TA N T I A N I G R A A S B I O M A R K E R S IN PARKINSON'S DISEASE Stefan T Schwarz1 ,4, Vamsi Gontu4, Maryam Abaei1, Paul S Morgan3, Nin Bajaj2, Dorothee P Auer1 ,4 1 Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK, 2Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, Nottinghamshire, UK, 3 Department of Medical Physics & Clinical Engineering, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, Nottinghamshire, UK, 4Deparment of Radiology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, Nottinghamshire, UK Parkinson's disease (PD) remains primarily a clinical diagnosis despite increasing research efforts to develop an affordable, reliable and easily available biomarker. Diffusion tensor imaging (DTI) of substantia nigra (SN) has recently been proposed to be sensitive to nigral neurodegeneration indexed as a decrease of SN fractional anisotropy (FA) or increase of mean diffusivity (MD). Findings are however controversial, which may reflect variable technical quality and potential regional specificity of DTI-metrics. The aims of this study were to investigate nigral MD and FA abnormalities in PD using a dedicated protocol at 3 T, and to assess their regional specificity. We investigated 21 PD patients and 22 age and sex matched controls by DTI-MRI (Philips 3 T, 32 directions, 1x1x2 mm). The SN as a region of interest (ROI) was manually outlined as a whole and also using smaller ROIs (2x2x2 mm) in the anterior, medial and posterior SN to calculate the MD and FA. Mean SN

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diffusivity was increased in PD vs. controls (0.80 ± 0.11•10-3 mm2/s vs. 0.73 ± 0.05•10-3 mm2/s, p < 0.05) while FA showed a non-significant tendency to decrease (0.42±0.05 vs. 0.46±0.09, p00.09). The MD changes were most pronounced in the anterior SN. Our findings are in partial agreement with previous studies showing nigral MD increase in patients with and animal models of PD. Lack to observe reduced FA values in the whole SN and specific subregions add to the published controversies regarding the diagnostic accuracy of nigral FA. Further studies are needed to assess the diagnostic value of DTI-metrics for subtyping of PD. O4A-2.6 ACUTE ALCOHOL INGESTION SIGNIFICANTLY AFFECTS RESTING STATE NETWORKS AND INDUCES CEREBELLAR CHEMICAL CHANGES ON MR SPECTROSCOPY Stuart Currie, Marios Hadjivassiliou, Matthew Clark, Iain Wilkinson, Paul Griffiths, Nigel Hoggard University of Sheffield, Sheffield, UK PURPOSE Binge drinking is a major global health and economic concern. Yet little is known of the effects acute alcohol ingestion has on the brain. Purpose: To establish possible changes in resting state network (RSN) connectivity and cerebellar spectroscopy following acute alcohol ingestion with a view to establishing a binge-drinking model. METHODS 20 male Caucasian social drinkers underwent 3 T-MR imaging including MR spectroscopy of the superior cerebellar vermis and resting-state fMRI. Imaging was performed prior to and then at hourly intervals following the ingestion of either 100mls of 40 % Vodka (equivalent 31.56 g of ethanol) or placebo. RESULTS Mean peak blood alcohol concentration (BAC) occurred at 60 mins post-alcohol ingestion (72.5 mg/dl). Cho/Cr and NAA/ Cr levels significantly increased (p<0.05) from pre-alcohol to 60 mins and 120 mins post-alcohol respectively. Various RSNs showed significant increase in BOLD signal fluctuations from pre-alcohol to post-alcohol state including, the cerebellum, primary visual, extrastriatal visual, and right and left parietal-frontal networks. No significant changes in RSN activity or neurometabolites were found in the placebo group. CONCLUSION Single bolus alcohol ingestion increases spontaneous BOLD signal fluctuations in RSNs including the cerebellum and causes significant changes in neurometabolites within the superior cerebellar vermis. Targeting these areas in future

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studies may lead to a reproducible neurological model for binge drinking. O4A-2.7 I N T R A C R A N I A L A RT E R I A L TO RT U O S I T Y AND ECTASIA IN ACROMEGALY: AN MRA QUANTITATIVE STUDY 1

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Joseph Gabrieli , Emanuele Orru' , Laura Milanese , Giulia Bommarito1, Filippo Ceccato1, Valentina Citton1, Francesca Dassie1, Fabio Zerbo2, Mario Ermani1, Chiara Martini1, Pietro Maffei1, Carla Scaroni1, Renzo Manara1 1 University of Padua, Padua, Italy, 2OC San Bassiano, Bassano del Grappa, Italy BACKGROUND intracranial artery tortuosity has been claimed to be increased in acromegaly, but no studies addressed this issue. Recently, reduced intercarotic distance was showed by CTangiography in acromegaly suggesting its possible implication for surgery planning. Our study investigated quantitatively carotid artery tortuosity, ectasia and intercarotic distance in a large cohort of acromegaly patients and their relationship with clinical, laboratory and neuroimaging findings. METHODS 170 acromegaly patients (median-age 56 y, age-range 21-88 y, 92 females) underwent magnetic resonance angiography (MRA). Clinical data, laboratory and pituitary adenoma imaging findings were recorded. Using commercially available softwares (Inspace for Syngo CT Workplace and Exprivia Medstation4), we measured the tortuosity index (curved length/linear length from C3 midpoint to ICA bifurcation), carotic ectasia (maximun intracranial carotic diameter/diameter at C2) and the minimum distance between carotids, at C3 and C4 levels. MRA of 101 subjects with headache or transient neurological deficits represented the control group. RESULTS mean intercarotic distance was reduced at C3 and increased at C4 segment in acromegaly patients compared to controls (16.6 mm vs 17.9 mm, p<0.001; 16.6 mm vs 15.5 mm, p< 0.05; t-test). Mean tortuosity index and carotic ectasia were increased in acromegaly patients (2.06 vs 1.93, p<0.001; 1.01 vs 0.92, p<0.0001). Tortuosity did not correlate with the presence of intracranial aneurysms, intercarotic distance, carotic ectasia, GH or IGF 1 levels, duration of disease. CONCLUSIONS acromegaly presents indirect signs of intracranial artery wall involvement, beyond the increased rate of intracranial aneurysms. Further studies are needed to unravel the link with GH excess.

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O4A-2.8 PROSPEC TIVE COMPAR ISON OF LATE 3T MAGNETIC RESONANCE IMAGING WITH CONVENTIONAL ANGIOGRAPHY IN EVALUATING THE PATENCY OF CEREBRAL AVMS TREATED WITH STEREOTACTIC RADIOSURGERY Nader Khandanpour, Paul Griffiths, Daniel Warren, Nigel Hoggard Sheffield NHS, Sheffield, UK BACKGROUND Risk of further haemorrhage in patients suffering from arteriovenous malformation (AVM) would be eliminated only if complete obliteration of the AVM is obtained. Therefore, these patients frequently need long term follow up. Conventional catheter angiography (CCA) with a risk of 0.5 %.to 1.6 % of significant neurological complications has traditionally been used for this purpose. However, Magnetic Resonance Imaging (MRI) at 3 T may be a safer alternative. OBJECTIVE To evaluate if MRI at 3 T can accurately evaluate closure of AVM in 2 years after stereotactic radiosurgery (STRS). METHODS The residual AVMs were evaluated by MRI at 3 T against CCA in a prospective study. RESULTS Twenty three patients had both MRI at 3 T and a CCA study. The time interval between radiosurgery and neuroimaging was on average of 25 months (range, 15-30 months) for MRI study and 33 months (range, 25-46 months) for CCA study. Ten patients showed closure of the AVM on MRI, all of which were confirmed on CCA. CONCLUSION There was a complete agreement between late MRI at 3 T scan and CCA in evaluation of AVM patency. Therefore, MRI at 3 T is a promising alternative for long term fallow up of AVMs treated with STRS. O4A-2.9 MRI-CRITERIA OF BRAIN ABSCESS DEVELOPMENT IN SEPTIC PATIENTS Valery Sandrikov, Valery Khovrin, Aram Tonoyan, Tatyana Galyan, Nina Brindar Russian Research Center of Surgery named after B.V. Petrovsky, Moscow, Russia PURPOSE To assess the MRI-criteria of brain abscess development in septic patients.

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METHODS The results of MRI of 18 septic patients using pre- and postcontrast T1WI, T2WI, FLAIR, SWI, DWI, PWI were analyzed. RESULTS 4 stages of brain abscess formation were established according the results of investigation. The 1 stage MRI-criteria were contours vagueness, varying degrees mass effect, high signal on T2WI, FLAIR, DWI, low signal on T1WI, mottled enhancement on postcontrast T1WI, considered as the inflammatory edema. 2 stage include the edema and mass effect enlargement, the appearance of high signal intensity on T2WI, FLAIR, DWI and low signal intensity on T1WI sites in the edema, without postcontrast enhancement, interpreted as the areas of necrosis. 3 stage demonstrates the encapsulation of necrotic areas with greatest perifocal edema (+mass effect), considered for the brain abscess formation. Abscess capsule displays low signal on T2WI, SWI, high signal on precontrast T1WI, signal enhancement on postcontrast T1WI. On 4 stage mature abscess formed with isointense on T1 and T2WI against the background of reduced surrounding edema thickened capsule. The perfusion parameters of inflammatory edema shows the increase of MTT and decrease of CBV and CBF. The decreased MTT, increased CBV and CBF are typical for the capsule of an abscess. In recovery the perfusion normalizes out of formed glial areas (decreased CBV, CBF). CONCLUSION The MRI analysis enables to divide the development of brain abscess into 4 stages. DWI and PWI facilitate the differentiation of inflammatory and other focal brain lesions.

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PURPOSE The goal of this retrospective study is to analyse our experience of management strategies in a small number of BBAs and to see if any one strategy could be recommended over the others. MATERIALS AND METHODS 7 patients (males: females03:4; mean age, 40 years) with ruptured BBAs over 5 years in a large Neurovascular centre were retrospectively reviewed. The clinical presentations, angiographic findings, treatment strategies, clinical and angiographic outcomes were analyzed. RESULTS The experience from our small patient group questions the role of aggressive endovascular techniques in the acute phase of BBAs. These aneurysms behave very different to the usual intracranial aneurysms and our experience clearly points to the need for improving our knowledge of these aneurysms. CONCLUSION Experience from our small series suggests that initial conservative management coupled with close angiographic observation followed by delayed endovascular/surgical treatment is a reasonable strategy in this group of aneurysms. Further multicentre studies on the management of these rare aneurysms are indicated before accepting aggressive and often expensive treatment strategies. O4B-1.2 FOLLOW-UP IMAGING OF SPONTANEOU S SUBARACHNOID HAEMORRHAGE IN PATIENTS WITH NEGATIVE INITIAL CTA AND CATHETER ANGIOGRAPHY: A REVIEW OF 109 CASES

PARALLEL SESSION 4B – SCIENTIFIC PAPERS 4B.1 O4B-1.1 BLOOD BLISTER ANEURYSMS - SHOULD WE LEAVE THEM ALONE??! Priya Bhatnagar, Ahmed Iqbal, Dipayan Mitra, Anil Gholkar, Vijay Jayakrishnan Royal Victoria Infirmary, Newcastle upon tyne, UK BACKGROUND Blood blister aneurysms (BBAs) are a rare type of small wide-neck shallow aneurysms, most commonly arising from the non-branching sites of the supraclinoid ICA. They cause significant therapeutic dilemmas. Due to their very unfavorable morphology and fragile thin walls, they are highly prone to intra-procedural rupture and difficult to treat surgically and endovascularly. Endovascular techniques including early stent and coiling, double stenting, parent artery occlusion and flow diverter stents have all been tried with varying claims of success.

Anoma Lalani Dias, Jonathan Hart, Kyriakos Lobotesis, Amrish Mehta, Iain Colquhoun Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK The need for follow-up imaging in patients with spontaneous subarachnoid haemorrhage (SAH) who have negative initial multimodality imaging remains contentious. METHODS Patients presenting to our institution with spontaneous subarachnoid haemorrhage and subsequent negative CTA and catheter digital subtraction angiography (DSA) between 31/ 03/2006 and 31/03/2012 were retrospectively reviewed. Follow-up imaging modality, timings and radiographic findings were analysed. RESULTS 109 patients were included. 27 patients had a CT negative SAH confirmed by CSF examination. In these patients, follow-up imaging did not yield any abnormality. The remainder (n082) were divided as perimesencephalic (n037)

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or non-perimesecephalic (n045) according to the distribution of blood on CT. In the perimesencephalic group, 89 % underwent follow-up cranial MR which yielded a single pontine cavernoma. 62 % and 27 % of this group underwent follow-up CTA and DSA respectively with no additional information garnered from this vascular imaging. Moreover, 5 patients who underwent repeat DSA developed procedure related complications. In the non-perimesencephalic group, 77 % underwent followup MR imaging, 17 % CTA and 64 % DSA. In 8 of the 45 cases a significant vascular abnormality was identified. CONCLUSIONS Normal CTA alone is reassuring in CT negative but CSF positive SAH and may preclude the need for invasive angiography. In perimesencephalic SAH, the yield of further catheter angiography is very low and may in fact incur significant risk in terms of catheter related complications. In non-perimesencephalic SAH the yield of follow-up imaging is higher and warrants routine DSA follow-up. O4B-1.3 A PROTECTION TECHNIQUE USING LOOPING OF THE MICROCATHETER TIP DURING COIL EMBOLIZATION OF MIDDLE CEREBRAL ARTERY ANEURYSMS LOCATED AT THE ENTRY OF ACUTELY ANGULATED BRANCHES Moon Hee Han1, Hyun-Seung Kang1, Young Dae Cho1, Jung Wook Lim1 1 Seoul National University Hospital, Seoul, Republic of Korea, 2Department of Neurosurgery, Sun Hospital, Daejeon, Republic of Korea BACKGROUND Protection techniques using stents or microcatheters have enabled the treatment of aneurysms with complex configurations by coil embolization. However, the application of these techniques is occasionally limited in cases, which wide-necked aneurysms are located at the entry of acutely angulated branching arteries. OBJECTIVE To introduce the looping technique to pass a microcatheter to protect the distal artery or to deliver a stent without irritating the wall of the aneurysm. METHODS This technique of the microcatheter looping to select the distal branch consists of making a loop of the microcatheter tip, advancing the looped microcatheter, and passing the microwire through the looped microcatheter into the distal branch. Tension is removed from the microcatheter to straighten the loop after the microwire has been reached far enough, and the microcatheter is then advanced into the distal branch.

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RESULTS A total of 36 wide-necked middle cerebral artery (MCA) aneurysms were successfully treated using the looping method. This technique was used to pass the microcatheter for stent protection in 13 patients, and for microcatheter protection in 23. The method was most commonly applied at M1 segment (n021), followed by the MCA bifurcation (n015). Complete or near-complete saccular occlusion could be achieved in 31 aneurysms. There were no complications related to looping the microcatheter. CONCLUSION The microcatheter looping technique is helpful in entering the distal branch without irritating the wall of the aneurysm during coil embolization of wide-necked MCA aneurysms incorporating the origin of acutely angulated branches. O4B-1.4 CAREFUL COILING OF WIDE NECK, RUPTURED AND UNRUPTURED INTRACRANIAL ANEURYSMS WITHOUT SUPPORTING DEVICES - A SINGLE CENTER EXPERIENCE Svetlana Milosevic Medenica Clinical Center of Serbia, Center of Radiology and Magnetic Resonance, Department of Neuroradiology, Belgrade, Serbia INTRODUCTION Despite of development of various supporting devices in EVT of wide-neck aneurysms, this procedure remains very challenging. We present small series of patients with relatively wide-neck aneurysms, treated only by use of 3D coils without supporting devices. PATIENTS/METHODS In the period July 2010 - February 2011 we treated thirteen patients with aneurysm neck>4 mm or dome/neck ratio<2. Aneurysms were located in anterior circulation in nine patients and in posterior in four. The size of aneurysms was from 3 to 21 mm; neck was>4 mm in 10 patients and the ratio dome/neck was<2 in 4. EVT was achieved using different dimensions 3D coils filled in „Russian doll" fashion. RESULTS Immediate angiographic results showed complete aneurysm obliteration in seven patients, small neck remnant in three, coil protrusion/herniation in two. In one patient large aneurysm of basilar bifurcation was completely closed, but the proximal pouch from which branches arised was left. Clinical results were excellent in ten patients, two developed mild hemiparesis and one left with aphasia and confusion. Three-months follow up (for six patients) showed complete obliteration in four patients; in one there was herniation of

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two loops in ACM branch, while in one with minimal neck remnant a new pouch appeared in front of coiled aneurysm. CONCLUSION The use of 3D coils without neck supporting devices may be an useful alternative in selected cases of wide-neck aneurysms. Larger series with longer follow-up are needed to evaluate the value of this approach. O4B-1.5 LONG TERM FOLLOW-UP STUDY OF ANEURYSM RECURRENCE AND IN-STENT STENOSIS RATES AFTER NEUROFORM-STENT ASSISTED TREATMENT OF CEREBRAL ANEURYSMS Zsolt Kulcsar3, Sophia Goericke1, Elke Gizewski2, Marc Schlamann1, Michael Forsting1, Isabel Wanke1 ,3 1 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany, 2Department of Neuroradiology, Innsbruck Medical University, Innsbruck, Austria, 3Department of Neuroradiology, Swiss Neuro Institute, Hirslanden Clinic, Zurich, Switzerland PURPOSE Our purpose was to analyze the long-term evolution of wide neck cerebral aneurysms treated with stent assistance. MATERIALS AND METHODS Data of consecutive patients treated with the Neuroform stent over nine years in a single center were retrospectively analyzed with emphasis on periprocedural complications, aneurysm occlusion grade evolution and in stent stenosis rates. RESULTS Altogether 113 patients with 117 unruptured and ruptured aneurysms were subject of analysis. Mean aneurysm size was 9.4 mm, and mean neck size was 4.7 mm. Side-wall and bifurcation aneurysms were similarly represented. Periprocedural thrombo-embolic and hemorrhagic complications affected eight (6.8 %) and four cases (3.4 %) respectively. Immediate complete occlusion and occlusion with residual neck (grade 1 and 2) was achieved in 85 % of cases, which at the first follow-up of nine months changed to 77 % and to 76 % at 36 months. Aneurysms >10 mm showed a higher tendency of recurrence. There was no difference in aneurysm evolution between sidewall and bifurcation aneurysms. During the mean longest follow-up time of 36 months an in stent stenosis of >50 % was observed only in three cases, all of them being asymptomatic.

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CONCLUSIONS Stent assisted coiling of wide neck aneurysms provided a stable occlusion over the long term follow-up both for sidewall and bifurcation aneurysms, with very low and silent in stent stenosis rates. Some incompletely occluded aneurysms showed a tendency of progressive occlusion, however this was counterbalanced by the regrowth of others. O4B-1.6 DETECTION OF TRUE ANEURYSM USING HIGH RESOLUTION TIME-OF-FLIGHT MAGNETIC RESONANCE ANGIOGRAPH (HR-MRA) AT 3.0 TESLA: CORRELATION WITH STANDARD DIGITAL SUBTRACTION ANGIOGRAPHY (DSA) Aleum Lee, Chul-ho Sohn Seoul National University Hospital, Seoul, Republic of Korea PURPOSE 1.To evaluate accuracy of 3 T HR-MRA in detecting aneurysm compared with conventional MRA (C-MRA) 2.To prove potential diagnostic advantage of HR-MRA using correlation with DSA MATERIAL AND METHODS 32 patients with 43 possible aneurysms on C-MRA were underwent 3 T HR-MRA and DSA. The protocols of HR-MRA were following: TR 29.0, TE 4.6, matrix 512x512, FOV 20 cm, and thickness 0.5 mm with 8 channel head coil. Two blinded neuroradiologists reviewed C-MRA and HR-MRA in the detection of aneurysms, independently. For each possible aneurysm, readers recorded the location and their level of confidence with a 3 point scale (0:no, 1:suspicious, and 2: definite aneurysm). 2D or VR-DSA were obtained and used as the standard of reference. The accuracy was calculated in addition to the sensitivity and specificity of HR-MRA compared to C-MRA. In particular, cases with advantage of detection on HR-MRA were evaluated in detail. RESULTS DSA revealed 35 aneurysms in 25 patients and no aneurysm or ID in 8 cases in 7 patients. Multiple aneurysms were 12 cases in 8 patients. On HR-MRA, reviewers exactly detected 40, 37 cases, superior to C-MRA (29, 32 cases). On the lesion-based evaluation, accuracy, sensitivity, and specificity of were 89.5 %, 91.5, and 81.3 % on HR-MRA and 72.1 %, 81.5 %, and 31.3 % on C-MRA, respectively.

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Each 3 and 5 suspicious aneurysm on C-MRA were recategorized as definite aneurysm. CONCLUSION HR-MRA had a high accuracy, sensitivity and specificity for the detection of intracranial aneurysms, comparing C-MRA. In equivocal aneurysm on C-MRA, HR-MRA can be a useful tool and replace DSA. O4B-1.7 FLAT-DETECTOR DSA FOR PERI-THERAPEUTIC QUANTITATIVE HEMODYNAMIC MEASUREMENT IN CAROTID ATERIAL OCCLUSIVE DISEASE Wan-Yuo Guo1 ,2, Sheng-Che Hung1 ,2, Chung-Jung Lin1 ,2, Feng-Chi Chang1 ,2, Chau-Bao Luo1 ,2, Michael MH Teng2 ,1, Wei-Fa Chu1 1 Taipei Veterans General Hospital, Taipei, Taiwan, 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan PURPOSES The study was aimed to prove the hypothesis that DSA using flat-detector (FD-DSA) only is able to provide peritherapeutic quantitative hemodynamics- intracranial circulation time (CirT) and parenchymal blood volume (PBV). MATERIAL AND METHODS 13 patients, having CAOD (carotid arterial occlusive disease) with 60 to 95 % stenosis of extracranial internal carotid artery and referred for CAS (carotid artery stenting), were recruited. A biplane angio-suite (AXIOM-Artis®, Siemens Healthcare) equipped with quantitative measurement of CirT and PBV, (syngo iFlow® and syngo PBV®, Siemens Healthcare) was used. In a single DSA session, peri-therapeutic CirT of 11 patients and peri-therapeutic PBV of middle cerebral arterial territory (MCA) of all patients were obtained. Individual CirT, defined by iFlow, was used individually for PBV measurement of each patient. A longitudinal comparison of CirT, PBV and hemodynamic changes based on selective angiography was performed. RESULTS After CAS, CirT shifted towards normalization (from 8.61±1.96 to 7.41±1.77 sec, p00.012). The therapeutic effects of CAS were evidenced on the PBV images by watershed zone shifting in all patients with moderate or severe degrees of stenosis (≥ 70 %). Morphological and flow direction changes of the circle of Willis were noted in 4 severe stenotic (≥ 90 %) patients, including 2 with isolated posterior communicating artery re-opening and 2 with isolated A1 re-opening. PBV of MCA did not

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change after CAS, even in patients with severe stenosis (≥ 90 %). CONCLUSION Evaluation of peri-therapeutic CirT, PBV and hemodynamic changes is able to be done using only FD-DSA imaging for timely management of CAOD. O4B-1.8 ENDOVASCULAR MANAGEMENT OF PATIENTS WITH HEAD-AND-NECK CANCERS AND ASSOCIATED CAROTID BLOWOUT SYNDROME FROM THE EXTERNAL CAROTID ARTERY: FACTORS INFLUENCING THE OUTCOME Feng-Chi Chang1 ,2, Chao-Bao Luo1 ,2, Hsiu-Mei Wu1 ,2, Wan-Yuo Guo1 ,2, Jiing-Feng Lirng1 ,2, Chung-Jung Lin1 ,2, Michael Mu Huo Teng1 ,2, Cheng-Yen Chang1 ,2 1 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, 2National Yang Ming University, School of Medicine, Taipei, Taiwan PURPOSE To retrospectively evaluate the factors related to the technical and hemostatic outcomes of endovascular management in patients with head-and-neck cancers associated with carotid blowout syndrome (CBS) from the branches of external carotid artery (ECA). MATERIALS AND METHODS From 2001 to 2011, 34 patients with head-and-neck cancers with CBS involving the ECA underwent endovascular therapy. This included embolization with microparticles, microcoils, or acrylic adhesives. Technical and hemostatic outcomes were recorded. Demographic features, clinical and imaging findings, and locations of the pathological lesion were examined as predictors of the outcome of endovascular management by using Fisher's exact test. RESULTS Technical success and immediate hemostasis were achieved in all patients. Technical complication was encountered in 1 patient (2.9 %). Rebleeding occurred in 9 patients (26.5 %). The mean duration of hemostasis after initial management was 10.0±14.8 months. Rebleeding was noted in 7 of 18 patients (38.9 %) with acute CBS and in 2 of 16 patients (12.5 %) with impending and threatened CBS (P00.1251). For the 25 patients with preoperative CT/MR examination, their clinical vs imaging correlation had the sensitivity, specificity and kappa value for recurrent tumors (1, 0.7143, 0.7826), soft tissue defect (0.9091, 0.3333, 0.2424) and sinus tract/fistula formation (0.4737, 0, 0.4286)

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CONCLUSION Endovascular management of patients with CBS from the ECA has high technical safety and good immediate hemostatic outcome. No single factor determines the therapeutic outcomes. A preoperative CT/MR can enhance the detection of clinical predisposing factors of CBS and thus help in the planning of endovascular management. O4B-1.9 CAROTID ARTERY STENTING: THE IRISH EXPERIENCE Joanna Pearly Ti, David Carmody, Sarah Power, Alison Corr, Joan Moroney, David Williams, Seamus Looby, John Thornton, Paul Brennan Beaumont Hospital, Dublin, Ireland Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are means of carotid revascularization in patients with carotid artery stenosis. Recent large randomized control trials (CREST, ICSS) compare the two methods of carotid revascularisation, with equivalent results in CREST, and CEA appearing superior in the interim ICSS study. We review our single-centre experience of CAS and compare it to the results of the RCTs and the American Heart Association/American Stroke Association (AHA/ASA) guidelines for the prevention of stroke to evaluate whether we are meeting international standards. We maintained a prospective database of all patients undergoing CAS in Beaumont Hospital, Dublin, Ireland, over a 10-year period extending from December 2001 until June 2011. Data was collected on clinical presentation, risk factors, non-invasive imaging findings, procedural details, 30-day periprocedural complications and clinical follow-up. 199 patients underwent CAS in the 10-year period. 135 patients were symptomatic and 63 patients were asymptomatic. The majority of the patients were stented successfully (n0192, 94.6 %), with failure mainly due to vessel tortuosity. There were 9 deaths (4.6 %) in the 30day periprocedural period and 17 (8.8 %) patients who died, suffered a stroke or myocardial infarction in the 30-day periprocedural period. There are more serious complications in the symptomatic (n014, 11.3 %) compared to the asymptomatic group (n03, 5.0 %), however this is not statistically significant (p00.27). CAS performed at our centre is a safe and dependable method of carotid revascularization. Outcomes are in line

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with major trials, and allow for CAS to be offered as an alternative to CEA. PARALLEL SESSION 4B – SCIENTIFIC PAPERS 4B.2 O4B-2.1 EARLY WHITE MATTER CHANGES CAN PREDICT LATE NEURODEVELOPMENTAL OUTCOME IN N E O N AT E S S U F F E R I N G F R O M H Y P O X I C ISCHEMIC ENCEPHALOPATHY: A TRACT-BASED SPATIAL STATISTICS STUDY Lajos Rudolf Kozák1 ,2, Márton Kolossváry1 ,3, Miklós Szabó3, Gábor Rudas1 1 MR Research Center, Semmelweis University, Budapest, Hungary, 2Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary, 31st Department of Pediatrics, Semmelweis University, Budapest, Hungary The hypoxic ischemic encephalopathy (HIE) is the leading cause of morbidity and mortality in term neonates. Early diagnostic and prognostic biomarkers are sought after for fine-tuning neuroprotection. Fractional anisotropy (FA), a non-invasive measure of white matter structure obtained from diffusion tensor imaging (DTI) measurements, can serve as such biomarker. Here, we investigated whether FA is useful for predicting long-term neurodevelopmental outcome in neonatal HIE patients. We did a retrospective analysis of first week-of-life DTI data of 26 hypothermia-treated children. Images were collected at 3 T in 32 non-collinear directions, then processed and analyzed using the FSL software library. First, FA maps were calculated using the dtifit tool, then tract-based spatial statistics (TBSS) were performed with the tbss tool. The children were divided into three groups based on their 18-24 months’ neurodevelopmental state assessed by the Bayley II. test: (S) severe HIE with persisting impairment (10 children); (R) severe HIE with almost complete recovery (10 children); and (M) mild HIE with full recovery 6 children). We found significantly lower FA-values in the left corticospinal tract of group S compared to group R, while widespread diffuse decrease of FA values was present compared to group M (p<0.05, familywise error corrected, for both comparisons). There was no significant difference between groups R and M. In conclusion, we demonstrated that first week-of-life fractional anisotropy scores can predict the long-term neurodevelopmental outcome of neonates suffering from

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HIE. Moreover, TBSS seems to be a promising approach for detecting white-matter changes in neonates O4B-2.2 ROLE OF DIFFUSION-WEIGHTED IMAGING IN THE FOLLOW-UP OF CHILDREN TREATED FOR MEDULLOBLASTOMA Luc van den Hauwe1 ,2, Corrie Gidding1, Erik van Lindert1, Pieter Wesseling1, Bozena Goraj1 1 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, 2Antwerp University Hospital, Antwerp, Belgium PURPOSE To study whether DWI is able to demonstrate intracranial recurrences of medulloblastoma with higher sensitivity than contrast-enhanced series. MATERIALS METHODS MRI examinations of 21 children with histologically proven MB were retrospectively evaluated. Routine follow-up examinations were performed initially 3 months after operation; thereafter, every 6 months for the next 2 years. Then, controls were done yearly. Concomittant cranial and spinal MRI included T1, T2, and FLAIR in the axial plane, followed by T1 after gadolinium in 3 orthogonal planes for the brain. Additional DWI was performed. Subsequent spinal imaging included sagittal T1en T2-weighted images. RESULTS In 6 patients intracranial recurrent disease was observed. In 4 patients recurrent disease was observed at the resection site; in 3 of which subarachnoid spread was also observed; with recurrence in loco only in 1 patient. 2 patients had recurrent disease away from the resection cavity, typical in the frontal areas. In 3 patients intraventricular recurrences at the supratentorial level were observed; all of them had also recurrence in the primary tumor bed. In 3 patients the recurrences were only observed on DWI in retrospect and were initially overlooked. On follow-up examination, 3-6 months later, the lesions were correctly identified. The tumor recurrences were much more obvious on DWI when compared to the Gd-enhanced images, especially the intraventricular ones. CONCLUSION Our results demonstrate that DWI is more sensitive than contrast-enhanced cranial MRI alone in the early diagnosis of recurrent disease and should therefore be included in the follow-up of patients with MB.

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O4B-2.3 EVALUATION OF A DECISION SUPPORT SYSTEM INTEGRATING MULTIPARAMETRIC MRI DATA TO THE RADIOLOGICAL PHENOTYPING OF PAEDIATRIC POSTERIOR FOSSA TUMOURS Stavros Stivaros1 ,2, Alex Leggate2 ,3, Ann Gledson1, Mathew Bailey2 ,3, Vivian Tang2, Neville Wright2, Calvin Soh3, Jill Birch1, Ian Kamaly2 ,1, John Keane1 1 University of Manchester, Manchester, UK, 2 Royal Manchester Children's Hospital, Manchester, UK, 3Salford Royal Foundation Trust, Manchester, UK PURPOSE Posterior fossa tumours account for the majority of paediatric brain tumours. Despite the advent of multiparametric MRI studies there remains significant uncertainty in radiological diagnosis. We have developed a decision support system that integrates a descriptive imaging model as well as advanced quantitative imaging metrics to facilitate radiological phenotyping of these tumours. METHODS Using the North West Children's Tumour Registry we identified all paediatric patients presenting with a posterior fossa tumours from 1953 to April 2012. We retrieved all cases with imaging and retrospectively applied a systematic imaging based scoring system. This data, captured in a separate database along with the known histological outcomes, was then used to develop a Bayesian statistical framework underpinning a clinical decision support system. 40 patients were then randomly selected and their imaging reported by four radiologists with specific interests in oncological neuroradiology. The imaging was then re-reported by the same radiologists one month later using the decision support system. RESULTS In 78 %-83 % of cases the individual radiologist correctly identified the tumour histology. A total of nine patients had disconcordant radiologic and histologic diagnoses. By contrast correct classification was obtained in more than 95 % by the use of the decision support system. CONCLUSIONS Posterior fossa tumours have a variable radiologic appearance with significant crossover between tissue types. However this study demonstrates the potential of a decision support system to facilitate radiological phenotyping. Validation and expansion of the system will require prospective analysis of larger numbers of patients as well as correlation to tumour grade.

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O4B-2.4 PINEAL GERM CELL TUMORS, PRE-OPERATIVE DIAGNOSIS BY CLINICAL AND IMAGE FINDINGS Yueh-hsun Lu1 ,2, Hseuh-Han Wang1 ,2, Y. W. Chen2, Tai-Tong Wong2 ,3, Fong-Chi Chang2 ,3, H. M. Wu2 ,3, Wan-Yuo Guo2 ,3 1 National Yang-Ming hospital, I-lan, Taiwan, 2Veterans general hospital, Taipei, Taiwan, 3National Yang-Ming university, Taipei, Taiwan BACKGROUND Pineal germinoma can be treated with only low-dose irradiation. Non-germinoma group needs aggressive therapy such as high-dose irradiation or surgery. These aggressive therapies can leave long-term side effect. This study was designed to make pre-therapeutic diagnosis for an appropriate treatment planning. MATERIAL AND METHODS From 2005 to 2011, 61 patients with pineal germ cell tumors (GCT) were treated. 49 patients had regular follow up. They included 17 germinomas and 27 non-germinoma (1 yolk sac tumor, 2 mature teratomas, 7 immature teratomas, 1 choriocarcinomas, 16 mixed GCT). 5 cases of germinoma were diagnosed clinically. The group of germinoma was treated by intracranial low dose irradiation, and non GCT by high sode. We compared the MRI findings and the therapeutic outcome. RESULTS The size of germinomas and non-germinomas are 2.39+/0.7 cm and 2.98+/-0.9 cm (p00.058). On T1WI, germinoma group showed high signal in 3/17 (18 %) and nongerminoma in 15/27 (56 %) (p00.003). On DWI sequence, germinoma group showed high signal in 5/17 (29 %) and non-germinoma in 19/27 (70 %) (p00.003). In post radiotherapy MRI, germinoma showed 63 % average size shrinkage and non-germinoma 36 % (p00.008). The therapeutic complete response rate is germinoma 15/17(88 %) and nongerminoma (22 %) (p<0.0001) CONCLUSION When pineal GCT presented with low signal on DWI and rapid tumor response to initial radiation, germinoma should be favored and further aggressive management is not indicated. O4B-2.5 A N O V E L , C L I N I C A L LY D I S T I N C T I V E CEREBROVASCULAR PHENOTYPE IS ASSOCIATED WITH MUTATIONS IN ACTA2 Dawn Saunders1, Pinki Munot1, Diane Milewicz3, John Ostergaarde4, Thomas Jacques1 ,2, Tim Cox1, Vijeya Ganesan1 ,2 1 Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK, 2Institutue of Child Health, London, UK, 3 University of Texas, Dallas, USA, 4Skejby Hospital, Aarhus, Denmark

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Mutations in the ACTA2 gene lead to diffuse and diverse vascular diseases, including thoracic aneurysms, dissections and premature coronary and cerebrovascular disease (CVD). The specific heterozygous missense ACTA2 mutation, R179H, is associated with a more severe condition characterized by early onset syndromic presentation due to global smooth muscle dysfunction. CVD associated with this variant and other mutations in ACTA2 has been likened to moyamoya. We reviewed the clinical features and neuroimaging of 13 patients with heterozygous missense mutations in the ACTA2 gene. As previously reported, all patients had persistent ductus arteriosus and congenital mydriasis. Distinctive cerebrovascular features were dilatation of the proximal internal carotid artery (ICA), occlusive disease of the terminal ICA, an abnormally straight course to the intracranial arteries and absence of basal "moyamoya" collaterals. The transition from dilated to normal/stenotic arterial caliber corresponds to the segment of the ICA where the artery transitions from an elastic to muscular artery. Key differences from moyamoya disease/syndrome were the more widespread distribution of arteriopathy, combination of arterial ectasia and stenosis and absence of basal collaterals. Brain images show patterns of ischaemic injury supportive of both large and small vessel disease. Distinctive clinical and radiological features, different from moyamoya disease/syndrome, should alert neuroradiologists to this diagnosis, which has potential genetic and prognostic implications and mandates surveillance of other organ systems. Patients with PDA or, congenital mydriasis with a diagnostic label of "moyamoya" should be reevaluated to ensure that clinical or radiological features of an underlying ACTA2 mutation have not been overlooked. O4B-2.6 ‘TO BE OR NOT TO BE?' THE RELATIONSHIP B E T W E E N T H E C L I N I C O PAT H O L O G I C A L DIAGNOSIS AND NEUROIMAGING IN THE IDENTIFICATION OF FOCAL CORTICAL DYSPLASIA TYPE IIB Roxana Gunny1 ,2, Vivian Elwell1, Tom Jacques1 ,2, William Harkness1 ,2 1 Great Ormond Street Hospital, London, UK, 2University College London Institute of CHild Health, London, UK BACKGROUND Focal cortical dysplasia (FCD) is a localised derangement of cortical organisation and is associated with medically refractory epilepsy in children. Recently, the ILEA Diagnostic Methods Committee proposed an international consensus to improve the clinicopathological diagnosis in FCDs. Resection of Type IIB compared to non-type IIB FCD is associated with better clinical outcome; accurate pre-operative diagnosis would help guide

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patient selection and counselling. The purpose of this study was to evaluate the pre-operative neuroimaging features of histologically confirmed FCD IIB. METHODS A six-year retrospective study of pre-operative neuroimaging of 24 children (<17 years of age) with FCD Type IIB confirmed histologically following surgical resection for epilepsy. All patients had epilepsy protocol brain MRI including 3D T1 and FLAIR volumetric sequences. Analysis was performed by review of medical notes, electronic databases, neuropathological slides and neuroimaging. MRI scans were evaluated based on a "seven point" classification scheme. RESULTS During January 2005-April 2011, 62 children with histologically confirmed FCD underwent neurosurgery. 24 patients met the histopathological diagnostic criteria of FCD Type IIB. According to our imaging classification, neuroimaging showed: subcortical white matter signal change (100 %), well-defined margins (87.5 %), blurring of gray-white matter junction (83 %), abnormal cortical gyration/sulcation (83 %), single lobe involvement (83 %),"transmantle sign" (70.1 %), and apparent cortical thickening (54.2 %). CONCLUSION Characteristic imaging features of FCD Type IIB were seen in most but not in all patients. As both patient selection and complete surgical resection improve long-term outcomes in patients with FCD Type IIB it is important to identify these characteristics pre-operatively. O4B-2.7 COMBINING MR DIFFUSION MEASURES TO DISCRIMINATE PAEDIATRIC BRAIN TUMOURS Daniel Rodriguez Gutierrez1,2, Amir Awwad1, Fotios Savvopoulos1 ,2, Richard Grundy2, Dorothee Auer1 1 Radiological and Imaging Sciences, The University of Nottingham, Nottingham, UK, 2Children's Brain Tumour Research Centre, The University of Nottingham, Nottingham, UK INTRODUCTION Techniques based on apparent diffusion coefficient (ADC) measures have been proposed to discriminate between brain tumours. These range from regional mean, minimum, or ADC histogram percentiles, but it is unclear that single features can effectively discriminate overlapping ADC populations. We propose using combinations of features to train Support Vector Machine (SVM)-based classifiers that allow discrimination of tumour-type or subtype. METHOD Diffusion data was analysed from 20 preoperative datasets of posterior-fossa tumours, 15 Medulloblastomas (MB) - 12 classic/3anaplastic and 5 Ependymomas (EP), were registered to contrast-enhanced T1w data, wherein regions of interests

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were drawn. ADC histogram and textural features were used to train tumour-type and subtype-specific classifiers. The performance of different subsets of features was investigated using randomly selected sets of training and test data. RESULTS The best tumour-type classifier was based on ADC median and histogram 25th-percentile (av. ± SD: MB median 00.85 ± 0.04x10-3 mm2/s, MB 25th-percentile00.69±0.03x10-3 mm2/s, EP median01.34±0.14x10-3 mm2/s, EP 25th-percentile01.14± 0.13x10-3 mm2/s) and correctly classified on average >98 % of MBs and >97 % of EPs using 8 training samples. The best tumour-subtype classifier was based on sum average (SA) and variance (SV) textural features (av.±SD: MBclassic SA0113± 10, MBclassic SV015±4x103, other SA0160±12, other SV0 27±4x103), and could differentiate on average >90 % classic MBs from anaplastic MB or EP. CONCLUSIONS These results suggest SVM-based classifiers using a small set of ADC features (histogram and/or textural) could possibly be trained, using small sample sizes, to discriminate between tumour types and subtypes. The approach however needs to be assessed on independent test data. O4B-2.8 COMPARING dec-t1 AND dec-t2* MR PERFUSION IN DIFFERENTIATING HIGH FROM LOW GRADE PAEDIATRIC BRAIN TUMOURS Muftah, A Manita1, Dorothee, P Auer1, Richard, G Grundy2, Timothy Jaspan3, Paul Morgan4 1 Radiological and Imaging Sciences Division, University of Nottingham, Nottingham, UK, 2Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK, 3Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK, 4Department of Medical Physics & Clinical Engineering at Nottingham University Hospitals, Nottingham, UK BACKGROUND AND AIM Dynamic contrast susceptibility (DSC) T2* MR perfusion is increasingly used in clinical practice to diagnose paediatric brain tumours. However, susceptibility effect in using this technique may lower its accuracy. We hypothesize Dynamic contrast enhanced (DCE) T1 perfusion may provide added value to DSC-T2* in defining high grade brain tumours. MATERIALS AND METHODS Retrospective study of 14 patients (7 high grades and 7 low grades) with different brain tumours. Cohort of 10 female and 4 male patients (mean age, 11.4 years; range, 3 months21 years).The protocol includes both T1 and T2* MR perfusion based on clinical image acquisition protocol at 3 T (Philips Achieva). DSC-T2* perfusion was performed using 3D PRESTO MR perfusion and DCE-T1 Perfusion was performed using

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turbo field echo. Regions of interest of ≤28 mm2 were placed over the hyperaemic areas of the tumour. The maximum value of the mean of the tumour blood volume (TBVmax) was normalized to normal appearing white matter (rTBVmax). Pearson correlation coefficient was used to assess the correlation between the two techniques and receiver operator characteristic was used as classifier to assess the diagnostic accuracy. RESULTS Threshold value of 6.1 had showed optimum accuracy of the two techniques. Both techniques allow separating high from low grade tumours. The optimum accuracy of DCE- MR Perfusion and DSC- MR Perfusion are 79 % and 86 % respectively. Poor correlation between the two techniques (r00.35; P00.20) was reached. CONCLUSION DSC-T2* MR perfusion in this cohort study is more robust in grading brain tumours. O4B-2.9 QUANTITATIVE APPROACH FOR CLASSIFICATION OF THE MALIGNANCY GRADE OF THE BRAIN TUMORS IN CHILDREN: DWI, DTI, AND IN-VIVO 1 H MRS STUDY Zinayida Rozhkova1, Alex Dukhovsky1 1 Medical Clinic BORIS, Kiev, Ukraine, 2Kharkiv Children's Hospital, Kharkiv, Ukraine PURPOSE We propose classification of the brain tumors in children using microstructural and metabolic alterations in the

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peritumoral region based on ADC, FA, and ratios of the NAA/Cr, and NAA/Cho. METHOD AND MATERIALS 23 children (2-16y) are examined using 1.5 T Signa Excite (GE). The 1st group (VG) consists of 10 children without neurological disorders (18mo-16y). The spectra are recorded in four locations of the brain: in the peritumoral region, in intact tissue of the ipsilateral hemisphere, and symmetrically, in the contralateral side on the tumor's level, and on the level of the examined intact tissue of the affected hemisphere. ADC and FA values are calculated in all above mentioned regions of the brain. RESULTS ADC values in peritumoral regions of gliomas of high grade of malignancy:(0.98 +-0.13)x10-3 mm2/s, of low grade (1.46+-0.03)x10-3 mm2/s, and in region of cystic mass (2.07+-0.09)x10-3 mm2/s. ADC value of 1.23x10-3 mm2/ s as the threshold value for differentiation of malignant from benign tumors. The mean peritumoral FAp:0.653+-0.13 and FAp/Fan00.450 for high and 0.796+-0.09, FAp/Fan00.694 low grade of malignancy, respectively; FAn are FA's for the normal tissue in the contralateral side on the tumor's level. (NAA/Cr)p 00.95, (NAA/Cho)p 00.81, for high, (NAA/ Cr)p01.39, (NAA/Cho)p01.24 for low grade of malignancy. In peritumoral regions ADC, FA, FAp/Fan, NAA/Cr, and NAA/Cho are significantly lower for the tumor of high grade malignancy. The data of DWI, DTI, and MRS examinations are well correlated. CONCLUSIONS DWI, DTI, and MRS are very useful methods for preoperative assessment of brain tumors in children.

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POSTER ABSTRACTS

MRI and DCE-MRI. DCE-MRI better able to predict tumour grades for these patients compared with DSCMRI.

THEME: BRAIN TUMOURS

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CALVARIAL LESIONS: PICTORIAL ESSAY

GRADING OF LOW-GRADE GLIOMAS WITH PERFUSION MRI: DSC OR DCE?

Estanislao Arana1, Beatriz Asenjo2, Ana Marhuenda1 1 Fundacion IVO, Valencia, Spain, 2Hospital Universitario Carlos Haya, Málaga, Spain

Eamon Al-Hadithi1, Steven Sourbron1, Paul Chumas2, Tufail Patankar3, Jeremy Macmullen-Price3 1 University of Leeds, Leeds, W Yorkshire, UK, 2Consultant neurosurgeon Leeds Teaching Hospitals NHS Trust, Leeds, W Yorkshire, UK, 3Consultant neuroradiologist Leeds Teaching Hospitals NHS Trust, Leeds, W Yorkshire, UK PURPOSE Preliminary investigation into comparison of DSC-MRI and DCE-MRI perfusion data with tumour grade in low-grade gliomas METHODS 9 patients with low-grade gliomas underwent T1 and T2 MR perfusion imaging. Data was analysed using PMI software written in IDL 6.4 (Steven Sourbron software) to obtain cerebral blood flow and blood volume measurements. Tumour regions of interest were drawn by two experienced neuroradiologists using both methods. Scatter plots were drawn comparing results from two observers, linear trendlines were drawn and Pearson’s correlation coefficients were calculated to test for interobserver bias when selecting ROI’s, and to test for correlation between the two ROI selection methods. Scatter plots were drawn to show any correlation between DSC-MRI and DCE-MRI CBF and CBV results. Preliminary scatter plots were drawn showing perfusion data against tumour grade obtained from biopsy. Ability of DSC-MRI and DCE-MRI to distinguish different tumour grades was assessed. RESULTS There was correlation between results obtained from the two observers (r squared average 0.738, sd/mean 24 %), and between the two methods of ROI selection (r squared average 0.651, sd/mean 28 %). Poor correlation observed between DSC-MRI and DCE-MRI (r squared average -0.571), with greatest correlation between CBV data. DCE-MRI showed some distinction between tumour grades, particularly using CBV and CBF together. DSC-MRI was unable to distinguish between the grades of tumours. CONCLUSION Little interobserver bias shows good reproducibility of ROI selection method. Poor correlation between DSC-

PURPOSE Calvarial lesions are often encountered during head MRI and CT. To show the spectrum of calvarial lesions with computed tomography (CT) and magnetic resonance (MR) imaging. MATERIAL AND METHODS We have reviewed 192 patients with proved calvarial lesions at two institutions. All of them had plain films and CT, and 97 patients also MR imaging. Statistics were analyzed using SPSS 20 (IBM, NY, USA). RESULTS There were 87 men (45.3 %) and 105 women (54.7 %) aged 34.1±25.5 years (mean±SD). The lesions were 73.1 % benign and 26.9 % malignant. The most common diagnoses encountered were: Langerhans' cell histiocytosis, 18.9 %; Osteoma, 15.1 %; Epidermoid and Dermoid cyst, 12.9 %; Metastasis, 12.4 %; Meningioma, 10.8 %; Hemangioma, 9.1 %; Fibrous dysplasia 6.4 % and miscellaneous diseases 16.2 %. Important features needed for malignancy classification were age and edge definition, and for the histologic diagnoses matrix, marginal sclerosis, and age. CONCLUSIONS The main problem in the classification of bone lesions is a lack of familiarity with these lesions. This pictorial essay illustrates ancillary signs and potential imaging pitfalls. Also, discrepancies between CT and MRI are also depicted. P-3 ASTROCYTOMA-BRAIN DIFFERENTIATION BY NORMALIZATION OF MAGNETIC RESONANCE IMAGES Estanislao Arana1, Alejandro Moreno2, Beatriz Asenjo3, David Moratal2, Daniel Monleón4 1 Fundación IVO, Valencia, Spain, 2Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain, 3Hospital Universitario Carlos Haya, Málaga, Spain, 4Fundación de Investigación del Hospital Clínico Universitario de Valencia, Valencia, Spain

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PURPOSE To differentiate astrocytomas from brain and cerebrospinal fluid in magnetic resonance (MR) images and compare those lesions in terms of image intensity with other patients, independently of the scanner manufacturer. MATERIAL AND METHODS Sixty-four patients, 34 male and 30 women (age: 56,34± 14.69 [mean±standard deviation]) with histologically confirmed astrocytomas grade III-IV were studied in three different manufacturer 1.5 T MRI scanners (General Electric, Philips and Siemens). From common imaging sequences, only T1 pre- and post-contrast and T2 weighted images were needed. Normalization image processing was applied using MATLAB (The MathWorks, Inc., Natick, MA, USA). It relies on mode signal intensity and multilevel Otsu segmentation in multiparametric imaging from different sequences. All images were normalized based on the mode signal intensity of each image. For each patient, mean signal intensity was obtained from the parametric maps derived from the original images, in a region-of-interest placed on cerebrospinal fluid, normal white matter and brain tumor. Statistics were analyzed using SPSS 20 (IBM, NY, USA). RESULTS All signal intensity variables were normally distributed. Multiparametric normalization allowed differentiation of the three different tissues (ANOVA, p <0.001) for each scanner brand, although worst results were found with Siemens Symphony sequences (ANOVA test, p00.285). However, normalized brain tissue could not be separated among different scanners (ANOVA, p00.85). CONCLUSION This work introduces a quantitative analysis of focal lesions based on image intensity, independently of the manufacturer. It differentiates tumoral tissue from its surroundings and allows a fair comparison among patients and scanner manufacturers.

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PURPOSE To assess the diagnostic usefulness of textural features derived from standard Gd-enhanced MRI in paediatric posterior fossa tumours to differentiate classical medulloblastma (MB), anaplastic MB, ependymoma (EP) and anaplastic EP. METHODS T1-weighted Gd-enhanced preoperative MRI data from 26 children with infratentorial brain cancer (12 males, 14 females, 17 MB, 9 EP) were included into this retrospective study after parental consent. There were 4 anaplastic tumours in each group. Enhancing tumour and normal white matter were manually outlined. Shape, histogram and texture (Grey-level Co-occurrence Matrices; GLCM) features were computed and used to train a Support Vector Machine (SVM) Classifier for each tumour type and subtype. RESULTS The best MB classifier trained by a 10-sample training set using a combination of shape, histogram and GLCM textural features yielded 91 % accuracy in discrimination from EP. Using a 6-sample training set, a classic MB classifier was found to have about 78 % accuracy in discriminating classic MB from anaplastic MB, anaplastic and benign EP in our cohort. CONCLUSIONS & Texture analysis based on standard MRI showed potential for automated classification of tumour type and subtype in paediatric posterior fossa tumours. & Further research to establish new textural features is essential to improve the accuracy of tumour subtype classifiers.

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ANALYSIS OF THE LAYERING PATTERN OF ADC FOR DIFFERENTIATION OF RADIATION NECROSIS FROM TUMOR PROGRESSION

T 1 B A S E D T E X T U R E A N A LY S I S F O R T H E C L A S S I F I C AT I O N O F PA E D I AT R I C MEDULLOBLASTOMA, EPENDYMOMA AND THEIR ANAPLASTIC SUBTYPES

Jihoon Cha, Hong Sik Byun, Sung Tae Kim, Hyung-Jin Kim, Hye Jeong Kim, Byung-joon Kim, Pyoung Jeon, Keon Ha Kim Samsung Medical Center, Seoul, Republic of Korea

Amir Awwad 1 ,3 , Daniel Rodriguez 1 ,2, Tim Jaspan 3 , Richard Grundy2, Dorothee Auer1 1 Radiological and Imaging Sciences, University of Nottingham, Nottingham, UK, 2Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK, 3Department of Neuroradiology, Nottingham University Hospitals, Nottingham, UK

OBJECTIVES To evaluate the added value of DWI on PWI for differentiating tumor progression from radiation necrosis. METHODS Sixteen consecutive patients who underwent tumor removal for metastatic brain tumor that increased in size after stereotactic radiosurgery were included in this study. The layering

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of ADC was categorized into three patterns. ADC values were measured on the each layer, and maximum rCBV was also measured. rCBV and the layering pattern of ADC between the radiation necrosis and the tumor progression were compared. RESULTS Nine cases of radiation necrosis and 7 cases of tumor progression were pathologically confirmed. Radiation necrosis more frequently (88.9 % vs 14.3 %) showed three layer pattern of ADC with middle layer of minimum ADC. If rCBV larger than 2.6 was used to differentiate radiation necrosis and tumor progression, the sensitivity was 100 %, but specificity was 56 %. If the lesions with the 3 layer pattern of ADC with moderately increased rCBV (2.6~4.1) were excluded from tumor progression, the sensitivity and specificity were increased to 100 %. CONCLUSIONS The 3 layer pattern of ADC shows high specificity in diagnosing radiation necrosis; therefore, combined analysis of ADC pattern with rCBV may have added value in correct differentiation of tumor progression from radiation necrosis. P-6 AUTOMATED SEGMENTATION OF CEREBRAL GLIOMAS IN DT-MR AND FLAIR IMAGES USING 3D TEXTURE ANALYSIS Giorgio De Nunzio2 ,3, Antonella Castellano1 ,2, Marina Donativi2 ,3, Gabriella Pastore2 ,5, Matteo Rucco2 ,4, Lorenzo Bello6, Andrea Falini1 1 Neuroradiology Unit and CERMAC, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy, 2A.D.A.M. (Advanced Data Analysis in Medicine, http://adam.unisalento.it), University of Salento, Lecce, Italy, 3INFN (National Institute of Nuclear Physics), Lecce, Italy, 4University of Camerino, School of Science and Technology, Computer Science Division, Camerino, MC, Italy, 5Ecomedica Institute of Clinical Research, Centre for Radiotherapy and IGRT, Empoli, FI, Italy, 6Neurosurgery, Istituto Clinico Humanitas, University of Milano, Milan, Italy The aim of this study is to characterize pathological and healthy tissue in MR datasets of patients with cerebral glioma by 3D statistical Texture Analysis, developing an automatic segmentation technique (CAD, Computer Assisted Detection), with volumetric assessment. This technique may be useful for preoperative evaluation of tumor extension, for radiation therapy planning, and to assess response to chemotherapy. We tested our system on Diffusion Tensor

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Imaging (DTI) scans, capable of revealing peritumoral abnormalities that are not apparent on conventional MRI, and on FLAIR (Fluid Attenuated Inversion Recovery) images. For thirty-four patients with glioma (22LGGs/12HGGs), 3D axial FLAIR images (TR/TE 10000/110 ms) and 3 T MR-DTI (b01000 s/mm2, 32 gradient directions) were acquired. Fractional anisotropy (FA), mean diffusivity (MD), p and q tensor decomposition maps, were obtained. Manual segmentation of pathological areas was performed on each map. 3D texture analysis was applied with a sliding window approach to the segmented ROIs and to the contralateral healthy tissue, in order to identify discriminating features calculated from the co-occurrence matrices and from the Run Length Matrices. The feature-space dimensionality was reduced by Linear Discriminant Analysis (LDA), which allowed tissue classification by a threshold choice. Glioma segmentations were compared with the manual ones by the Jaccard Coefficient. For each map, classifier sensitivity, specificity and ROC curves were calculated, giving satisfying results (e.g. for MD and p: AUC00.95, 11 % error, and for FLAIR: AUC00.98, 7 % error). Manual and automatic segmentations were quantitatively compared, showing good concordance. P-7 PATHOLOGICALLY CONFIRMED RECURRENT GLIOBLASTOMAS: POTENTIAL UTILITY OF BIMODAL HISTOGRAM ANALYSIS OF WASH-IN E MAX RATIO DERIVED FROM T1-WEIGHTED PERFUSION MR IMAGING Won-Jung Chung, Ho Sung Kim, Sang Joon Kim, Choong Gon Choi Asan Medical Center, Seoul, Republic of Korea PURPOSE To determine whether a bimodal histogram analysis of wash-in - Emax ratio (WER) derived from T1-weighted dynamic contrast-enhanced (DCE) MR perfusion imaging can be a reliable and reproducible imaging biomarker for distingushing recurrent glioblastoma from radiation necrosis. MATERIALS AND METHODS The institutional review board approved this retrospective study. Fifty-one consecutive patients with pathologically confirmed recurrent glioblastoma or radiation necrosis were reviewed. Regions of interest were drawn around the entire contrast-enhanced region and were analyzed by using WER

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bimodal histograms with a two normal distribution mixture fitting curve. The bimodal histogram parameters which were calculated with model-free DCE indices, included mean WER at higher curve (mWERH), three cumulative histogram parameters (WER50, WER75, and WER90) and WER at mode (WERmode). The best predictor for differentiating recurrent glioblastoma from radiation necrosis was determined by logistic regression and receiver operating characteristic (ROC) curve analyses. RESULT Fifty-one study patients were subsequently classified as recurrent glioblastoma (n029, 56.9 %) or from radiation necrosis (n022, 43.1 %). There were statistically significant differences of mWER H, WER50, WER75, WER 90, and WERmode between the recurrent glioblastoma and the radiation necrosis groups (P<.0001). The logistic regression and ROC curve analyses showed the mWERH to be the best single predictor of recurrent glioblastoma, with a sensitivity of 90.9 % and a specificity of 83.7 %. CONCLUSION Bimodal histogram analysis of WER derived from modelfree DCE indices can be used as a potential, noninvasive imaging biomarker for differentiating recurrent glioblastoma and radiation necrosis. P-8 MENINGIOMA - UNCOMMON IMAGING FEATURES OF A COMMON PATHOLOGY

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The purpose of this presentation is to show uncommon features of meningiomas in order to facilitate the diagnosis in such challenging cases. MATERIALS AND METHODS From our database, pathology reports and teaching files we retrospectively identified cases with atypical imaging features of histologically typical meningioma. RESULTS The following atypical imaging features were found: Atypical signal/density: Melanocytic meningioma - mimicking a hemorrhagic lesion. Cystic meningioma - mimicking an intra-axial cystic lesion. Lipomatous meningioma. Atypical location: Intraosseous meningioma - mimicking an aggressive bone tumor. Intra-ventricular meningioma. Cervical meningioma - mimicking a neck mass. Orbital meningioma Optic tubercle menigioma - mimicking a pituitary tumor. Others: Childhood meningioma Secretory meningioma - mimicking an aggressive lesion with substantial edema. CONCLUSION Familiarity with atypical features of meningiomas is important for accurate diagnosis; thereby improving patients' care. P-9

Ayelet Eran, Roni Shreter Rambam Health Care Campus, Haifa, Israel PURPOSE Meningiomas are the most common nonglial primary tumors of the central nervous system. Meningiomas are generally benign neoplasms that are derived from meningothelial cells. They typically occur as extraaxial lesions attached to the dura mater and may exhibit adjacent calvarial hyperostosis or lysis. The tumor is usually avidly enhancing following contrast administration both on CT and MR. When presenting with the typical CT and MR imaging charectaristic, meningiomas are easily diagnosed and differential diagnosis possibilities are relatively limited. However, as this is a very common pathology it might sometimes take an uncommon appearance and represent a radiological diagnostic challenge. In such cases, including meningioma as a possible pathology is important from the pre-surgical and surgical planning perspective.

LOW-GRADE GLIOMAS: DIFFUSION (DWI) AND PERFUSION MRI (PWI) FOR THE DIFFERENTIAL DIAGNOSIS WITH HIGH-GRADE GLIOMAS AND NONNEOPLASTIC LESIONS Davide Gadda, Lorenzo Mazzoni, Stefano Chiti, Gian Paolo Giordano Careggi University Hospital, Firenze, Italy BACKGROUND AND PURPOSE Low-grade gliomas (LGG) may be difficult to distinguish from high-grade gliomas (HGG) and nonneoplastic lesions (NNL) with conventional MRI. We investigated which DWI and PWI parameters could be useful for such differential diagnoses. MATERIALS AND METHODS We compared the DWI and PWI data of 7 histologically confirmed LGG to those of 22 HGG and 7 NNL. For PWI, T2*-weighted dynamic susceptibility contrast technique was

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utilized. The minimum apparent diffusion coefficient (rADC) and maximal cerebral blood volume (rCBV) values were measured on the solid part of the lesions and were normalized to contralateral white matter (WM). On the areas of maximal rCBV we measured the normalized values of blood flow (rCBF) and mean transit time (rMTT). Time to peak (TTP) values were measured as differences between TTP of the lesion and that of contralateral WM. For comparative analysis of DWI and PWI data, Student’s t-test was utilized. RESULTS Significant differences between LGG and HGG were found for rADC (LGG 1,61+/-0,28, HGG 1,18+/-0,27, p00,002), rCBV (LGG 1,67+/-0,55, HGG 5,07+/-2,1, p<0,0001) and rCBF (LGG 1,9+/-0,57, HGG 6,64+/-3,43, p<0,0001). Significant differences between LGG and NNL were found for rCBF (LGG 1,9+/-0,57, NNL 1,03+/-0,57, p00,01) and rMTT (LGG 0,82+/-0,11, NNL 1,54+/-0,76, p00,04). Even for TTP a difference was found, although not statistically significant (LGG -0,35+/-0,54, NNL 2,82+/-3,61, p00,06). CONCLUSION Measuring rCBV, rCBF and rADC can provide valuable information for differentiation between LGG and HGG, whereas rCBF and rMTT might help in the differential diagnosis between LGG and NNL. P-10 MULTI-MODALITY BRAIN MRI FOR NEUROSURGICAL PLANNING AND NEURONAVIGATION IN PATIENTS WITH BRAIN TUMORS

protocol included neuropsychological tests, structural MRI , fMRI, diffusion and perfusion MRI as well as MR- Spectroscopy on a 1.5 T magnet before surgery and 3 and 12 months follow-up after surgery. The fMRI paradigms were selected according to the neuropsychological results. The acquired and post-processed data from structural, functional and DTI sequences were then transfered to the neuronavigation system and were used for presurgical planning and for intraoperative guidance in selected cases. In all cases we had the histological correlation. We have been able to evaluate 16 patients after surgery. RESULTS Our cohort comprised of 12 patients with low-grade gliomas, 1 DNET, 19 high-grade gliomas, 5 lymphomas, 14 meningiomas, 2 hemangiomas, 17 metastases, 2 colloid cysts. Using the validated algorithm for intraaxial tumors we were able to establish the correct presurgical diagnosis in 69/72 patients (95,8 %). In several cases the combination of neuropsychological and neuroimaging evaluation emerged the need for surgery, either excision or biopsy. The neuronavigation guided surgery in most of the tumors allowed almost radical excision of the tumors especially the low-grade gliomas. CONCLUSION Our multi-modality brain MRI approach in combination with neuropsychological evaluation is an invaluable tool for planning and guiding the surgery thus providing the best health-care management of patients with brain tumors. P-11

1 ,2

2 ,3

Vasileios K. Katsaros , Evangelia Liouta , Laurent Hermoye4, Wojciech Gradkowski4, Nikolaos Tsiotas5, Christos Koutsarnakis2 ,3, Nikolaos Andreadis2 ,3, Theodoros Argyrakos6, Aggeliki Tavernaraki1, George Stranjalis2 ,3 1 Department of MRI and Neuroradiology, Saint Savvas AntiCancer - Oncology Hospital, Athens, Greece, 2Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece, 3Hellenic Center of Neurosurgical Research, Prof. P. Kokkalis, Athens, Greece, 4Imagilys, Brussels, Belgium, 5Medtronic, Athens, Greece, 6Department of Pathology, Evangelismos Hospital, Athens, Greece PURPOSE To demonstrate our pre-surgical planning protocol as well as the MRI data transfer into the neuronavigation system in patients with brain tumors. MATERIALS AND METHODS The last 11 months 72 cases were evaluated presurgically as well as post-surgically. Our evaluation

INTER-OBSERVER AND INTRA-OBSERVER AGREEMENT OF rCBV VALUES IN GLIAL TUMORS USING DIFFERENT PROPRIETARY ANALYSIS SOFTWARES Sameeha Fallatah1, Anant Krishnan1, Melanie Brisson1, Matthew Adams1, Xavier Golay0 ,2, Rolf Jager1 ,2 1 National Hospital for Neurology and Neurosurgery, London, UK, 2Institute of Neurology, UCL, London, UK PURPOSE The measurement of relative cerebral blood flow (rCBV) in the clinical management of brain tumors is being increasingly utilized. However for accurate comparison across centers, the technique must reliably identify areas of high rCBV and be reproducible, independent of manufacturer. The degree of inter- and intra-observer errors should also be known to enable

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critical interpretation. This study aimed to assess the inter-observer and intra-observer reliability and reproducibility of rCBV measurements in patients with glial brain tumors using different proprietary perfusion analysis software packages. METHODS: Dynamic susceptibility contrast MR perfusion images of 17 histologically confirmed glial brain tumors of varying WHO grade were analyzed by two independent operators blinded to the histopathologic diagnosis. The highest rCBV measurement of several intra-tumoral regions of interest was normalized to the contralateral white matter. Three different commercial perfusion analysis software packages were utilized to classify patients into low ( < 1.7) and high ( > 1.7) rCBV groups. The inter- and intra-observer levels of agreement were measured. RESULTS The inter-observer agreement appears substantial with intraclass correlation coefficient (ICC) of 0.74. The intraobserver agreement was good (ICC was 0.59). Both observers showed excellent agreement in grouping patients low and high rCBV groups, though there remained variations between the different software packages, particularly at high rCBV values. CONCLUSION Measurements of rCBV values obtained from the three perfusion analysis softwares showed an increasing divergence for high rCBV values. Distinction between tumors with low rCBVs showed however good agreement between all observers and types of analysis software.

MATERIALS AND METHODS Our institutional review board approved this retrospective study. Seventy-one consecutive patients who showed new or enlarged, contrast-enhancing lesions after concurrent chemoradiotherapy (CCRT) were assessed using conventional and DCE perfusion MR imaging. Twenty patients with treatmentnaive glioblastomas were enrolled as the control group. The bimodal histogram parameters of WER, which included mean WER at higher curve (mWERH), three cumulative histogram parameters (WER50, WER75, and WER90) and WER at mode (WERmode), were calculated with model-free DCE indices and was correlated with the final diagnosis. The best predictor for differentiating pseudoprogression from ETP was determined by logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS Seventy-one study patients were subsequently classified as pseudoprogression (n033, 46.5 %) or ETP (n038, 53.5 %). There were statistically significant differences of mWERH, WER50, WER75, WER90, and WERmode between the pseudoprogression group and the ETP group (P<.0001). The logistic regression and ROC curve analyses showed the mWERH to be the best single predictor of pseudoprogression, with a sensitivity of 89.9 % and a specificity of 82.2 %. CONCLUSION Bimodal histogram analysis of WER derived from modelfree DCE indices which do not require a complex modelbased approach, can be used as a potential, noninvasive imaging biomarker for monitoring early treatment response in patients with glioblastomas.

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BIMODAL HISTOGRAM ANALYSIS OF WASH-IN - E MAX RATIO DERIVED FROM T1-WEIGHTED PERFUSION MR IMAGING - POTENTIAL UTILITY FOR THE DIAGNOSIS OF PSEUDOPROGRESSION IN PATIENTS WITH GLIOBLASTOMAS

UNUSUAL LOCATION OF INTRACRANIAL GERMINOMA: THE LATERAL VENTRICLE AND CEREBRAL PERIVENTRICULAR WHITE MATTER INVOLVEMENT

Won Chan Lee, Ho Sung Kim, Choong Gon Choi, Sang Joon Kim, Won-Jung Chung Asan Medical Center, Seoul, Republic of Korea

Han Bee Lee1, Eunhee Kim2, Dong Hoon Lee3 1 Sanggye Paik Hospital, Seoul, Republic of Korea, 2Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea, 3Seoul Medical Center, Seoul, Republic of Korea

PURPOSE To test the predictive value of the bimodal histogram parameters of wash-in - Emax ratio (WER) derived from dynamic contrast-enhanced (DCE) perfusion MR imaging for differentiating pseudoprogression from early tumor progression (ETP) in patients with newly diagnosed glioblastomas.

Intracranial germinoma occurs most commonly in the pineal or suprasellar area, less often in the thalamus and basal ganglia. Herein, we report two cases of intracranial germinoma with unusual location except the above regions. One is presenting as a bubbly enhancing intraventricular mass involving the lateral ventricle in 24-year-old women. Therefore, it was preoperatively diagnosed as central neurocy-

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toma on MR imaging. Mass was totally removed, and surgical specimens revealed germinoma. The other case is a 37year-old man with progressive lower leg weakness over two years. MR imaging showed initially multifocal periventricular T2-high signal intensity lesions without enhancement. Over the times, slow progression was observed in extent of multifocal T2 high signal intensity lesions showing a few patchy enhancements in the cerebral periventricular white matters. We diagnosed initially demyelinating disease such as multiple sclerosis, and lately gliomatosis cerebri on MR imaging. Stereotaxic biopsy for the lesion was performed, and its pathology revealed germinoma. Two cases were showed no demonstrable pineal and suprasellar mass on MR imaging. Germinoma located in the lateral ventricle or cerebral periventricular white matter without any association of pineal and suprasellar area is a rare entity. P-14 USEFULNESS OF THE MRI VOLUMETRY IN THE FOLLOW-UP OF VESTIBULAR SCHWANNOMAS AFTER STEREOTACTIC RADIOTHERAPY Federico Mata Escolano0 ,1, Esther Blanco Pérez1, Piedad Almendros Blanco0 ,1, J.María Gallego1, Adela Batista Domenech0 ,1 1 consorcio Hospital General Universitario, Valencia, Spain, 2 eresa, Valencia, Spain Schwannomas represent the great majority of estraaxial tumors in infratentorial location. Currently, MR imaging is regarded as the most sensitive neuroimaging technique to evaluate tumor growth in non-surgical tumors, mainly asymptomatic meningiomas; and the tumor response in patients underwent gamma knife radiosurgery, such as the schwannomas. The axial measurement is usually used to determine tumor size during follow-up of this tumors to establish tumor progression or recurrence. An alternative way to do this is to take volumetric measures. A prospective study was performed to evaluate the effectiveness of volumetric control rates in follow-up MR studies. It included 41 patients with histological and radiological diagnosis of schwannomas, treated with fractionated stereotactic radiotherapy or stereotactic radiosurgery. Follow-up neuroimaging was performed with MR imaging 1.5 Tesla (Siemens Medical, and General Electric) at 3, 6 and 12 months during the first year; every 6 months during second year; and yearly thereafter. SPGR go prep and FLASH images were obtained, which favors the differentiation between the white matter and grey. The volumetry was made semi-automatic with manual delineation of the tumor contours

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in the parallel cross-sectional MRI images with electronic tool, excluding extratumoral vascular structures. The volumetry technical on axial magnetic resonance imaging seems to be a reliable parameter to assess the dimensions of the vestibular schwannomas monitoring. P-15 NON-ADENOMATOUS PITUITARY FOSSA LESIONS; RADIOLOGICAL ACCURACY IN DISTINGUISHING THESE FROM PITUITARY ADENOMAS AND RADIOLOGICAL FEATURES WHICH SUGGEST A NON-ADENOMATOUS PATHOLOGY Samantha Mills1, Tom Grundy3, David Hughes1, Kanna Gnanalingham2, Tina Karabatsou2 1 Department of Neurordiology, Salford Royal Foundation Hospital, Salford, Greater Manchester, UK, 2Department of Neurosurgery, Salford Royal Foundation Hospital, Salford, Greater Manchester, UK, 3University of Manchester, Manchester, UK BACKGROUND There are a number of pituitary fossa based lesions which can be difficult to distinguish radiologically from pituitary adenomas. The aim of this study was to assess the radiological accuracy in distinguishing non-adenomatous lesions from pituitary adenomas, and assess which radiological features indicate an alternative diagnosis. METHODS 441 pituitary lesions were operated on presdominsntly via an endoscopic transphenoidal route. Of those cases, 24 were histologically confirmed as non-adenomatous lesions. These 24 cases were age and sex matched to histologically confirmed pituitary adenomas (n048). 2 consultant neuroradiologists independently reviewed the imaging of this cohort, blinded to the histological diagnosis. The consensus radiological opinion was then compared to the histology. Radiological sensitivity, specificity and accuracy were calculated. Morphological radiological features were evaluated for distinguishing between adenomas and non-adenomatous lesions. RESULTS Of the 48 cases reviewed, 5 patients with non-diagnostic histology were excluded. Histological confirmation demonstrated a wide case mix including; adenoma, craniopharyngioma, lymphocytic hypophysitis, pituicytoma, meningioma, pilocytic astrocytoma, granulomatosis hypophysitis and metastasis. In this cohort, radiological sensitivity in identifying adenomas was 91 %, with a specificity of 40 % and accuracy of 67 %. Rare lesions including pilocytic astrocyto-

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ma, granulomatosis hypophysitis and pituicytoma were more difficult to distinguish from adenomas than lesions such as meningioma and metastase. Features suggestive of alternative histology included involvement of the pituitary stalk and anterior cranial floor extension. CONCLUSION Distinguishing rare pituitary fossa lesions from adenomas can be difficult radiologically, but some radiological features should raise suspicion that an alternative diagnosis should be sought.

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activation distance using fMRI correlated with the risk of post-operative deficit. DISCUSSION FMRI may be used to guide risk-stratification preoperatively. The evidence for its replacing intra-operative DCS has not yet been established by any high quality trial. P-17

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MENINGIOMAS - CLASSIC IMAGING APPEARANCE, VARIANTS AND DIFFERENTIAL DIAGNOSES

A SYSTEMATIC REVIEW OF THE USE OF fMRI IN PRE-OPERATIVE EVALUATION BEFORE BRAIN TUMOUR SURGERY

Aileen O'Shea, Sarah Power, J Pearly Ti, P Brennan, J Thorton, S Looby, FM Brett, M Farrell Beaumont Hospital, Dublin, Ireland

Daisy Mollison, Hamzah Soleiman, Joanna Wardlaw Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK

PURPOSE To review the classic imaging appearances of both brain and spine meningiomas. To be aware of the more uncommon and atypical radiological appearances. To discuss the radiology of malignant meningiomas, with neuropathology correlation. To discuss the radiological differential diagnosis, illustrated with radiological images. MATERIALS & METHODS Using the records over a 12 month period at a decicated neurooncology multidisciplinary team meeting, the clinical presentation, radiological features, neuropathology results and clinical management of all brain and spinal meningiomas were reviewed. The radiological imaging of selected cases was reviewed. RESULTS Cases were selected which demonstrate classic CT, MRI and angiographic features of brain and spinal meningiomas. A number of cases with unusual and atypical radiological features were also selected. Radiological imaging was reviewed to predict features of high grade meningiomas. Differential diagnosis for both brain and spine meningiomas is discussed, illustrated with radiological images, again from cases presented at the conference. Some management caveats are discussed. CONCLUSION Meningiomas of the brain and spine are a common tumour, with classic imaging features. Our retrospective review of all meningiomas at a large tertiary referral centre neurooncology meeting illustrates the classic imaging features along with some more atypical and unusual cases, examples of high grade, invasive meningiomas with neuropathological correlation and examples of differential considerations for both brain and spine meningiomas.

BACKGROUND Functional MRI (fMRI) is frequently part of the preoperative work-up for surgery on brain tumours close to eloquent cortex. Non-invasively localising functional areas pre-operatively offers potential to influence surgical planning and reduce operative time. At present the gold standard for localising cortical function remains direct intra-operative cortical stimulation (DCS). We aimed to evaluate the evidence for using fMRI in neurosurgical planning. METHODS Embase and Medline databases were searched for relevant articles, with manual searching of these papers' references and the journal Neurosurgery. Included papers studied brain tumour patients undergoing pre-operative fMRI, using either an alternative modality for validating results or relating fMRI findings to effect on surgical planning and outcomes. Study quality was assessed with reference to QUADAS criteria for evaluating diagnostic accuracy studies. RESULTS 92 papers were identified, mostly small case series (median 17 patients), with an overall study population of 1457 patients. Technical details were well reported, although with variable details on fMRI interpretation. 54 % of papers included an alternative validation method, DCS in 65 % of these, although few investigators were blinded to other results. Correlation between fMRI and DCS was better for motor function, although most papers were limited to central sulcus localisation. Language results were more variable. Papers examining surgical outcomes showed lesion-to-

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P-18 A CASE OF BRAIN INVOLVEMENT OF PERIPHERAL T-CELL LYMPHOMA NOT OTHERWISE SPECIFIED (PTCL-NOS) Eri O'uchi, Toshihiro O'uchi, Kosei Matsue, Tomotaka Ugai, Kazuei Hoshi Kameda Medical Center, kamogawa City, Chiba, Japan, Japan INTRODUCTION Although there are characteristic radiographic features of CNS involvement of B-cell lymphomas, little is known about the specific features of T-cell lymphomas. To our knowledge, there have been no reports of imaging findings for CNS involvement in peripheral T-cell lymphoma not otherwise specified (PTCL-NOS).Here we report an unusual MRI features that turned out to be CNS involvement of PTCL-NOS, the most common subtype of T-cell lymphoma. An immunocompetent fifty-two year-old Japanese male with PTCL-NOS in the tongue was treated with appropriate chemotherapy. Although he achieved a complete remission that lasted for 18 months, he developed muscle weakness in his all four extremities. The MRI with gadolinium revealed a fourcentimeter ribbon-like enhancement in subcortical white matter in the left frontal lobe with hemorrhage and significant edema. The FDG-PET-CT showed increased uptake of FDG in peripheral portion of the enhanced lesion that suggested malignant lymphoma. An open cranial biopsy revealed a cluster of atypical lymphocytes with necrosis. The immunohistochemistry confirmed PTCL-NOS. The above MRI findings were unusual for CNS involvement of malignant lymphoma that occurs in immunocompetent patients. P-19 EXPLORING THE CAVERNOUS SINUS - PICTORIAL REVIEW OF IMPORTANT PATHOLOGICAL FINDINGS Jane Cunningham, Alison Corr, Joanna Pearly Ti, Sarah Power, Paul Brennan, John Thornton, Seamus Looby Beaumont Hospital, Dublin 9, Ireland PURPOSE Given the diversity of structures contained within the cavernous sinus and its proximity to the pituitary gland, nasopharynx and orbit, it is not surprising that it can be either primarily or secondarily involved by a broad spectrum of pathology. In addition, its small anatomical size makes evaluation of the cavernous sinus challenging for radiologists.

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EDUCATIONAL CONTENT This pictorial review demonstrates a vast array of lesions arising from structures within the cavernous sinus, namely, schwannomas, neurofibromas, meningiomas, epidermoid cysts, aneurysms and thrombosis. Examples of diseases from adjacent structures with extension into the cavernous sinus are also illustrated including pituitary adenomas, nasopharyngeal carcinoma, juvenile angiofibroma and tuberculosis. SUMMARY MRI is the imaging modality of choice in the evaluation of pathology related to the cavernous sinus. Although imaging appearances can be nonspecific, we provide illustrative examples of a range of diseases that involve the cavernous sinus and discuss their clinical presentation and epidemiology to assist formation of a logical differential diagnosis. CONCLUSION Imaging features of neoplastic, inflammatory and vascular lesions involving the cavernous sinus are presented in this educational exhibit to assist diagnostic evaluation of this complex region. P-20 SWAN (T2-STAR WEIGHTED ANGIOGRAPHY) IN DIFFERENTIATION OF GLIOBLASTOMAS AND SOLITARY BRAIN METASTASIS Igor Pronin, Mikhail Dolgushin, Ludmila Fadeeva, Alexey Podoprigora, Victor Anpilogov, Valery Kornienko Burdenko Neurosurgery Institute, Moscow, Russia SWAN (T2-star weighted angiography) is a fully velocitycompensated 3D gradient-echo sequence. It uses tissue contrast based on magnetic susceptibility and is effective in visualization of venous structures and microbleedings. SWAN- MRI can visualize local zones of hypointensity in brain tissue which are often invisible on standard T2WI. We used this method in differentiation between glioblastomas (GB) and solitary metastasis (Mets) because we hypothesized that intratumoral hemorrhages are more typical feature for malignant gliomas than for Mets. MRI was acquired using 3 T MR scanner. SWAN (TR/TE 82,0 ms/42,5 ms, flip angle- 20, whole brain, isitropic voxel) was added to routine MRI of 56 pts.:26 with brain mets ( breast-8 pts,lung-7 pts, kidney- 5 pts, melanoma- 2 pts, 4- from unknown sources) and 30 pts with glioblastomas. 5 pts with Mets were investigated after radiosurgery as well. SWAN MRI were postprocessed by minIP algorithm. Qualitative and quantitative analysis of hypointensive "dots" and "spots" was made (on all tumor levels). Anatomical structures containing deoxyhemoglobin or products of blood lysis were clearly depicted on SWAN

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images. Deformed blood vessels looked like hypointesive "dots" (size 1-2 mm) and microhemorrhages appeared as hypointensive "spots" with size > 2 mm. SWAN MRI demonstrated multiple "dots" and "spots" in all GB except 1 case (29 pts) and in all cases with posttreated Mets. In 8 % cases some "spots" were found in Mets before radiosurgery. SWAN MRI is informative method in evaluation of vascular structures and in microhemorrhages in GB and brain Mets allowing to make the differential diagnosis between these two entities with sensitivity-92 % and specificity -95 %. P-21

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RESULTS Mean rCBV (2,7 vs 1,7 P<0,05), maximum rCBV (4 vs 2,6 P<0,05) and minimum rCBV (1,2 vs 0,7 P<0,06) were higher in patients with a recurrence than in patients with pseudoprogression. Mean Ktrans (68,7 vs 112,7 P<0,05) maximum Ktrans (287 vs 312,8 P<0,5) minimum Ktrans (1 vs 14,5 P<0,05) were lower in patients with a recurrence than in patients with pseudoprogression. We propose a mean rCBV cut-off≥2,3 (sensibility: 64 %; specificity: 75 %; positive predictive value: 70 %; negative predictive value: 70 %). CONCLUSIONS DSC perfusion MRI can help to differentiate pseudoprogression from tumor recurrence thus impacting further treatment.

QUANTITATIVE T2* PERFUSION EVALUATION IN THE DIFFERENTIAL DIAGNOSIS BETWEEN RECURRENCE AND PSEUDO-PROGRESSION IN PATIENTS AFFECTED BY GLIOBLASTOMA MULTIFORME TREATED WITH RADIOTHERAPY AND TEMOZOLAMIDE

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Silvia Pugliese1, Andrea Romano1, Giuseppe Minniti1 ,2, Alessandro Bozzao1 1 Department of neuroradiology-Azienda ospedaliera S. Andrea-University La sapienza, Rome, Italy, 2Department of radiotherapy-Azienda ospedaliera S. Andrea-University La sapienza, Rome, Italy

Satheesh, K Ramalingam1, Muftah, A Manita2, Dorothee, P Auer1 ,2 1 Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK, 2Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, UK

PURPOSE Evaluation of T2*-weighted dynamic susceptibilityweighted contrast-enhanced (DSC) imaging, and the derived rCBV and Ktrans, in the differential diagnosis between recurrent GBM and early radiation necrosis (the so called pseudoprogression) in patient affected by glioblastoma multiforme treated with surgery followed by radiotherapy and temozolamide chemotherapy. METHODS AND MATERIALS A retrospective study was performed in 115 patients, affected by GBM, enrolled after surgery and radiotherapy associated to temozolamide. They all underwent DSC-MRI follow-up. In 24 of them, early follow-up MRI (within 4 months) revealed a new nodular area of contrast enhancement within the radiation field. The diagnosis of recurrence vs pseudoprogression was established with clinical-radiological follow-up or surgical resection. ROIs were drawn semiautomatically on the enhancing areas, avoiding cortical vessels; then they were copied on the CBV and K trans maps. The values obtained were normalized to the contralateral white matter. T test was used to compare the groups.

M R P E R F U S I O N D I F F E R E N T I AT E S NON-NEOPLASTIC BRAIN LESIONS FROM HIGH GRADE GLIOMAS

BACKGROUND AND AIM Non-neoplastic lesions can mimic high grade gliomas (HGG) on conventional imaging and may require further invasive investigation for diagnosis. Microvascular architecture of the high grade neoplastic lesion is different from that of nonneoplastic lesion. We aim to determine whether the relative cerebral blood volume (rCBVmax) derived from dynamic susceptibility contrast-enhanced MR imaging (DSC-MRI) can aid in the differentiation of non-neoplastic lesions from high grade cerebral gliomas. MATERIALS AND METHOD This retrospective study included 25 patients (M:F016 :9; mean age 49±16.5 years) with enhancing intra-axial lesions on conventional MRI (WHO grade III, n 07; WHO grade IV n08; inflammatory, n03; Abscess n02 and 5 lesions without histology, but long clinical and radiological follow up showing non-neoplastic behaviour). A 3D T2* gradient echo MR Perfusion was performed at 3 T (TR: 15 ms, TE: 24 ms) as part of clinical care. The maximum CBV from small tumour regions of interest was determined and normalized to white matter. Group means were compared, and receiver

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operating characteristic curve analysis was performed to assess the best diagnostic cut-off value. RESULTS The rCBVmax were significantly lower in non-neoplastic lesions compared to high-grade gliomas (3.53 ± 1.3 vs. 11.03±4.9, P<0.001). A tumour rCBVmax threshold value of 6.1 allowed prediction of HGG vs. non-neoplastic lesion with 87 % sensitivity, 100 % specificity and 92 % accuracy (P<0.001). CONCLUSION DSC-MR Perfusion imaging shows promise in differentiating non-neoplastic brain lesions from malignant high grade gliomas. P-23 COMPARATIVE STUDY OF PSEUDO-CONTINUOUS ARTERIAL SPIN LABELING AND DYNAMIC SUSCEPTIBILITY CONTRAST IMAGING AT 3.0 TESLA IN DIAGNOSIS AND FOLLOW UP OF BRAIN TUMOURS Pierre Reginster1, Michel Vandevelde1, Vincent Denolin2, Bénédicte Martin1 1 CHC Department of Radiology, Liege, Belgium, 2Philips Medical Systems, Belgium, Belgium PURPOSE To evaluate the efficiency of pseudo-continuous arterial spin labeling (pCASL) compared with dynamic susceptibility contrast imaging (DSC) at 3.0 Tesla in diagnosis and follow up of brain tumours. MATERIAL AND METHODS We reviewed 38 exams of 28 patients with contrast enhancing brain tumours from February 2011 to February 2012, performed at 3.0 Tesla using pCASL and DSC (Philips Achieva). A visual qualitative evaluation of signal enhancement and of the degree of susceptibility artefacts in the tumours were each scored from 0 to 2. A quantitative analysis was performed with tumour blood flow values: mean value for region of interest (ROI) in an area with maximum signal enhancement / mean value for ROI in thalamus. RESULTS Visual scores: - Enhancement scores: significant correlation between ASL and DSC, Spearman correlation coefficient 0.69, p<0.00001 -Severity of susceptibility artefacts: the artefact scores are significantly lower with ASL than with

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DSC: p < 0.001, Wilcoxon signed rank test for paired samples. Quantitative measures: We observe a significant correlation between ASL and DSC signal ratios with an average deviation from 29.2 % in favour of DSC ratios: Spearman correlation coefficient 0.61, p<0.0001 CONCLUSION pCASL may be a good alternative to DSC and presents two advantages : -Absence of injection of a contrast agent, which allows to increase the frequency of controls in patients with renal failure. -Reduction of susceptibility artefacts, contributing to better study of some tumours near the skull base. P-24 PLANAR VERSES VOLUMETRIC ANALYSIS OF MENINGIOMAS - A PILOT STUDY Benjamin Salt, Mufudzi Maviki, Thomas Wilhelm Royal Free Hospital, London, UK INTRODUCTION Meningiomas represent the most common primary brain tumour, are usually benign in nature and management relies upon serial MRI imaging to assess growth rate and location in order to decide whether surgical intervention is appropriate. METHODS In this pilot study we looked at 3 patients with meningiomas who had yearly followup MRIs over at least 3 years. Subsequently all patients developed symptoms & had their tumours resected. Our aim was to assess the volumes of the tumours on serial scans to see whether volumetric analysis provides a more accurate picture of tumour growth. Tumour volumes were calculated using QBrain® software from T1 gadolinium enhanced MRI sequences. The results were then compared with the original radiology reports. RESULTS The three patients assessed all had tumours reported as stable when assessed using conventional planar imaging, and indeed comparing scans and axial measurements of the tumours demonstrated only very minor increases in the size of the tumour (max 1 mm increase). However, the volume of the tumours were seen to increase remarkably, in one case the volume doubling between subsequent scans.

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CONCLUSION This small scale pilot has shown how deceiving conventional planar imaging can be in assessing tumour size and growth over time when compared to volumetric analysis. The clinical significance for patients whose disease has previously been reported as ‘stable' is great. Further investigation & comparison between the two analysis techniques is warranted. P-25

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RESULTS AND DISSCUSION Gliomatosis cerebri showed significantly higher (p<0.05) FA compared to anaplastic astrocytoma and glioblastoma multiforme which may be explained by sparing of structure of nerve tracts. The retained values of NAA/Cr ratio in gliomatosis cerebri and higher mIno/Cr (p<0.02) levels compared to high grade astrocytoma support this assumption. CONCLUSION DTI and MRS can be useful in differentiation of gliomatosis cerebri from other high grade astroctytoma.

Abstract Withdrawn P-27 P-26 ROLE OF DIFFUSION TENSOR IMAGING AND MAGNETIC RESONANCE SPECTROSCOPY IN DIFFERENTIATION OF GLIOMATOSIS CEREBRI FROM OTHER ASTROCYTOMA Tatjana Stosic-Opincal1 ,2, Slobodan Lavrnic1, Brankica Vasic1, Danica Grujicic1 ,2, Marko Dakovic1 ,3 1 Clinical Center of Serbia, Belgrade, Serbia, 2Medical Faculty University of Belgrade, Belgrade, Serbia, 3Faculty of Physical Chemistry University of Belgrade, Belgrade, Serbia INTRODUCTION Gliomatosis cerebri is rare condition characterized by diffuse infiltration of the brain with neoplastic glial cells that affect various areas of the cerebral lobes. Its appearance on conventional MRI is similar to anaplastic astrocytoma and/or glioblastoma multiforme. The aim of this study is to evaluate the role of DTI and MRS in differentiation from other astrocytoma. PATIENTS AND METHODS This retrospective study included nine patients with gliomatosis cerebri, 6 patients with anaplastic astrocytoma and 14 patients with glioblastoma multiforme. After conventional MRI (T1, T2 and FLAIR sequences), DTI was performed using 20 directions and b-values 0 and 1000·s/mm2 and maps of mean diffusivity and fraction anisotropy (FA) were calculated. Chemical shift imaging was performed using TR 01500 ms and TE 030 ms; spectroscopic matrix was chosen to encompass regions of hyperintesities on T2W images and areas of lower mean diffusivities. Metabolite maps choline/creatine, myoinositol/creatine and N-acetyl aspartate/creatine maps were calculated. Single voxel spectroscopy with TE0 30 ms was performed by voxel postioning in regions which were characterized by high Cho/Cr and Myo/Cr levels on CSI. One-way ANOVA was used in analysis of obtained data.

IMAGING OF WHITE MATTER INFILTRATION END HETEROGENEOUS HISTOPATHOLOGY IN CEREBRAL GLIOMAS - DO [11 C]-METHIONINE POSITRON EMISSION TOMOGRAPHY (PET) AND PERFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING (MRI) YIELD SIMILAR RESULTS? Anna Tietze 1 ,2, Kim Mouridsen 1, Suzan Dyve 5, Leif Østergaard1 ,2, Per Borghammer3 ,4 1 Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark, 2Dept. of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark, 3Dept. of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark, 4PET Center, Aarhus University Hospital, Aarhus, Denmark, 5Dept. of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark Conventional Magnetic Resonance Imaging (MRI) is the cornerstone of cerebral glioma evaluation describing size, localization and morphological characteristics. However, the diffuse and infiltrative glioma growth remains undetected with this technique. As the treatment of gliomas is a subtle balance between the widest possible resection and preservation of brain function, exact tumour delineation is of crucial importance. Various physiology-based MRI and Positron Emission Tomography (PET) techniques have been implemented with substantial improvement in diagnostics and tumour evaluation. [11 C]-methionine PET, an indirect marker for protein synthesis, has shown to detect tumour extent and heterogeneity at high sensitivity and specificity. Another more prevalent technique is perfusion-weighted MRI, thought to estimate tumour angiogenesis and capillary permeability, both a measure for malignancy. As [11 C]-methionine PET is an expensive and time-consuming technique the objective of our study is to compare this method with perfusion-weighted MRI and conventional MRI. We present preliminary results in four patients with cerebral gliomas with respect to extent of white matter infiltration and tumour heterogeneity.

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PROGNOSTIC VALUE OF CONSECUTIVE MRI DSC-T2* CEREBRAL PERFUSION STUDIES OBTAINED AFTER CHEMO & RADIOTHERAPY FINALIZATION IN GBM (GLIOBLASTOMA MULTIFORME) PATIENTS

DECREASED INCIDENCE OF THE MEASURABLE ENHANCING LESION AFTER CHEMORADIATION THERAPY WITH TEMOZOLOMIDE IN GLIOBLASTOMA PATIENTS RECEIVING 5-AMINOLEVULINIC ACID-ASSISTED TUMORECTOMY

Jorge A. Villanua1, Esther Fernandez1, Jose A. Larrea2 ,1, Edurne Pardo2 ,1, Cristina Sarasqueta2, Garbiñe Liceaga2, Cristina Caballero2, Miguel Urtasun2, Ander Matheu2 1 Osatek. Unidad Donostia, Donostia-San Sebastian, Spain, 2 Neuroradiology section, Epidemiology, Hospital Pharmacy, Pathology, Neurology services and Neuro-oncology BioDonostia Reserch Institute. Radiology depatment. Donostia Hospital, Donostia-San Sebastian, Spain OBJECTIVES To determine the prognostic value in GBM patients of consecutive MRI DSC-T2* cerebral perfusion studies obtained immediately after the end of Chemo & Radiotherapyn (QT&RT) and at a follow up study three months later. METHODS We performed a retrospective study of 76 patients diagnosed by surgical intervention of GBM between March 2007 and November 2011. 38 out of 76 patients completed Chemo & Radiotherapy. In 35 out of 38 subjects consecutive MRI DSC-T2* cerebral perfusion studies were obtained immediately after the end of QT&RT and at a follow up three months later. We analyzed the Kaplan-Meier survival test for maximum rCBV values obtained immediately after the end of Chemo & Radiotherapy (QT&RT) and at a follow up study three months later. RESULTS The median survival rate for the 35 subjects with two consecutive MRI DSC-T2* cerebral perfusion studies was 14,9 months(m) (4-40) interval confidence (IC) 95 %. Kaplan-Meier test for rCBV<2,7 vs rCBV>2,7 immediately after the end of QT&RT was median 16,9 m (16,3-17,5) IC 95 % vs median 14,9 m (14,6-15,1) IC al 95 % with p(Log Rank)00,3. From the other hand KaplanMeier test for rCBV<2,7 vs rCBV>2,7 at a follow up study three months later shows a median 18,9 m (15,722,1) IC 95 % vs median 14,9 m (13,9-15,9) IC 95 % with p(Log Rank)00,003. CONCLUSION Consecutive MRI DSC-T2* studies obtained 3 months after QT&RT finalization in GBM patients appears to correlate with overall survival.

Jeong A Yeom, Seung Hong Choi, Hwa Seon Shin, Soo Chin Kim, Seung Chai Jung, Inseon Ryoo Seoul National University hospital, Seoul, Republic of Korea PURPOSE The purpose of our study was to evaluate the incidence of measurable enhancing lesions, suggestive of pseudoprogression or true-progression after 5-aminolevulinic acid(ALA)assisted tumorectomy, which was compared with that after conventional surgery followed by chemoradiation(CCRT) therapy with temozolomide(TMZ) in glioblastoma patients. MATERIALS AND METHODS A total number of 95 patients who received brain tumor surgery for glioblastoma and CCRT with TMZ between July 2000 and January 2012 were included for study(mean age 52.1 years; male057,female038). In all patients, conventional magnetic resonance imaging(MRI) was performed after surgery and after CCRT with TMZ. We reviewed the MR images, and confirmed whether measurable enhancing lesions were demonstrable on post-CCRT MRI. In the patients with measurable enhancing lesion, pseudoprogression or trueprogression was determined by follow-up images or pathology. For the statistical analysis, we used Fisher's exact test. RESULTS Eight of 31 patients who underwent 5-ALA-assisted tumorectomy showed measurable enhancing lesions on postCCRT MRI, while in 35 of 64 patients treated with conventional surgery, we found measurable enhancing lesions on post-CCRT MRI, which resulted in significant difference (P0.009). Among the measurable enhancing lesions, pseudoprogression was determined in three of eight patients with 5-ALA-assisted tumorectomy and in 12 of 35 patients treated with conventional surgery(P01.00). CONCLUSION We found that the patients receiving 5-ALA-assisted tumorectomy showed lower incidence of the measurable enhancing lesion after CCRT with TMZ than those with conventional tumorectomy, and the incidence of pseudoprogression was not significantly different between two groups. Thus, we believe that 5-ALA-assisted operation enabled more resection of high grade foci than conventional tumorectomy in glioblastoma.

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THEME: DEMENTIA

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findings of hippocampal asymmetry which is neither age nor gender dependent.

P-30 P-31 HIPPOCAMPAL VOLUME AND ASYMMETRY: AN ANALYSIS OF 3 TESLA DATA FROM HEALTHY ADULTS Hamza Alshuft, Dorothee Auer, Robert Dineen University of Nottingham, Nottingham, UK INTRODUCTION Hippocampal volume change has been a research target for studies concerned with imaging biomarkers for neurological and neuropsychiatric diseases. Previous studies providing normative data are limited by low magnetic field strength, image resolution and slice thickness. We conduct a high resolution, high field strength volumetric study to characterise normal hippocampal volume and asymmetry in healthy adults. MATERIALS AND METHODS 53 healthy participants (age 18-65 years, 32 male) undergoing high-resolution structural brain MRI scanning at 3-Tesla (3D-MPRAGE, 1 mm3 voxels) participating in Research Ethic Committee approved studies. 3D-Slicer software (www.slicer.org) was used for manual volumetric measurements using a tightly defined protocol. To reduce observer bias, images were duplicated and flipped so that all hippocampi were outlined on the left side of the image, and the observer blinded to image laterality. High intra- and inter-rater reliability (92 % and 80 % respectively) was achieved. Hippocampal volume was normalized to intracranial volume to correct for differences in head size, and an asymmetry index was calculated. RESULTS Normalized volumes were significantly (p00.027) larger on the right (mean 2.51 ml, sd 0.27, range 1.92-3.22 ml) than left (mean 2.45 ml, sd 0.28, range 1.96-3.08 ml). Hippocampal volume decreased with increasing age (right 0.0137 ml/year, p0.016; left -0.0130 ml/year, p 0.019). Gender had no effect on hippocampal volume (p>0.3). The mean asymmetry index was 0.012 (sd 0.04) and was unrelated to age or gender. CONCLUSION We provide up-to-date hippocampal volumetrics using high resolution / high field strength data. We confirm previous

VOXEL-BASED MORPHOMETRY AND DIFFUSION TENSOR IMAGING IN ASSESSMENT OF DEMENTIA IN PARKINSON DISEASE Aleksandr Efimtsev, Vladimir Fokin, Andrei Sokolov, Artem Trufanov, Dmitry Khaimov, Igor Litvinenko Military Medical Academy, Saint Petersburg, Russia INTRODUCTION The purpose of this study was to find out if a microstructural damage to cerebral white matter correlates with grey matter volume changes and cognitive symptoms in idiopathic Parkinson disease (PD). METHODS 36 patients with de novo PD were examined (Hoehn and Yahr stages I, III; two age subgroups, 41 to 60 (A) and 63 to 80 (B) years old; with and without cognitive impairments). T1- weighted images (gradient echo, voxel 1 mm3), diffusion tensor images (DTI) were obtained. Total brain, grey matter (GM), white matter (WM) volumes were defined from T1-WI, fractional anisotropy (FA) meanings were calculated using FSL. RESULTS Patients of A age subgroup did not show any significant difference with controls, despite that duration of illness was twice longer than in patients 63 to 80 years. Subgroup B had shown decreased volume in medium temporal gyrus, fronto-temporal area, pons. Putamen, thalamus, caudate nucleus, amygdala volumes did not demonstrate difference with controls. FA, measured in all patients was unaltered in the midbrain, lowered in the corticospinal tract, in splenium of corpus callosum, front lobes, centrum semiovale, pons (in projection of substantia nigra). There were lower FA meanings in corpus callosum and internal capsule in patients with cognitive impairments and III Hoehn and Yahr stage, not depending on age or duration of illness. CONCLUSIONS Correlation of FA decrease and worse cognitive state in patients of any age, without brain structure volume changes can be a proved that widespread neurodegeneration is already present at the time of clinical onset.

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P-32 DTI FINDINGS IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS Eftychia Kapsalaki, Ioannis Siasios, Ioannis Tsougos, Efthymios Dardiotis, George hatzigeorgiou, Kostas Fountas University of Thessaly, Larissa, Greece PURPOSE Idiopathic Normal pressure hydrocephalus (iNPH) constitutes a treatable cause of dementia. However, its accurate diagnosis remains puzzling. The purpose of our study is to apply Diffusion Tensor Imaging (DTI) in order to differentiate iNPH from other white matter pathology. MATERIAL AND METHODS Twenty patients aged 50-80 yo (mean 67) with a dilated ventricular system (Evans index>3) and 20 normal agedmatched volunteers underwent a brain MRI on a 3Tesla MRI scanner. Axial T2, FLAIR, T2*, DWI and DTI (32directions) were obtained. Mean diffusivity (MD) and Fractional Anisotropy (FA) were measured at the corpus callosum, and the periventricular white matter (PVWM). Twelve patients had clinical symptoms compatible with iNPH. A CSF tap test was performed on all these patients. RESULTS Compared to normal volunteers, all patients with dilated ventricular system showed an overall increased MD in the PVWM. Patients with clinically proven iNPH showed increased MD in the PVWM, and the CC. Regarding FA, in the 12 patients with clinical iNPH, 9 showed normal FA in the PVWM, and 3 showed decreased FA in the PVWM and the CC. The CSF tap test showed improvement of the symptoms in all but the 3 patients with decreased FA. Interestingly, in 3 patients without clinical iNPH, FA was also decreased in the PVWM but not at the CC. CONCLUSIONS MD may be increased in iNPH as well as in other pathologies. However, reduction of FA is associated with more permanent changes, suggesting irreversible damage in patients with iNPH.

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PURPOSE We investigated the diagnostic value of standard conventional MRI sequences and diffusion tensor imaging (DTI) at 3 Tesla for the differentiation of Parkinson disease (PD) and multiple system atrophy (MSA). METHODOLOGY Brain MRI (T1-weighted, T2-weighted, gradient echo and DTI) was performed on 64 patients (26 PD, 15 MSA, 23 age and sex matched healthy controls). Region of interests were the substantia nigra (SN), pons, putamen, middle cerebellar peduncles (MCP) and cerebellum. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) scores were obtained on DTI using Functool software. Morphology (susceptibility artifact) and volumetry (area, volume and width) were measured on standard imaging. RESULTS Compared to PD and controls, MSA showed significantly lower volume in the pons (8.5±3.0 cm³ vs 11.7±1.5 cm³ and 11.4±1.2 cm³), putamen (2.6±0.7 cm³ vs 3.3±0.8 cm³ and 3.5±0.7 cm³), cerebellum (96.3±14.7 cm³ vs 118.0± 14.8 cm³ and 118.5±10.4 cm³) on 3D imaging and significantly lower MCP width (12.0±3.8 mm vs 16.1±0.7 mm and 16.3±1.0 mm) and pontine diameter (18.8±3.7 mm vs 21.9± 1.5 mm and 22.0±1.1 mm) on 2D imaging. Comparison of MSA with PD and controls showed generally lower FA values with significance in the MCP (0.53 ± 0.13 vs 0.62±0.09 and 0.61±0.06) and cerebellum (0.34±0.10 vs 0.42±0.09 and 0.44±0.06) and higher ADC values with significance only in the MCP (8.92±1.30 vs 8.10±1.11 and 7.70±0.72). CONCLUSION We were able to distinguish MSA patients from PD through the higher volume loss within the pons, putamen, cerebellum and MCP. Greater disorder and atrophy of the fiber tracts were likely to be present in MSA with evidence of lower FA and higher MD trend especially in the olivopontocerebellar region. P-34 HOT CROSS BUN SIGN IS USEFUL TO DIFFERENTIATE PARKINSON DISEASE FROM MULTIPLE SYSTEM ATROPHY

P-33 DIFFERENTIATING PARKINSON DISEASE AND MULTIPLE SYSTEM ATROPHY (MSA) WITH 3 T MRI

Shalini Rajandran Nair, Norlisah Ramli, Kartini Rahmat, Hazman Mohd-Nor, Li-Kuo Tan, Shen-Yang Lim, Mohammad Nazri Md Shah University Malaya, Kuala Lumpur, Malaysia

Shalini Rajandran Nair, Norlisah Ramli, Kartini Rahmat, Hazman Mohd-Nor, Li-Kuo Tan, Shen-Yang Lim University Malaya, Kuala Lumpur, Malaysia

BACKGROUND AND PURPOSE Differentiating Parkinson disease (PD) and multiple system atrophy (MSA) remains a clinical challenge. The ‘hot cross

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bun’ and dorsolateral putaminal hyperintense signs detected on MRI are recognised features of MSA. Previous studies have found MRI of lower than 3 T to have low sensitivity and specificity in detecting these signs. The aim of this study is to revisit the ‘hot cross bun’ and dorsolateral putaminal hyperintense signs in 3 T for distinguishing MSA and PD. MATERIALS & METHODS We performed MRI brain (T1-weighted, T2-weighted and gradient echo) at 3.0 Tesla on 64 patients (24 PD, 14 MSA and 26 age-matched healthy controls). Parameter measured on the gradient echo was susceptibility artifact indicating iron deposition in the substantia nigra, putamen and pons. T2-weighted images were used to detect the presence of ‘hot cross bun’ and dorsolateral putaminal hyperintense signs. The results were compared between the three groups. RESULTS The ‘hot cross bun’ sign was not present in PD and normal subjects. This sign had a low sensitivity of 35.7 % and high specificity of 100 % (PPV01, NPV00.85) in MSA. The dorsolateral putaminal hyperintense sign was detected in two normal subjects and MSA with sensitivity of 57.1 % and specificity of 96 % (PPV00.8, NPV00.89 %) for MSA. Susceptibility artifact was only significantly higher in the putamen in MSA compared to PD (64.3 % vs 30.8 %, p0 0.042). CONCLUSION The ‘hot cross bun’ and the dorsolateral putaminal hyperintense signs had high specificity for MSA and can be an imaging feature in distinguishing MSA and PD. P-35 DTI IMAGING AND TBSS OF WHITE MATTER CHANGES IN NORMAL PRESSURE HYDROCEPHALUS COMPARED WITH ALZHEIMER DISEASE PATIENTS Jirí Vrána1, Daniel Horínek2, Irena Buksakowska1, Milan Mohapl2, Pavel Rejchrt1, Tomáš Belšan1 1 Radiology Department, Military University Hospital, Prague, Czech Republic, 2Neurosurgery Department, Military University Hospital, Prague, Czech Republic PURPOSE Normal pressure hydrocephalus (NPH) is an idiopathic treatable cause of cognitive derangement in the elderly. Reliable noninvasive markers of the disease are still in need. Major hypothesis for gait and cognitive impairment in NPH is the affection of periventricular white matter. METHODS In this study 17 patients were investigated for confirmed NPH (confirmed by lumbar infusion/drainage tests). All

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patients were finally treated by shunting. The patients underwent MRI examination including T2W, T1W and DTI sequence of the whole brain in axial sections (EPI, TR/TE 012,000/89.4 ms, 30 slices 2,4 mm thick, 128x128 matrix, FOV 24x24 cm2; 30 noncollinear gradient directions, b value 1000 s/mm2, 5 b0 images). 17 age matched Alzheimer disease patients with marked brain atrophy and ventricular dilation, without clinical signs of NPH were examined with the same technique. Tract based spatial statistics (TBSS) as implemented in the FSL software package was used to evaluate the group differences in fractional anisotropy (FA) and mean diffusivity (MD). RESULTS FA was significantly higher in the NPH group in posterior limb of capsula interna. Reduced FA was found acros corpus callosum and in optic radiation. MD was not changed in these regions. CONCLUSION The DTI measurements reveal specific white matter structural impairment in patients with normal pressure hydrocephalus. The method shows promising as a possible non invasive diagnostic marker. Suppported by grant GACR P304/10/P464. THEME: HOT TOPICS P-36 MRI-GUIDED DEEP BRAIN STIMULATION OF THE SUBTHALAMIC NUCLEUS: CORRELATION OF POSTOPERATIVE 1.5 T MRI WITH POST MORTEM 9.4 T MRI AND HISTOPATHOLOGY Othman Al Helli, Luke Massey, David Thomas, Marwan Hariz, Thomas Foltynie, Janice Hoton, Tarek Yousry, Ludvic Zrinzo University College London, London, UK Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established procedure for patients with advanced idiopathic Parkinson’s disease (PD). Anatomical location of active stimulation contacts is most accurately determined with postoperative stereotactic MRI., Postmortem examination of the brain provides additional details. This report uses 9.4 T MRI and histopathology to documents electrode location in a single patient who had received bilateral MRI-guided STN DBS. A 67-year-old patient with idiopathic PD underwent surgery for DBS of the STN using a MRI-guided targeting and macro-electrode stimulation. Postoperatively, the patient experienced transient agitation and increased dyskinesia lasting for a few hours. Postoperative MRI documented lead location within the subthalamic nuclei

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and high signal consistent with oedema along the length of the DBS leads. Chronic stimulation provided moderate improvement in both motor and quality of life scores. After death at age 74, the brain was examined with MRI at 9.4 T, followed by gross and microscopic histological analysis. On the right the lead trajectory was seen to traverse the centre of the STN; on the left it traversed the medial part of this nucleus. Both electrode tracks were surrounded by a small amount of collagen, gliosis and a mild chronic inflammatory infiltrate that may represent the long term histological correlate of the perioperative MRI changes. Our findings demonstrate that lead artefact location on postoperative 1.5 T MRI corresponds well with anatomical location as determined on subsequent 9.4 T MRI and histological examination.

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showed cortical restriction or basal ganglia ischemia. Susceptibility Weighted Imaging was helpful in identifying subtle hemorrhagic lesions. Angiography illustrated vascular irregularity and or beaded appearance of vessels with resolution of vascular and cortical findings within few months on follow up imaging. The angiographic appearance of RCVS may mimic primary cerebral angiitis or vasculitis which poses a diagnostic dilemma. CONCLUSION Imaging presentation of RCVS can be varied, ranging from ischemic to hemorrhagic lesions. Appropriate history, clinical presentation along with imaging findings is useful in differentiating it from CNS vasculitis. This is vital as it directly influences patient management. P-38

P-37 REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME: NEUROIMAGING FINDINGS AND DIAGNOSTIC CHALLENGE Maud Cazot1, Sandeep Bhuta1 ,2 1 Dept of Medical Imaging, Gold Coast Hospital, 108 Nerang Street Southport, Gold Coast, QLD, 4215, Australia, 2Griffith University, School of Medicine Southport, Gold Coast, QLD, 4215, Australia PURPOSE RCVS is a relatively newly described group of vasoconstrictive syndromes which is often underdiagnosed. High degree of clinical suspicion & multimodality imaging may aid in early diagnosis. It is a devastating syndrome with complications like ischemic or haemorrhagic stroke. Aim of the presentation is to highlight imaging findings and role of clinico-radiological correlation in establishing a final diagnosis of RCVS. This entity remains a diagnostic challenge and is not well described in Radiology literature. MATERIALS AND METHODS Retrospective one year review of cases referred from Neurology was performed. 8 cases with diagnosis of RCVS were identified. All patients underwent a baseline CT/CTA (SIEMENS SOMATOM AS PLUS),MRI/MRA on 1.5 T and or 3.0 T MR (SIEMENS MAGNETOM SYMPHONY AND SKYRA).Most cases had a history of headache and drug abuse. RESULTS Subarachnoid or intraparenchymal haemorrhage was identified on baseline CT whereas cortical ischaemia was better seen on MRI. Diffusion weighted and FLAIR sequences

FUNCTIONAL BRAIN MAPPING OF THE LANGUAGE AREA DURING WORD GENERATION TASK. Gyung Ho Chung, Seung Bae Hwang, Gong Yong Jin, Young Min Han, Sang Yong Lee Chonbuk National University Medical School, Jeonju, Jeonbuk, Republic of Korea PURPOSE The purpose of this study was to assess the spatial brain mapping of Broca's and supplementary motor area (SMA) activation during word generation task using functional magnetic resonance imaging (fMRI). MATERIALS AND METHODS Eleven healthy right-handed and eleven healthy left-handed volunteers were imaged on a Siemens 3.0 T scanner. Whole brain functional maps were acquired using EPI sequences in the axial plane. Each paradigm consisted of five epochs of activation vs. control condition. The activation tasks consisted of word generation. The reference function was boxcar waveform. Activation maps were thresholded at p00.001. The thresholded activation maps were placed into MNI space and the anatomic localization and volume of activation within the broca's area and the SMA were analyzed. RESULTS Broca's area and SMA activation were observed in all volunteers during the word generation task. We observed left Broca's and left SMA activation in eleven subjects in right handed volunteers. And Broca's and SMA activation on the right side in three subjects, both sides in two subjects, left sides in six subjects in left handed volunteers during the word generation task. There was correlation between the activated volume of Broca's area and the SMA.

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CONCLUSION Broca's area and SMA were activated during the word generation task. Broca's area and SMA activation were observed predominantly on the left side regardless of one's dominant hand.

of emotional processes in PTSD. It results in hyperactivation of subcortical areas such as the insula, that would underlie emotional,social and relational difficulties in PTSD.

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DIFFUSION TENSOR TRACTOGRAPHY AND MAGNETIZATION TRANSFER RATIO DIFFERENTIATES SUBTYPES OF TEMPORAL LOBE EPILEPSY

REGIONAL CEREBRAL CHANGES AND FUNCTIONAL CONNECTIVITY DURING THE OBSERVATION OF NEGATIVE EMOTIONAL STIMULI IN SUBJECTS WITH POST-TRAUMATIC STRESS DISORDER SURVIVED THE EARTHQUAKE ON 6, APRIL 2009 IN L’AQUILA Alessia Catalucci1, Monica Mazza1 ,2, Monica Anselmi1, Valentina Felli1, Maria Chiara Pino1 ,2, Michele Ferrara1 ,2, Massimo Gallucci1 1 Department of Neuroradiology, “San Salvatore” Hospital/ University of L'Aquila, L'Aquila, Abruzzo, Italy, 2Department of Health Sciences, University of L’Aquila, L'Aquila, Abruzzo, Italy INTRODUCTION PTSD patients exhibit exaggerated brain responses to emotionally negative stimuli, normally activating limbic system. Identifying the neural correlates of emotion regulation in PTSD is important to elucidate the neural circuitry involved in emotional dysfunction. Purpose: to investigate functional connectivity between the areas activated during emotional processing of negative stimuli in PTSD compared to healthy subjects. MATERIALS AND METHOD Ten PTSD subjects (survived the earthquake on April6,2009 in L’Aquila) (DSM-IV-R,APA2000) and ten healthy controls underwent fMRI (GE,1.5 T), during observation of 40 negative emotional stimuli and 40 scrambled neutral stimuli. Statistical data analysis were performed using Brain Voyager QX4.6. RESULTS A higher activation was found in the left posterior (LP) insula for PTSD group, and in the ventromedial prefrontal cortex (vmPFC) for the healthy group.Two sets of Granger causality modeling (GCM) analyses were performed, to examine the directed influences to other brain regions from LP-insula and vmPFC.Activity in the vmPFC in the healthy group while observing negative emotional stimuli predicted activity in several subcortical regions and insula. CONCLUSION The activation of the fronto-limbic network in healthy but not in PTSD subjects suggests a lack of mediation/cortical control

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Siew-Min Gan1 ,2, Guoqi Qian1, Udaya Seneviratne3, Mark Cook1 ,2 1 The University of Melbourne, Melbourne, Australia, 2 St Vincent's Hospital, Melbourne, Melbourne, Australia, 3 Monash Medical Centre, Melbourne, Australia White matter Diffusion Tensor Imaging (DTI) changes in the Fornix and Cingulum were consistently reported in Temporal lobe Epilepsy (TLE). Magnetization Transfer Imaging provides indication of myelin changes. This study investigates 1) if DTI and MTR changes in the Fornix, Cingulum and temporal lobe white matter ROIs can differentiate TLE with Hippocampal Sclerosis (HS + veTLE) and without (HSveTLE), and 2) If the DTI and MTR measurments are associated and may reflect myelin changes in subtypes of TLE. METHODS 8 unilateral HS+veTLE, 12 HS-veTLE and 15 control are recruited. Atlas Based Analysis was performed registering the white matter tracts and temporal lobe Region-Of-Interests to subjects native DTI and MTI space. Hippocampal volumetricROIs were manually delineated on T1-images. Volume, FA, ADC, Parallel (λ||), Perpendicular Diffusivity (λ⊥) and MTR were calculated on ipsilateral and contralateral ROIs and their assymetry index. MANOVAs followed by ANOVAs and between group contrasts tests were computed. Correlations between DTI and MTR measurements were analyzed. RESULTS At p<0.05, both TLE subgroups have decreased FA, increased ADC, λ||, λ⊥ and MTR in the ipsilateral fornix compared to controls. HS-veTLE have decreased temporal-Cingulum λ|| index compared to HS+veTLE and controls. HS-veTLE showed decreased Ipsilateral MTR in Entorhinal-cortex white matter (ErC)compared to controls, and decreased Ipsilateral FA compared to HS+veTLE. Ipsilateral Fornix MTR correlates negatively with Ipsilateral ADC, λ||, λ⊥ in TLE subgroups. Fornix and ErC Ipsilateral MTR correlates positively with FA in HS-veTLE. The results suggest white matter myelin changes. MTR with Diffusion Tensor Tractography may be used to differentiate TLE subtypes.

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P-41 THE MANY FACES OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES); IMAGING FINDINGS AND CLINICAL CORRELATES Mufudzi Maviki, Benjamin Salt, Bernadine Murtagh, Anastastassia Gontsarova, Lorna Woodbridge, Farrah Jabeen, Peter Cowley Royal Free London NHS Foundation Trust, London, UK Posterior reversible encephalopathy syndrome is a diagnostic enigma whose list of causes and associations continues to expand. While commonly associated with uncontrolled hypertension, traditionally in the context of pregnancy (eclampsia and pre-eclampsia), several other conditions have been described including severe sepsis, transplantation, immune modulating drugs and autoimmune disease. The diagnostic algorithm invokes the use of multimodality cranial imaging, and findings are best demonstrated on FLAIR, DWI and ADC sequences. Imaging features are mainly those of cerebral oedema resulting from neurotoxicity. In this review imaging manifestations are discussed, with emphasis on the typical and atypical geographical distributions as well as disease evolution on subsequent imaging. Emphasis on both clinical and radiological input to the diagnosis is made, and early treatment of the underlying cause or removal of the offending agent invariably results in disease remission.

consider resting state as a stationary, yet the transient behavior of the DMN and its sub-networks is still largely unexplored. METHODS Here we consider data from six healthy subjects who performed a cognitively demanding real-time fMRI neurofeedback task that targeted down-regulation of the primary auditory cortex. In a block-design experiment, periods of down-regulation where interleaved with rest. For each subject, we acquired 4 runs per day during 4 days, resulting in 16 runs. The analysis included data-driven independent component analysis (ICA) and high-resolution latency estimation between the four components that corresponded to sub-networks of the DMN. RESULTS The different sub-networks of the DMN recovered with a time lag of 7.34 sec between them; i.e., the sub-network’s recovery first shifts from anterior to posterior, and then gradually focuses on the ventral part of the posterior cingulate cortex, which is known to be implicated in internally directed cognition. In addition, we found positive correlation between activity in the early anterior sub-network and regulation strength, but negative correlation for the late subnetwork that encompassed the ventral PCC. CONCLUSIONS This finding confirms that the level of task engagement correlates positively with activity in subsequent rest in regions related to attention, but negatively with activity in those related to internally directed cognition. P-43

P-42 DYNAMICS OF THE DEFAULT-MODE MODE NETWORK: RECOVERY OF SUB-NETWORKS FOLLOWING NEUROFEEDBACK TRAINING

DYNAMIC RECONFIGURATION OF HUMAN BRAIN FUNCTIONAL NETWORKS THROUGH NEUROFEEDBACK

Sven Haller , Permi Jhooti , Tanja Haas , Rotem Kopel , Karl-Olof Lovblad1, Klaus Scheffler4, Dimitri Van de Ville2 1 Neuroradiology DISIM, Geneva, Switzerland, 2Institute of Radiology, Basel, Switzerland, 3Department of Radiology and Medical Informatics, Geneva, Switzerland, 4 Max Planck Institute for Biological Cybernetics, Department of Neuroimaging, Center for Integrative Neuroscience, CIN, Tübingen, Germany

Sven Haller1, Permi Jhooti2, Tanja Haas2, Rotem Kopel3, Frank Scharnowski3, Karl-Olof Lovblad1, Klaus Scheffler4, Dimitri Van de Ville3 1 Neuroradiology DISIM, Geneva, Switzerland, 2Institute of Radiology, University Hospital Basel, Basel, Switzerland, 3 Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland, 4Max Planck Institute for Biological Cybernetics, Department of Neuroimaging, Center for Integrative Neuroscience, CIN, Tübingen, Germany

PURPOSE The default mode network (DMN) is a major large-scale cerebral network that can be identified with functional magnetic resonance imaging (fMRI) during resting state. Most studies

PURPOSE Recent fMRI studies demonstrate that functional connectivity is altered in certain neurological disorders and change as a function of learning.

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METHODS In order to directly probe the dynamic reconfiguration of brain networks through learning, we taught participants to voluntarily control activity in the auditory cortex using realtime fMRI-based neurofeedback. RESULTS Applying data-driven techniques, we found that neurofeedback learning reconfigures the functional interactions between the auditory target area with the auditory pathway, visual areas related to visual feedback processing, working memory areas related to cognitive effort, and reward areas related to reinforcement learning. Interestingly, the auditory target region for neurofeedback was identified as the hub of the reconfigured functional networks even though this was not specified a priori. When participants performed learned self-regulation in the absence of neurofeedback, connectivity with visual, working memory, and reward-related areas were no longer modified. This is consistent with the absence of the visual feedback and thus learning. CONCLUSIONS Our results reveal that neurofeedback learning is mediated by widespread changes in functional connectivity. In contrast, applying learned self-regulation involves more limited and specific network changes. Hence, neurofeedback training might be used to promote recovery from neurological disorders that are linked to abnormal patterns of brain connectivity. P-44 COMPARISON OF IMAGE QUALITY IN HEAD CT STUDIES WITH DIFFERENT DOSE-REDUCTION STRATEGIES Jeppe Johansen1, Rikke Nielsen1, Vibeke Fink-Jensen1, Mette Hjørringgaard Madsen1, Anna Tietze1 ,2 1 Dept. of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark, 2Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark The number of multi-detector CT examinations is increasing rapidly. They allow high quality reformatted images providing accurate and precise diagnosis at maximum speed. Brain examinations are the most commonly requested studies, and although they come at a lower effective dose than body CT, can account to a considerable radiation dose as many patients undergo repeated studies. Therefore, various dose-reduction strategies are applied such as automated tube current and voltage modulation and recently different iterative reconstruction algorithms. However, the trade-off of all dose-reduction maneuvers is

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reduction of image quality due to image noise or artifacts. The aim of our study was therefore to find the best diagnostic images with lowest possible dose. We present results of dose- and image quality optimizing strategies of brain CT examinations at our institution. We compare sequential and helical head CT with different tube current and voltage settings including protocols with and without automated dose modulation and assess quality of noise reduction in conjunction with iterative reconstruction algorithms. P-45 CENTRAL NERVOUS SYSTEM TUBERCULOSIS: A SPECTRUM OF COMMON AND UNCOMMON IMAGING FINDINGS Ruchi Kabra, Alireza Zavareh, Rolf Jager The National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK AIM To illustrate the range of central nervous system (CNS) mycobacterium tuberculosis (TB) infection and present a pictorial review of CT and MR imaging manifestations. METHODS We reviewed the case histories and corresponding CT and MRI studies of a selection of patients with microbiologically proven tuberculosis performed in our institution. We demonstrate the spectrum of radiological findings in intracranial and spinal tuberculosis infection. We also discuss the important differential diagnoses and present their imaging findings. FINDINGS A collection of CT and gadolinium-enhanced and diffusionweighted MRI studies that demonstrate manifestations of intracranial TB including parenchymal macro- and microabscesses, leptomeningeal, basal cistern and nodular cortical enhancement are presented. Spinal involvement in the form of meningeal and intramedullary disease, as well as cauda equina nerve root enhancement is also illustrated. A number of complications of CNS TB infection such as hydrocephalus, haemorrhage and cerebral infarcts are exhibited, as well as post treatment imaging to assess response. In addition, the main differential diagnoses of neurosarcoidosis and metastatic disease are presented. CONCLUSION TB of the CNS principally affects the brain and meninges, but occasionally, it involves the spinal cord. We present a constellation of common and uncommon imaging findings in patients with CNS TB and the relevant differential diagnoses.

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P-46 A REVIEW OF THE INTRACRANIAL IMAGING FINDINGS ASSOCIATED WITH ALCOHOL ABUSE Edel Kelliher, Jane Cunningham, Sarah Power, Joanna Pearly-Ti, John Thornton, Paul Brennan, Seamus Looby Beaumont Hospital, Dublin 9, Ireland PURPOSE To demonstrate the intracranial imaging findings in alcohol abuse. MATERIALS AND METHODS A review of the literature was performed to verify the current intracranial imaging findings associated with alcohol abuse. RESULTS In a national study, one in four Irish emergency department attendances are alcohol related, of which 13 % of patients are alcohol dependent, nearly 50 % were between 1829 years. Alcohol related discharges increased by 92 % between 1995 and 2002, highlighting that alcohol abuse is a very real entity in the Irish health service. The gastrointestinal findings of alcohol abuse are well known, however, there are a number of CNS imaging findings also seen in alcohol abuse. The intracranial imaging findings in alcohol abuse can be divided into acute and chronic. The acute findings are often related to trauma and its sequela; contusions, extradural, subdural and traumatic subarachnoid haemorrhages. The more chronic findings include cerebellar volume loss, Wernicke’s encephalopathy, osmotic demyelination syndrome and Marchiafava-Bignami disease. CONCLUSION In view of the increasing nature of the problem, it is valuable to be aware of the intracranial imaging findings of alcohol abuse P-47 ADVANTAGES AND PITFALLS OF fMRI AND DTI FOR NEUROSURGICAL INTERVENTION PLANNING: INTRIGUING CASES FROM THE LAST 5 YEARS Lajos Rudolf Kozák1, Ádám Szabó1, Vivien Tóth1 ,2, Péter Barsi1, Márta Hegyi3, Anna Kelemen4, György Rásonyi4, Anna SzŰcs4, Attila Bagó4, Bognár László4, Loránd Erőss4, István Valálik5, Gábor Rudas1 1 MR Research Center, Semmelweis University, Budapest, Hungary, 2Abt. Neuroradiologie, Klinikum rechts der Isar, Technischen Universität München, München, Germany, 3 Dept. Neurology, Bethesda Children's Hospital of Hungarian Reformed Church, Budapest, Hungary, 4National Institute of Neurosciences, Budapest, Hungary, 5Dept. Neurosurgery, St. John Hospital, Budapest, Hungary

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Originally, the main goals of neurosurgical procedures were the curative resection of pathological tissues or the minimization of symptoms but nowadays maintaining the best possible quality of life became an equally desirable goal. Therefore, functional MRI (fMRI) and diffusion tensor imaging (DTI) gained importance in the neurosurgical work-up of brain tumor and epilepsy patients. These non-invasive imaging methods can help achieving the above-mentioned goals by delineating eloquent areas, i.e. brain regions that are vital for providing an acceptable quality of life, albeit not prone to compensatory reorganization. These areas include among others the primary motor, sensory and visual cortices, and the Broca and Wernicke regions for speech. Equally important is the mapping of the main neural fiber tracts, such as the corticospinal tract or the arcuate fasciculus. Our more than 250 presurgical imaging sessions included language mapping, senso-motory mapping, and other mapping tasks (in 51 %, 45 % and 20 % of the patients, respectively), depending on the location of the given target lesion. The target lesions were tumors, epileptogenic foci, and arteriovenous malformations (in 52 %, 36 % and 11 % of the cases, respectively). Here, we present some cases from this series of examinations that highlight the advantages of presurgical fMRI and DTI studies, and some that underline the possible pitfalls of these methods. P-48 IMAGING OF ANAPLASTIC THYROID CARCINOMA (ATC): AN UNFAMILIAR ENTITY IN FATAL NEOPLASM Aleum Lee, Jihoon Kim Seoul National University Hospital, Seoul, Republic of Korea PURPOSE ATC is rare but is one of the most aggressive malignancies with limited reports on its imaging findings. The purpose of this study is to present typical US and CT features of ATC and to determine useful imaging features as predictor of prognosis MATERIAL AND METHODS We retrospectively reviewed the imaging and medical records of the 36 patients diagnosed with ATC from 1995 to 2011 at our hospital. Image analysis was performed according to the following US and CT parameters: size, echogenecity on US, presence of necrosis/calcification, perithyroidal invasion, LN and distant metastasis. Clinical data were sex, age, treatment, pathologic subgroup (pure ATC, ATC arising from papillary carcinoma, and focal anaplastic change) and survival duration. Diagnosis of ATC was confirmed by histopathologically in 30 patients and cytopathologically in 6 patients. Statistical

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analysis was assessed with univariate/multivariate analysis and Kaplan-Meier survival curve. RESULTS The mean age of patient at diagnosis was 61 year. ATC appeared as large (average 3.9 cm) mass accompanied by necrosis (22cases, 61.1 %), calcification (31, 86.1 %), direct invasion into the adjacent organs (27, 75.0 %), and cervical LN metastasis (23, 63.9 %). Median overall survival was 7.9 months (95 % CI, 6.0-8.6). Multi-variant analysis identified patient age (p00.004), tumor size (p00.011), LN metastasis (p 00.001) and pure ATC on pathology (p 0 0.016) as significant predictors for poor prognosis. CONCLUSION Radiologists should be familiar with clinical manifestation, characteristic imaging findings, and their prognostic factors for the appropriate diagnosis of ATC.

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increased from 2 cases in 2006 to 41 cases in 2009, falling to 25 in 2011. Scanner use has changed from exclusively 1.5 T to predominantly 3 T, with cases performed at 1.5 T when there are contraindications to 3 T, or on private patients. FMRI analyses now use SPM8. DTI analyses changed from DTI-studio to FSL and MRtrix. Tracts examined include optic radiation, arcuate fasciculus and corticospinal tracts. FMRI protocols now include motor, language, auditory, visual and somatosensory mapping. CONCLUSION The initial increasing demand for fMRI and DTI data for pre-surgical planning appears to have levelled out. The introduction of intra-operative MRI may result in a further increase in demand for the service. P-50

P-49 THE USE OF FUNCTIONAL MRI AND DIFFUSION TENSOR IMAGING IN CLINICAL PRACTICE: EXPERIENCES AT THE NATIONAL HOSPITAL FOR NEUROLOGY AND NEUROSURGERY 2004 TO 2011 Lucy Lee1, Laura Mancini1 ,2, Caroline Micallef1 ,2 1 National Hospital for Neurology and Neurosurgery, London, UK, 2University College London, London, UK INTRODUCTION Functional MRI (fMRI) and diffusion tensor imaging (DTI) are well established neuroscience research methods increasingly used in clinical practice to localize eloquent cortical areas and major tracts prior to epilepsy surgery and tumour resection. Clinical fMRI and DTI services were introduced in our institution in 2004 and 2006 respectively. This study examines trends in fMRI and DTI use. METHODS Records of fMRI and DTI studies performed for clinical indications from 2004 to 2011 were examined. Clinical indication, examinations performed (fMRI and/or DTI), scanner used (1.5 T or 3 T), analysis software, fMRI protocols performed, tracts analysed and quality of data obtained were recorded. Trends in examination number and type, changes in protocols and analyses over time were explored. RESULTS fMRI examinations increased from 1 case in 2004 to 47 in 2009, falling to 45 in 2011. DTI examinations

THE APPLICATION OF FOUR-DIMENSIONAL TIME-RESOLVED ANGIOGRAPHY USING KEYHOLE AT 3 TESLA DYNAMIC MRA IN DIAGNOSING HEAD AND NECK VASCULAR LESIONS Ming-Cheng Liu, Chen-Hao Wu, Wen-Hsien Chen, Hung-Chieh Chen, Clayton Chi-Chang Chen Taichung Veterans General Hosipital, Taichung, Taiwan Four-dimensional time-resolved angiography using keyhole (4D-TRAK) is a new technique of performing contrast-enhanced MRA. By combining parallel imaging with sensitivity encoding with the keyhole imaging technique and a high field strength magnet, we have been able to obtain detailed hemodynamic information similar to that obtained via catheter angiography with digital subtraction), but without the risks from ionizing radiation exposure, iodizing contrast agents, or catheterization itself. Besides, imaging at 3 Tesla gives higher signal, resulting in better spatial resolution and improved diagnostic accuracy. In this study, we use 4D-TRAK MRA protocol to evaluate head and neck vascular abnormalities, including arteriovenous malformation, carotid-cavernous sinus fistula, dural arteriovenous fistula, venous thrombosis, arterial stenosis, subclavian steal syndrome and moymoya disease. With this techniques, the information of arterial feeder, venous drainage, collateral pathways and hemodynamic status could be demonstrated clearly. In summary, using 4D-TRAK dynamic MRA has much advantages in current neuroradiology practice.

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from other CNS pathology as well as in guiding neurosurgical biopsy.

P-51 MR IMAGING OF LYMPHOMATOSIS CEREBRI

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Vasileios K. Katsaros , Dimitra Rontogianni , Laurent Hermoye3, Stavroula Lyra4, Evangelia Liouta5 ,6, Aggeliki Tavernaraki1, Panagiotis Toulas7, George Stranjalis5 ,6 1 Department of MRI and Neuroradiology, “Saint Savvas” AntiCancer - Oncology Hospital, Athens, Greece, 2Department of Pathology, “Evangelismos” Hospital, Athens, Greece, 3 Imagilys, Brussels, Belgium, 4Department of Radiology, Red Cross Hospital, Athens, Greece, 5Department of Neurosurgery, University of Athens, “Evangelismos” Hospital, Athens, Greece, 6Hellenic Center of Neurosurgical Research, Prof. P. Kokkalis, Athens, Greece, 7Diagnostic Institute, EncephalosEuromedica, Athens, Greece PURPOSE Lymphomatosis cerebri is a very rare condition in which PCNSL presents as a diffuse, infiltrating process without formation of a discrete mass. Histologically, the widespread, diffuse infiltration by lymphocytes with some perivascular cuffing can be mistaken for viral encephalitis. The cellular composition of the infiltrate can be clarified with immunohistochemical stains. The purpose of this report is to present histologically proven cases of this entity and the role of newer imaging modalities (fMRI and DTI) in open biopsy by neuronavigation. MATERIALS AND METHODS Two immunocompetent patients (both females, 22 and 47 years-old) underwent MRI of the brain in a 1.5 T Magnet. Structural MRI by T1-W, before and after administration of i. v. Gadolinium, T2-W, FLAIR sequences were obtained, followed by advanced imaging of the brain (DWI, PWI, fMRI, DTI and MR spectroscopy). Data were transferred in neuronavigation system for open biopsy. RESULTS fMRI and DTI helped the open biopsy to avoid eloquent regions of gray and white matter. The first female patient showed diffuse white matter involvement of the brainstem and the corpus callosum extending gradually to the periventricular white matter, which in biopsy proved to be a very rare PCNSL (NKTCL-Nasal Type). Another female patient demonstrated also diffuse white matter involvement, which after administration of cortisone reduced moderately. The biopsy also showed a PCNSL (DLBCL). CONCLUSION MR imaging especially using advanced modalities proved to be a significant tool in the discrimination of CNS lymphoma

INITIAL EXPERIENCE OF A NOVEL SHEATH GUIDE FOR TRANSBRACHIAL COIL EMBOLIZATION OF CEREBRAL ANEURYSMS IN THE ANTERIOR CEREBRAL CIRCULATION Takahisa Mori, Tomonori Iwata, Yuichi Miyazaki, Masahito Nakazaki, Kouji Mizogami, Yoichiro Takahashi, Syunichiro Inagaki, Gen Sihashi Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan BACKGROUNDS AND PURPOSE Transfemoral approach is a common technique for coil embolization of cerebral aneurysms in the anterior cerebral circulation. However, it is difficult to advance a guiding catheter into the carotid artery through the femoral route in patients with a tortuous aortic arch, an unfavorable supraaortic takeoff, aortic diseases or occlusion of the femoral artery. The purpose of our study was to report initial experiences of coil embolization of cerebral aneurysms in the anterior cerebral circulation with a novel sheath guide for transbrachial carotid cannulation. SUBJECTS AND METHODS A sheath guide designed specifically for transbrachial carotid cannulation was developed, transbrachial coil embolization for cerebral aneurysms was started in May 2011 and data was collected prospectively. Included for analysis were patients who underwent transbrachial coil embolization for cerebral aneurysms in the anterior cerebral circulation from May 2011 to January 2012. Every coil embolization was started through the right brachial route under local anesthesia. Adjuvant techniques, angiographic results, procedural success and periprocedural complications were investigated. RESULTS Ten patients underwent transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation. All procedures were successful through the brachial route. No periprocedural complications occurred. Patients were free on their beds immediately after coil embolization even during hemostasis. CONCLUSIONS The sheath guide specifically designed for transbrachial carotid cannulation was useful for coil embolization of cerebral aneurysms in the anterior cerebral circulation.

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the current study was to perform the visual assessment for the capability and pattern of the abnormal findings on ASL-MRI in putaminal hemorrhage. MATERIALS AND METHODS 13 patients with putaminal hemorrhage underwent a pulsed ASL-MRI (Q2TIPS) using 3.0 T-MRI. Firstly, we assessed the imaging quality of ASL-MRI. Secondly, the patterns of abnormal findings on ASL-MRI were estimated. RESULTS Four patients were determined to have a suboptimal imaging quality of ASL-MRI due to movement artifact. Eight of 9 patients had low perfusion-related signal areas in the cerebrum; the ipsilateral hemisphere in 5 , the ipsilateral hemisphere as well as the contralateral frontal lobe or the contralateral occipital lobe in 3. Three of 9 patients had low perfusion-related signals in contralateral cerebellar hemisphere. CONCLUSION ASL-MRI could not necessarily preserve the imaging quality in patients with putaminal hemorrhage due to the agitated behavior. However, ASL-MRI had a potential for demonstrating the perfusion abnormality which could not recognize on the other conventional MRI methods noninvasively. ASL-MRI might be helpful to monitor the brain functional abnormality in putaminal hemorrhage.

VALIDATION OF 3D VOLUMETRIC ANALYSIS SOFTWARE Benjamin Salt, Mufudzi Maviki, Thomas Wilhelm, Kesavan Nayagam Royal Free Hospital, London, UK INTRODUCTION The use of volumetric analysis software for assessing brain tumour size & growth rate has mostly been confined to research applications. However studies have shown the increased sensitivity & accuracy of volumetric analysis compared with planar imaging, and volumetric tools are now included with many CT & MRI software packages. It is however necessary to validate the accuracy of these tools and ensure there is consistency beteween different MRI scanners before this software can be adopted. METHODS Several water-filled syringes of varying volumes (1 ml-20 ml) were aligned in 3 different orientations & scanned with axial slices of 1.5 mm & 6 mm thickness using T1 & T2 weighted sequences on an MRI scanner used in our department. Subsequently the images were analysed using two different Volumetric analysis software packages. The analysis was performed using the semi-automated tools available & performed by two different operators. These volumes were then compared to the known volumes from the syringes. RESULTS For each sequence scanned, we obtained slices of syringes containing 1, 5, 10, 20 ml water sliced axially, obliquely & longitudinally. The volumes calculated were accurate to within 5 %, the maximum error was found on the 1 ml syringe sliced longitudinally - this was visible on only one slice and gave a volume of 1.05 ml. CONCLUSION With this study, we have shown a methodology that can easily be replicated and used to validate the accuracy and calibration of MRI scanners with volumetric analysis software packages. P-54 ARTERIAL SPIN-LABELING MR IMAGING IN PUTAMINAL HEMORRHAGE: A PILOT STUDY Tomoyuki Noguchi Saga University, Saga City, Saga Province, Japan PURPOSE Arterial spin-labeling MR imaging (ASL-MRI) provides brain perfusion information noninvasively. Our purpose in

P-55 AUTOMATED 3D BRAIN MODEL IN MONITORING OF TRAUMATIC BRAIN INJURY Veljko Popov1, Lyubomir Zagorchev1 ,2, Carsten Meyer3, Thomas Stehle3, Astrid Franz3, Fabian Wenzel3, Juergen Weese3, Sebastian Flacke1 1 Lahey Clinic, Burlington, MA, USA, 2Phillips Research, Briarcliff Manor, NY, USA, 3Philips Research, Hamburg, Germany INTRODUCTION Traumatic brain injury (TBI) is a significant public health problem worldwide and is estimated to be a major cause of death and disability for young adults. While tractography remains a method of choice for detecting DAI, MR Spectroscopy or volumetric measurements are used to assess the degree of neuronal degeneration in chronic state of TBI. The degree of the subcortical grey matter atrophy correlates with the likelihood for developing TBI. Visual inspection and 3D volume calculation based on manual segmentation are both inaccurate. Here, we present a fully automated 13-component shape constrained Deformable 3D Brain model for automatic segmentation and quantification of sub-cortical brain structure volumes.

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The model was used in a retrospective clinical study, using clinically well-defined cohorts including subjects with TBI and age-matched healthy controls. METHODS Fully automatic, shape-constrained deformable brain model contains a number of sub-cortical brain structures including the amygdala, brainstem, caudate, cerebellum, corpus callosum, hippocampus, putamen, and thalamus. RESULTS Visual inspection did not detect differences in the size of subcortical grey matter structures between TBI patients and normal controls. Brain model detected volumetric difference in the putamen, thalamus, caudate, and brainstem. CONCLUSION Subtle volumetric changes can be correlated with the functional outcome in TBI patients. Brain model reliably detects volumetric changes of <20 % and thus lends itself well for serial imaging and monitoring of the disease progression over time. This methodology could help to set new standards for assessment of volumetric changes not only in patients with TBI but also dementia or demyelinating diseases.

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Multiple databases were searched using Web of Science. Application of the predefined exclusion criteria permitted 15 studies for meta-Analysis; A case-control study of TCS on 17 individuals from the Queen's Medical Centre (Nottingham, UK) was also included. Meta-analysis used a random effects model assuming unequal variance, as well as a sensitivity and specificity analysis. A subset of 11 out of the 15 studies, constituting 2361 subjects (823 PD, 1538 controls), provided binary data regarding SN echogenicity. SNH was defined as signals≥ 0.2 cm² which yielded a sensitivity of 88.8 % (C.I:83.892.4) and specificity of 87.6 % (C.I:82.4-91.4). Continuous data was extracted from 10 out of 15 studies, constituting 1010 subjects (478 PD, 532 controls), demonstrating a weighted mean difference in substantia nigra echogenicity of 0.154 cm² when comparing PD and controls (C.I:0.1210.186 p<0.001). The association between SNH and PD combined with the high sensitivity and specificity of the investigation implicates TCS as a valuable tool. As an imaging modality, TCS is advantageous in its comparative safety and cost, making it an attractive method to assist diagnosing PD.

P-56 P-57 MEASURING SUBSTANTIA NIGRA ECHOGENICITY WITH TRANSCRANIAL SONOGRAPHY AS AN ADJUVANT TO DIAGNOSIS OF PARKINSON'S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS Aaron Ray1, Nin Bajaj2, Dorothee P. Auer3 ,4, Stefan T. Schwarz3 ,4 1 Faculty of Medicine and Health Sciences, The University of Nottingham Medical School,, Nottingham, Nottinghamshire, UK, 2Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, Nottinghamshire, UK, 3Division of Radiological and Imaging Sciences, University of Nottingham,, Nottingham, Nottinghamshire, UK, 4Deparment of Radiology, Queen's Medical Centre,, Nottingham, Nottinghamshire, UK There is increasing evidence that Transcranial Sonography (TCS) can be used to demonstrate Substantia Nigra hyperechogenicity(SNH) as a sign of Parkinson's disease (PD). A few centres in Europe, mainly Austria and Germany, utilise this technique as a diagnostic adjuvant in the early detection of PD, however, in the United Kingdom, this technique is not well established. The objective in this systematic review and meta-analysis is to further determine the diagnostic value of TCS in the detection of PD.

NEURO-ANATOMICAL CORRELATES OF NEUROPSYCHOLOGICAL AND PSYCHOPATHOLOGICAL DOMAINS IN FIRST EPISODE SCHIZOPHRENIA: A MULTIMODAL ANALYSIS Maria Camilla Rossi Espagnet1, Andrea Romano1, Silvia Rigucci1, Valeria Coppola1, Danilo Guida1, Filippo Carducci2, Paolo Girardi1, Alessandro Bozzao1 1 NESMOS Department, Sant'Andrea Hospital, Rome, Italy, 2 Laboratory of Neuroimaging, Department of Human Phyisiology; University La Sapienza, Rome, Italy INTRODUCTION A few studies explored the relationships between gray matter volume and neuro-psychopathological features in firstepisode schizophrenia (FES). The aims of our study were to explore grey and white matter (WM) abnormalities comparing FES patients to healthy controls (HCs) and to evaluate possible relationships between grey matter volume and neuro-psychopathological features in FES. METHOD Both FES and HCs underwent to MRI (1,5 T) acquisitions. GM volumes were evaluated using voxel based morphometry and DARTEL algorithm wereas WM analysis was performed by the Tract-Based Spatial Statistics method after

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calculation of fractional anisotropy (FA) maps. For multiple regression analysis, symptoms and neuropsychological performances were scored by PANSS scale and by a neuropsychological comprehensive assessment (MATRICS), respectively. RESULTS patients showed significantly decreased volume of left Brodmann-area (BA) 37 and decreased FA of all major WM tracts (p<0,005). Left cerebellar volume was inversely related to disorganized/cognitive PANSS factor. TrailMaking A, Wisconsin Test and Facial-Affect Recognition scores significantly correlated with right BA32, BA28 and BA36 volumes, respectively (p <0.005). CONCLUSIONS we confirm the presence of morphologic alterations of both grey and white matter in FES with an involvement of the fronto-limbic structures, consistently with a synthesis between a neurodevelopmental perspective and a neoBleulerian model. P-58 EPONYMS IN NEURORADIOLOGY: USES, ORIGINS AND CONTROVERSIES! Elizabeth Ryan, Kevin Pennycooke, Sarah Power, Joanna Pearly-Ti, Paul Brennan, John Thornton, Seamus Looby Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland PURPOSE There are innumerable eponyms in medicine, including within radiology. Within neuroradiology there are many eponyms. We illustrate with radiological images some of the common and interesting neuroradiological eponyms. We discuss the origins of the eponyms with a brief focus on some of the more interesting ones and on controversies related to some of them. MATERIALS AND METHODS Using a PACS system, neuroimaging reports at a tertiary referral centre for neurosciences were reviewed for eponym terms used. We classify the eponyms into those used in normal neuroradiological anatomy, cerebral and spinal angiography, central nervous system (CNS) congenital disorders, CNS trauma, CNS haemorrhage, CNS tumours, CNS infections and CNS metabolic, degenerative and other diseases. Radiological images are used to illustrate the findings. RESULTS There are many eponyms used in neuroradiology and throughout the neuroscience specialties. We illustrate many

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of them and uncover their origins, with interesting facts on the physicians, surgeons, radiologists, pathologists and others who have given their names to them through the ages. CONCLUSION There are many eponyms in neuroradiology. This poster illustrates many of them and discusses their origins. P-59 OBSTRUCTIVE SLEEP APNEA AND CARDIOVASCULAR DISEASE: EVALUATION WITH SLEEP CINE MRI, CORONARY CT ANGOGRAPHY AND CAROTID DOPPLER ULTRASONOGRAPHY Hyobin Seo, Hua Sun Kim, Se-Yeong Chung Seoul National University hospital healthcare system Gangnam center, Seoul, Republic of Korea The purpose of this study is to verify the association between OSA and atherosclerotic change of coronary artery, aorta and carotid arteries via sleep MRI, coronary computed tomography angiography (CTA) and carotid doppler ultrasonography(US). From April 2009 to October 2011, 120 consecutive subjects were evaluated with sleep MRI and carotid doppler US. Among them coronary CTA was performed in 54 patients. A balanced fast field-echo sequence and turbo field-echo mode were used to create the cine MR images for sleep MRI using 1.5 T MRI machine. Sleep was induced with intravenously administered midazolam. The upper airway was classified into 2 (retropalatal and retroglossal) levels. The axial and sagittal cine images were provided. We retrospectively measured anterior-to-posterior (AP) and transverse diameter at 2 levels on pre-sedation and post-sedation images. We assessed the coronary artery stenosis>50 %, vulnerable plaque, number of involved major vessels, aortic atherosclerosis and patent foramen ovale (PFO) on coronary CTA images. We also evaluated the intima-media thickeness and plaque (calcified, mixed and noncalcified) of carotid artery on carotid Doppler images. Airway collapse was significantly observed in patient with PFO, coronary artery stenosis>50 %, aortic atherosclerosis, vulnerable plaque on CTA and mixed plaque on Carotid Doppler US. (p<0.05). There is no relation between numbers of involved major coronary or calcified plaque plaque. Airway collapse in patient with OSA is related to coronary artery stenosis and atherosclerotic change of large arteries (greater than carotid artery).

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DIFFUSION WEIGHTED IMAGING APPEARANCES OF THE BRAIN IN ACUTE CARBON MONOXIDE POISONING

GET SMASHED - AN AUDIT OF CT IMAGING IN ALCOHOL-ASSOCIATED HEAD INJURY

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Chang June Song , Sang Hoon Cha , In Kyu 1 Chungnam National University Hospital, Daejon, Republic of Korea, 2Chungbuk National University, Chungju, Republic of Korea, 3Eulji University Hospital, Daejon, Republic of Korea PURPOSE The purpose of this study was to describe the diffusion weighted imaging findings of acute carbon monoxide (CO) poisoning. MATERIALS AND METHODS We retrospectively reviewed MR imaging features and medical records in six patients. Lesion location, MR signal intensity, the presence of restricted diffusion, and enhancement pattern were analyzed. We also evaluated clinical features including presenting symptoms and signs and treatment response. Time between MRI and initial exposure to CO poisoning was less than 7 days in all patients. RESULTS Age of the patients with acute CO poisoning was ranged between 25-82 years (M:F05:1, mean age: 52 years). All patients presented with mental change. The level of COHb was 8.3- 28 % (normal<1.5) was in five patients with available COHb. The affected sites were both side globus pallidus (n 02), both side globus pallidus, periventricular white matter and midbrain (n01), both side globus pallidus, hippocampus, midbrain, cerebellum, splenium, and right temporal cortex (n01), both side globus pallidus, left insula and parietotemporooccipital cortex (n01), and both side globus pallidus, periventricular white matter and left parietal cortex (n01). All lesions showed restricted diffusion on diffusion weighted image and ADC map. The most common site was the globus pallidus (n06). CONCLUSION Acute carbon monoxide poisoning was not common. Although any region in the brain may be involved, globus pallidus was the most common site. Restricted diffusion of bilateral globus pallidus may be pathognomonic feature in the patients with acute CO poisoning.

Olwen Westerland1, Stefanie Thust1, Robert Barker2, Nyree Griffin1 1 Guys and St Thomas NHS Trust, London, UK, 2Frimley Park Hospital, Surrey, UK Alcohol misuse is a problem of epidemic proportions in the UK, and is the cause of emergency department attendances in 70 % of night time and 40 % of day time cases. A significant proportion of patients with an alcoholassociated minor head injury are referred for CT head. However, in the intoxicated patient, the accurate application of the National Institute for Health and Clinical Excellence (NICE) guidelines for Head Injury (2007) is often challenging. We will present the findings of a retrospective audit, conducted in a central London teaching hospital, in which 100 adult patients receiving a CT head for alcohol-associated head injury were evaluated for the following; patient demographics including age and sex, mechanism of injury, risk factors for traumatic intracranial pathology, CT head result and whether imaging was performed immediately, at one hour or eight hours following presentation. We aim to identify current trends in imaging practice and local performance with respect to national guidelines. We will also try to identify factors which may increase the likelihood of the detection of traumatic intracranial lesions, with the intention of promoting the sensible application of current guidelines in this prevalent and challenging patient cohort. P-62 NON-INFECTIVE, NON-NEOPLASTIC NEUROLOGICAL COMPLICATIONS OF HIV/AIDS ON CRANIO-SPINAL IMAGING; A DIFFERENT PERSPECTIVE ON A PERENNIAL PROBLEM Mufudzi Maviki, Benjamin Salt, Bernadine Murtagh, Anastastassia Gontsarova, Lorna Woodbridge, Peter Cowley Royal Free Hospital NHS Foundation Trust, London, UK HIV/AIDS is a common pandemic that is an extremely difficult disease to manage. Although the advent of highly

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active antiretroviral therapy (HAART) has relegated it to a chronic disease in developed countries, it remains a significant cause of mortality especially in the third world. Neurological manifestations in the brain, spinal cord and peripheral nervous system are very common, with infectious diseases such as Tuberculosis, Cryptococcal meningitis and Toxoplasmosis while lymphoma represents the most commonly recognized neurological neoplastic disease. However, HIV may present with inflammatory and neurodegenerative conditions which are also important to identify on neuro-imaging. In addition, the complications of HAART and replenishing the immune system, seen in Immune Reconstitution Inflammatory syndrome (IRIS) are also important to recognise. This educational exhibit will illustrate common and uncommon radiological features of these non-infectious non-neoplastic conditions, provide a radiological diagnostic algorithm, and generate a useful differential diagnosis with clinical correlates. P-63 PERFUSION CT STUDY OF BRAIN STEM BLOOD FLOW IN PATIENTS WITH TRAUMATIC BRAIN INJURIES Natalia Zakharova, Alexander Potapov, Valerij Kornienko, Igor Pronin, Oleg Zaytsev, Anton Gavrilov, Alexander Kravchuk, Andrej Oshorov, Alexander Sychev, Evgeniya Alexandrova, Liudmila Fadeeva, Sergej Takush, Alexander Polupan Burdenko Neurosurgery Institute, Moscow, Russia The method of CT perfusion (CTP) has become a widespread procedure in different brain diseases. However, for patients with traumatic brain injury (TBI) it was used to study cerebral blood flow (CBF) only in hemispheric structures. PURPOSE The aim of this study was to evaluate brain stem blood flow parameters in patients with TBI. METHOD Twenty four patients (mean age 29,7) were examined by CTP in the acute stage of TBI; of them 20 pts had severe TBI (Glasgow Coma Scale≤8) and 4 pts - mild TBI (GCS 1315). Regional CBF was studied in symmetrical vascular regions of the anterior, middle and posterior cerebral arteries, subcortical structures, thalamus and midbrain. RESULTS Patients with mild TBI showed brain stem CBF values ranging 17,1-36,9 ml/100 g/min (average 24,3±6,7); patients with

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severe head injury in coma (mean GCS 05) had CBF levels ranging 4,0-51,0 ml/100 g/min (average 26,9±7,7). The lowest levels 4,0 and 12,2 ml/100 g/min were marked in patients in deep coma with hemorrhagic foci in the brain stem. Repeated studies of 7 patients with favourable outcome and 12 patients with unfavourable outcome demonstrated similar mean values of brain stem CBF. One patient with high intracranial hypertension and brain stem compression, with further death, revealed decrease in CBF parameters in the midbrain from 39,4 to 9,2 ml/100 g/min. CONCLUSION The method of CTP allows revealing critical levels of CBF in hemispheric and brain stem structures in patients with primary or secondary brain damage. THEME: NEUROINTERVENTION P-64 NEUROVISUALISATION WHILE PLANNING CEREBRAL OPERATIONS UNDER THE NAVIGATIONAL CONTROL. A.V. Andrey Arablinskiy, IA Danchenko, A.V Gorozhanin, DV Vakatov, A/S Osipovskaya Moscow City Hospital named Botkin, Moscow, Russia The detection of the most informative neurovisualisation methods and the attempt to find the universal method under the condition of different neurosurgical brain pathologies for planning cerebral operations under the navigational control. Fusion of different neurovisualisation images (CT and MRI) are used intraoperatively in a number of cases subject to the kind of pathology. In total 167 operations have been performed for the last 3 years with the use of the navigational systems synchronized to the operating microscopes (47 intracerebral tumour, 36 pituitary adenoma, 27 cavernomas, 8 parasaggital meningiomas, 6 skull base tumour, 4 arterial aneurysms, 3 AVM, 32 navigational biopsies). Patients with skull base tumors, basal brain tumors can optimally be imaged by CT of the brain in the bone window, MRI of the brain, CT angiography with the fusion of research data in the navigational station. It is necessary to perform CT in the bone window and MRI of the brain for pituitary adenoma patients, and in case of paracellar growth (cavernous sinus and carotid artery) – CT angiography. Patients with arterial aneurysms and AVM need fusion – MR- and CT-angiography. Patients with intracerebral tumors, convexital and parasagital meningiomas, cavernomas should give preference to MRI with i.v. SPGR images.

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The exact ranging of the necessary MRI programs for certain nosologies has been performed. High diagnostic value has been determined, as well as the opportunity to use in the navigated surgery with several groups of patients having intracerebral and extracerebral processes. P-65 DO PREOPERATIVE INTRA ARTERIAL INFUSION OF COMBINATION OF NIMODIPINE AND MILRINONE DECREASE THE RATE OF PER PROCEDURAL COMPLICATION OF ANEURISMAL EMBOLISATION ? Benjamin Daumas Duport, Hubert Desal, Alina Lintia Gaultier CHU Nantes, Nantes, France MATERIAL AND METHODS Among 322 patients suffering of subarachnoid hemorrage, treated in our institution in the last 3 years, 23 patients were treated in angiographic mild to severe vasospasm. 9 among those patients had pre operative intra arterial infusion of a combination of Nimodipine and Milrinone. 14 had usual per procedural low infusion of Nimodipine via the guiding catheter We tried to compare per procedural rate of complication among the two populations. RESULT We observed severe decrease of per operative aneurysmal rupture in the vasodilator group (VG) 0/9, versus 21 % in the non vasodilatator group (NVG) but one patient (11 %) suffured from distal intraparenchymatous hemoragical suffusion. Thrombo embolic adverse event were stable (VG 22 %, NVG 21 %), while arterial spasm provoqued by embolisation material where more frequent in VG (44 % vs 21 %). CONCLUSION Rapid intra arterial infusion of vasodilatators is safe while encountering perprocedural arterial vasospasm. This treatment, in this observational study, decrease damaticaly per procedural aneurysmal rupture. P-66 ENDOVASCULAR TREATMENT OF A POSTTRAUMATIC CAROTID-CAVERNOUS FISTULA: CASE REPORT Stefano Vannucci1, Guido Andrea Lazzarotti2, Ilaria Desideri1, Silvia Canovetti1, Rosa Pasquariello1, Michele Puglioli2, Carlo Bartolozzi1 1 Department of Radiology, Vascular and Interventional Radiology and Nuclear Medicine, University of Pisa, Pisa, Italy, 2Unit of Neuroradiology, AOUP, Pisa, Italy

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We report the case of a 49 years old male that was admitted to the Radiology of Emergency Room after a falling from a height with cerebral concussion and facial trauma. CT study showed a fracture of the skull base involving the large and small right wings of sphenoid, the left petrous and the walls of the petrous and cavernous portion of ipsilateral carotid siphon, determining hemotympanum and hemorrhage in the left parasellar region extended to left sylvian valley and to ipsilateral middle frontal cortical sulci. Post traumatic hemorrhages were also in the left peripontine cistern and in the interhemispheric anterior frontal region . Left common carotid angiography showed a complete occlusion over the carotid bulb. Right vertebral angiography showed a retrograde opacification of the carotid siphon up to the petro-cavernous segment through posterior communicating artery and the presence of a carotid-cavernous fistula with involvement of cerebral veins. The opacification of left anterior and middle cerebral artery was allowed by anterior communicating artery, as shown by the right internal carotid artery angiography. After placement of a 5 F guiding catheter in the left vertebral artery, we reached the petrous portion of the left internal carotid navigating through the left posterior communicating artery with 0.014 inches microcatheter. Progressing towards the cavernous portion of carotid siphon, we progressively detached 10 coils, obtaining complete exclusion of the fistula with good opacification of the left carotid circulation through the left posterior communicating artery and the anterior communicating artery. Parenchymographic deficits were not observed. P-67 AN AUDIT ON THE CONSENTING PROCESS IN ELECTIVE THERAPEUTIC PROCEDURES Sana Eljamel, Philip White, Robin Sellar University of Edinburgh, Edinburgh, UK OBJECTIVES To determine how satisfactorily the aspects surrounding obtainment of informed consent for elective interventional neuroradiological therapeutic procedures were carried out and documented, and to determine how often, and in what form, written information was provided to patients. METHODS A retrospective audit of all elective interventional neuroradiological therapeutic procedures performed by 2 experienced interventional neuroradiologists between 2009-2011. Patient health records were critically reviewed and data analysed.

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RESULTS "Time for reflection" documentation was recorded in 98.5 % and was always adequate. Discussion with patient was documented in 97 %. The presence of witnesses to discussion was associated with higher documentation rates of specific discussion areas (p00.009). Consent forms were completed to at least ‘adequate'standards and were more likely to be ‘comprehensive' in aneurysmal treatment (p< 0.001) and if both family member/friend and another medical professional were witness (p00.001). Written information was documented as provided to patients in only 35.6 %, primarily a copied outpatient clinic letter. CONCLUSIONS High standards were almost all attained. Documentation of specific areas of discussion could be improved. Regular audit of note-keeping to ensure adequate documentation of the consent process and appropriate filing of documents and filling of consent forms is recommended and witnesses to discussions encouraged. Written information should be considered and re-audit performed in due course.

ballooning, pseudoaneurysm and rupture. Endovascular embolisation was carried out in 12 patients. 1 patient could not undergo embolisation due to direct invasion of ICA by tumour. 2 patients could not undergo embolisation due to bad pre-morbid conditions and one of them underwent balloon occlusion. 1 patient had an unsuccessful attempt at stenting. 1 patient had an ICA-ECA bypass in addition to embolisation. 2 patients who underwent embolisation and 4 patients in whom embolisation could not be carried out died largely due to initial massive blood loss. CONCLUSION Understanding the evolution and distribution of arterial involvement in RCBS can greatly help in the management of this devastating complication. Endovascular embolisation offers a safe and effective treatment.

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Yonkwon Ihn1, Myengjin Kim2, Bum-soo Kim2 1 St. Vincent's hospital, Suwon/Gyenggi-do, Republic of Korea, 2Seoul St.Mary's hospital, Seoul, Republic of Korea

A 10 YEAR RETROSPECTIVE REVIEW OF RADIATION CAROTID BLOWOUT SYNDROME (RCBS) IN NASOPHARYNGEAL CARCINOMA (NPC) Nishini Hekha1, Francis Hui1, Jeeve Kanagalingam2, Peter Choo3 1 National Neuroscience Institute, Singapore, Singapore, 2 Tan Tock Seng Hospital, Singapore, Singapore, 3Yong Loo Lin School of Medicine, Singapore, Singapore

P-69 DURAL ARTERIOVENOUS FISTULA INVOLVING AN ISOLATED TRANSVERSE SINUS TREATED USING TRANSARTERIAL ONYX EMBOLIZATION

The authors present a case of isolated dural arteriovenous fistula (DAVF) in the transverse sinus, which developed 6 years after the microvascular decompression due to hemifacial spasm via suboccipital craniectomy. The lesion was treated by transarterial embolization using Onyx. We review some radiologic and therapeutic features involving DAVF with an isolated sinus and describe the feasibility of the use of Onyx. P-70

OBJECTIVES We aim to summarize our experience that will guide future approaches in the management of RCBS after carefully analyzing the imaging features, treatment methods, clinical outcomes and other important factors such as age, gender, past medical history including other medical risk factors such as coagulopathy etc. METHOD A retrospective review of NPC patients who presented with epistaxis during follow up after radiotherapy from 2001 to 2011 was carried out. Diagnostic catheter angiography was performed in all the patients. CT angiography was also performed whenever feasible. RESULT A total of 16 patients were included. The age of the patients ranged from 47 to 68 years with a mean age of 53.31 years and the sex ratio was 3:1 (M:F). Imaging features included irregular segmental stenosis with subtle aneurysm, arterial

GIANT SPHENOID SINUS PSEUDOANEURYSM ASSOCIATED WITH CAROTID-CAVERNOUS FISTULA AND COMPLEX CAROTID ARTERY TEARS: NEURORADIOLOGICAL FEATURES AND MANAGEMENT STRATEGIES Joseph Lansley, Sanjiv Chawda, Dhuleep Wijayatilake, Olivia Sanders, Shahram Derakhshani Queen’s University Hospital, Romford, UK INTRODUCTION Traumatic carotid-cavernous fistula (TCCF) is a rare complication of facial trauma with typical clinical manifestations and established endovascular treatment. Traumatic intrasphenoidal pseudoaneurysm of the internal carotid (TISP) is a less common, potentially fatal complication of head injury. Whilst the signs of TCCF may develop within hours

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of trauma, the clinical manifestation of TISP (Maurer’s triad) is frequently delayed by months or even years. TISP may be mistaken for a neoplastic or inflammatory lesion with potential catastrophic consequences. CASE DESCRIPTION We present a rare case of complex cavernous-carotid tears resulting in TCCF and TISP. CT, MRI and DSA features are presented. Endovascular treatment was performed in three stages: TCCF embolisation, TISP embolisation, and finally parent vessel occlusion. There were no neurological complications following treatment. DISCUSSION Intracavernous sinus hypertension caused by TCCF, combined with fracture of the lateral sphenoid sinus wall has been proposed as a cause of TISP. Our case demonstrates independent TSIP and TCCF due to complex internal carotid artery tears. Pseudoaneurysm treatment options include coil / detachable balloon embolisation, flow diversion, covered stenting, and parent vessel occlusion. The efficacy of different treatment strategies is reviewed. CONCLUSION Early angiographic investigation should be considered in cases of epistaxis and facial trauma. The radiological signs described here should alert the neuroradiologist to the diagnosis of TISP prompting definitive angiographic investigation and treatment. Controlled, three step coil occlusion of a carotid-cavernous fistula, intrasphenoidal pseudoaneurysm, and carotid artery was successfully undertaken in this rare case of multiple, complex carotid tears. P-71 TO OCCLUDE OR NOT TO OCCLUDE? VISION IS THE QUESTION. ENDOVASCULAR TREATMENT OF DYSPLASTIC CEREBRAL ARTERIES OF THE POSTERIOR CIRCULATION: A PICTORIAL REVIEW

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CASE DESCRIPTION We present five cases of dysplastic cerebral arteries highlighting the risks and benefits of different surgical and endovascular treatment approaches. Treatments offered included clipping, endovascular parent vessel occlusion and stent assisted coiling. In four cases a dysplastic vessel was the cause of subarachnoid haemorrhage or significant midbrain compression. One case was asymptomatic. In all cases the dysplastic vessel contributed to the supply of the visual cortex. CT, DSA and MR imaging illustrate the presentation, treatment and outcomes of each case. DISCUSSION Vessel occlusion is a definitive treatment for dysplastic posterior circulation vessels. The risk to vision may be predicted by balloon test-occlusion. Stent assisted coiling may be undertaken to preserve vessel patency. Partial clipping can result in recurrent subarachnoid haemorrhage. SUMMARY Dysplastic cerebral arteries are potentially fatal vascular abnormalities which pose complex management decisions. Endovascular treatment can reduce the risk of recurrent haemorrhage or decrease associated mass effect thereby improving neurological symptoms. Vessel occlusion offers a definitive treatment but may risk cortical blindness. Risks and benefits of all available options should be carefully considered to inform patient choice and optimise clinical outcome. P-72 CASE REPORT OF SUBARACHNOID HEMORRHAGE (ESA) CAUSED BY GIANT ANEURYSM OF VERTERBRO-BASILAR JUNCTION TREATED, AS SECOND STEP PROCEDURE, WITH A FLOW DIVERTER STENT (PED)

Joseph Lansley, Sanjiv Chawda, Ra'ed Al-Kilani, Shahram Derakhshani Queen’s University Hospital, Romford, UK

Giuseppe Lucente1, Monica Raguso0 ,2, Pierluigi Giordano1, Ivo Francavilla1 1 Interventional Neuroradiology Unit, Perrino Hospital, Brindisi, Italy, 1Radiology Unit, S. Marco Hospital, Grottaglie, Italy

INTRODUCTION Dysplastic cerebral arteries of the posterior circulation may present with potentially fatal subarachnoid haemorrhage or cause debilitating neurological symptoms due to midbrain compression. Management poses a challenge for the neurointerventionist with little evidence-based guidance in the literature. Endovascular treatment can preserve vessel patency utilising stent assisted techniques. Vessel occlusion can be undertaken as a definitive treatment although this risks occipital infarction depending on collateral supply.

Patients undergoing PED reconstruction are pretreated and maintained in double antiplatelet antiaggregation for at least 3 months, this requirement represents a contraindication within the context of ESA. We propose a case report of ESA cause by giant aneurysm of verterbro-basilar junction treated in first step with partial coiling and after 20 days with PED. Followup with Angio-MR (MRA) and Angiography (DSA) showed complete occlusion of the aneurysm in six months. Male, 54 years old, alert and oriented, claimed head, neck and upper limb pain. CT showed ESA in basal and sylvian cisterns and fourth ventricle. Angio-CT revealed a giant,

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aneurysm of verterbro-basilar junction with a little bleb of rupture of aneurysmatic dome. We performed a partial coiling in the distal side of the aneurysm, covering the dome and filling the bleb of rupture. After a bolus of Clopidogrel (450 mg) on the 20th day after the embolizzazion, we implanted a flow diverter stent 3x20mm (Pipeline, Ev3) in the vertebro-basilar junction. The patient had not any neurological deficit caused by the ESA and the follow-up at 2 months with MRA and at 4 months with DSA showed an aneurysm almost excluded by the flow and a DSA at 6 months revealed the complete thrombosis of the aneurysmatic sac. We considered that the partial coiling, the stability of CT controls and the DSA pattern on the 10th days, allowed the pre-operative antiaggregation bolus. Therefore we believe that PED, as the second step procedure, can also be used in ESA. P-73 REVERSE WAFFLE-CONE TECHNIQUE IN MANAGEMENT OF STENT DISLODGEMENT INTO INTRACRANIAL ANEURYSMS Chao-Bao Luo1 ,2, Yen-Jun Lai1 ,2, Michael MH Teng1 ,2, Feng-Chi Chang1 ,2, Chung-Jung Lin1 ,2, Wan-Yuo Guo1 ,2 1 Departmenbt of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Taiwan, 2Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, Taiwan OBJECTIVE Waffle-cone technique has been selected to treat bifurcation aneurysms by deployment of distal part of the stent into aneurysm sac following by aneurysm coiling. We reported our experience of endovascular management of intra-procedure stent dislodgement into aneurysms of the internal carotid arteries by using reverse Waffle-cone technique. CLINICAL PRESENTATION Two female patients, age 36 and 61, harboring unruptured wide-neck aneurysms of internal carotid arteries underwent stent-assisted coil embolisation. Unfortunately, intraprocedure stent forward stent migration occurred during catheterization to aneurysm sacs with proximal end of stent dislodgement into aneurysm sacs. By the reverse Waffle cone technique, the microcatheters were navigated into aneurysm sacs. Coils were safely and stably detached into aneurysm sac without any device assistance, these two wide-neck aneurysms were successfully managed with preservation of the flow of internal carotid arteries. Patients tolerated the whole procedures well without untoward

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neurological event. There was no any procedure-related neurologic deficit on 5- and 9-month clinical follow up, respectively. CONCLUSION Intra-procedural distal migration and dislodgement with proximal end of stent proplase into aneurysm sac may not mean failure to coiling aneurysms. Reverse Waffle cone technique provides an alternative to manage this complication. P-74 ACCESSING THE INACCESSIBLE - AN ILLUSTRATED RETROSPECTIVE REVIEW OF CT GUIDED CORE BIOPSIES OF HEAD AND NECK TUMOURS Jane Cunningham, Mark McCusker, Sarah Power, Alan O'Hare, John Thornton, Paul Brennan, Seamus Looby Beaumont Hospital, Dublin 9, Ireland PURPOSE Tumours occurring in the infratemporal fossa, parapharyngeal, parotid and carotid spaces have been considered notoriously inaccessible. Traditionally, histopathological diagnosis has been achieved by open surgical biopsy in patients who are poor surgical candidates due to multiple comorbidities. This retrospective review assesses whether requirements for open surgical biopsy in this population can be reduced. MATERIALS AND METHODS All patients who underwent CT guided core biopsy of head or neck masses during the three year period from April 2009 to April 2012 were identified using the CT Interventional Procedures database. Patients received conscious sedation and core needle biopsies were performed by one of three experienced neuroradiologists. Histopathology results were obtained for each of the patients biopsied and diagnostic outcomes were assessed. RESULTS Sixteen core biopsies were performed in the three year period. 10 (62 %) yielded diagnostic samples. Pathologies encountered included pleomorphic adenoma, gliosarcoma, B-cell NHL and squamous cell carcinomas. Six core biopsies were non diagnostic and occurred in the pterygopalatine fossa, hard palate and parapharyngeal spaces. There were no procedure related complications. CONCLUSION The use of CT guidance to perform core biopsies of head and neck masses significantly reduces the need for general anaesthetic and open surgical biopsy in frail patients. The anatomical locations, imaging features and histopathology of the tumours encountered are discussed as well as the biopsy technique.

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P-75 ENDOVASCULAR TREATMENT OF SMALL CEREBRAL ANEURYSMS Branko Prstojevic, Ivan Vukasinovic, Dragoslav Nestorovic Section for Neuroradiology, Clinical Center of Serbia, Belgrade, Serbia BACKGROUND Endovascular treatment of cerebral aneurysms with diameter ≤5 mm, especially those measuring ≤3 mm, may be difficult and associated with high risk of complications because of their small size. METHODS Between August 2008 and April 2012, of 114 aneurysms selected for embolization, 109 were successfully treated. Of 109 treated aneurysms, 13 (two ≤3 mm) were acutely ruptured, and 96 (38 ≤3 mm) were unruptured or treated after period of vasospasm. All but six aneurysms were treated with coil embolization, one of them with balloon remodeling technique and nine with stent assisted coiling. Five aneurysms were treated with stents only. In one patient distal aneurysm was treated with liquid embolic material Onyx. RESULTS Embolization was carried out without technical difficulties in 109 of 114 cases (in five cases unfavorable angioarchitecture). Coil packing was not available after stent implantation in three cases. Stent-in-stent technique was performed in two cases. Initially on postembolization angiography 69 (63.3 %) aneurysms were completely obliterated. One year follow-up period performed for 91 aneurysms, showed complete obliteration in 81 (87.9 %), there was no recanalisation, and no patient needed additional coil embolization. Final outcomes were good recovery in 96 patients, moderate disability in three, and no severe disability. Procedure-related rupture occurred in one (0.9 %) of 109 treated aneurysm. CONCLUSIONS With appropriate selection of patients and material, endovascular treatment of small aneurysms (≤5 mm) is a safe, effective and occasionally only therapeutic technique. Short term follow-up showed stable occlusion. Long term durability of the treatment remains to be determined. P-76 T E C H N I Q U E S F O R T H E E N D O VA S C U L A R TREATMENT OF CAROTID-CAVERNOUS FISTULAE Pedro Vega, Eduardo Murias, Ana Benitez, Nancy Sanchez, Beatriz Escobar, Pilar Redondo Hosptial Central De Asturias, Oviedo, Spain

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INTRODUCTION Carotid-cavernous fistulae are abnormal connections between the carotid artery and the cavernous sinus. They are classified as type A, or direct, and Type B, C and D, or indirect, which may received arterial afferences from the dural branch of the internal carotid artery, the external carotid artery or both. Endovascular treatment is the treatment of choice and there are different options that adapt to each type of fistula and patient. MATERIAL AND METHODS Retrospective analysis of patients with carotid-cavernous fistulae receiving endovascular treatment at the Hospital Central de Asturias between 2005 and the present. The most illustrative cases of each one of the treatment options were selected. RESULTS The different endovascular techniques that are presented for the treatment of carotid-cavernous fistulae are: &

DIRECT FISTULAE:

& &

Balloon-assisted arterial coil embolization. Venous embolization with high-density onyx.

&

o Implantation of covered stent in the internal carotid artery. INDIRECT FISTULAE: o Artery embolization with particles. o Venous coil embolization through the posterior petrosal sinus. o Venous coil embolization through the ophthalmic vein. o Venous coil embolization with percutaneous puncture through the foramen ovale.

& & & & &

Complication-free fistula closure was achieved in all cases. CONCLUSIONS Representative cases of the different endovascular techniques available for the treatment of different types of carotid-cavernous fistulae are presented. P-77 COELIAC PLEXUS NEUROLYSIS FOR PANCREATIC CANCER PAIN: A STUDY OF THE RELEVANT ANATOMY Emily Ward University of Leeds, Leeds, UK Coeliac plexus neurolysis for pancreatic cancer pain has seen many developments and improvements since its initial description in 1919. The two techniques commonly used today are a variation on the original posterior percutaneous approach and an endoscopic ultrasound guided approach.

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The anatomy is an important consideration but textbook descriptions of the coeliac plexus are often vague and conflicting. This study aims to compare these two approaches with reference to a study of the relevant anatomy. The literature was reviewed and three cadaveric dissections undertaken to arrive at a well-informed opinion on the subject. The dissections confirmed some of the anatomy as described in textbooks and clarified their topography. Furthermore, the coeliac ganglia were found to have a visible blood supply, which has not been reported before. A review of the literature and study of the anatomy confirmed that the endoscopic ultrasound guided approach is a safer method for coeliac plexus neurolysis. The efficacy of the procedure is improved by direct ganglionic injection and wider spread of the injectate. Therefore, coeliac plexus neurolysis should be undertaken by endoscopic ultrasound guidance, with an aim to target the coeliac ganglia bilaterally as visualised by an ultrasound probe. It is speculated that the finding of a ganglionic blood supply may aid the visualisation of the ganglia by an endoscopic ultrasound probe.

patients developed ischemic symptoms after the three month course of dual antiplatelet treatment (at 4 and 10 months), and hence hypothetically, only one patient could be prevented from developing transient ischemic attack if the initial dual antiplatelet treatment were of six months. As compared to dual antiplatelet treatment of 13 to 15 weeks, the three patients with shorter (6-8 weeks) dual antiplatelet treatment did not develop any ischemic symptom (p00.231). CONCLUSION We recommend that a post-procedural 6-14 week dual antiplatelet treatment for unruptured intracranial small saccular aneurysm is adequate.

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Priya Bhatnagar, R Andy James, Richard Quinton, Dipayan Mitra, Ahmed Iqbal Royal Victoria Infirmary, Newcastle upon tyne, UK

PIPELINE EMBOLIZATION DEVICE (PED) FOR UNRUPTURED INTRACRANIAL ANEURYSMS: A SINGLE CENTER EXPERIENCE USING SHORTER DUAL ANTIPLATELET TREATMENT George Kwok Chu Wong, Simon Yu, Wai Sang Poon Chinese University of Hong Kong, Hong Kong, Hong Kong PURPOSE Dual antiplatelets, typically aspirin and clopidogrel, are recently recommended to continue for at least six months after Pipeline Embolization Device (PED) treatment. However, prolonged dual antiplatelet treatment is known to be associated with increased risk of major bleeding. We aim to report our management outcome in using a shorter postprocedural dual antiplatelet treatment. METHOD A retrospective review of eighteen patients with 19 unruptured intracranial aneurysms with PED treatment between September 2008 and January 2012 was performed. RESULTS Median clinical follow up was 25 months and ranged from 2 to 42 months. Satisfactory occlusion was attained in 10(77 %) patients at a median of 8 months (range: 3 to 17 months). Two

THEME: PAEDIATRIC NEURORADIOLOGY P-79 A PICTORIAL REVIEW OF THE VARIOUS CONGENITAL ABNORMALITIES AFFECTING THE HYPOTHALAMIC-PITUITARY AXIS

AIMS 1. To review the embryology and anatomy of the pituitary gland. 2. To discuss the imaging appearances of the various congenital abnormalities affecting the hypothalamic-pituitary axis. BACKGROUND Congenital abnormalities affecting the hypothalamicpituitary axis constitute a major group of childhood hypopituitarism. The structural abnormalities of the stalk and the pituitary gland correlate with the number and severity of concurrent hormone deficiencies. Imaging with MRI plays a crucial role in their diagnosis and management. IMAGING FINDINGS We discuss the relevant anatomy of the pituitary gland. This along with the embryological correlations of the pituitary gland with the adjacent structures facilitate the correct interpretation of these congenital abnormalities. Using case studies, we demonstrate the various conditions that may affect the hypothalamic-pituitary axis. We also discuss the appropriate imaging protocols for optimizing sensitivity to these conditions and discuss the differential diagnoses.

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We illustrate examples of pituitary agenesis and hypoplasia, duplicated pituitary gland, ectopic posterior pituitary bright spot, septo-optic dysplasia, hypothalamic abnormalities associated with pituitary duplication and hypothalamic hamartoma , etc. CONCLUSION An understanding of embryology of the pituitary gland will help in the correct interpretation of the various congenital abnormalities and their imaging characteristics. This review will update the Neuroradiologist and enable physicians to manage patients effectively. P-80 CURVILINEAR REFORMATTING OF 3D MRI DATA OF THE CEREBRAL CORTEX FOR IMPROVED DELINEATION OF CORTICAL MALFORMATIONS Norbert Campeau, Alice Patton Mayo Clinic, Rochester, Minnesota, USA PURPOSE To illustrate the merits of a curved reformatting postprocessing algorithm for assessment of epileptogenic cortical malformations. METHODS Three-dimensional (3D) volumetric T1-weighted data sets obtained from magnetic resonance imaging studies performed for evaluation of individuals with epilepsy were post-processed manually on a computer workstation using a curvilinear reformatting algorithm to produce a flattened 2-dimensional rendition of the cortex of the entire brain. Reformatted images of the brain were obtained to depict the cortical surface, and serial reformatted curvilinear planes at varying depths/thickness from the cortical surface. RESULTS Pathology identified and processed with curved reformatting included focal cortical dysplasia, lissencephaly, pachygyria, polymicrogyria, and schizencephaly. The location of the pathology and extent of cortical involvement was improved with curved reformatting algorithm. Anatomic landmarks and their relationship to the location of abnormalities are determined more precisely with curved reformatting. Improved comparison of contralateral anatomy allows for more confident determination of subtle abnormalities.

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CONCLUSION Curvilinear reformatting not only allows improved delineation of cortical malformations, but assists in identification of normal anatomic landmarks. This technique provides an efficient and concise visual representation of pathology, useful for conveying imaging findings to referring clinicians and helpful for surgical planning. P-81 COMPARISON OF A STRUCTURAL MRI GRADING SYSTEM WITH PROTON MR SPECTROSCOPY IN PERINATAL HYPOXIC ISCHAEMIC INJURY Julie Chandra1, Morag Andrew2, Jonathan Downer1, Jamie Near 3 , Peter Sullivan 2 , Jeremy Parr 2 ,4 , Gerardine Quaghebeur1 1 Department of Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK, 2Department of Paediatrics, University of Oxford, Oxford, UK, 3Oxford Centre of Functional MRI of the Brain, University of Oxford, Oxford, UK, 4 Institute of Neuroscience, University of Newcastle, Newcastle, UK Previous studies have demonstrated that elevated deep grey matter lactate/N-acetyl aspartate ratios in the neonatal period most accurately predict later neurodevelopmental outcome, and may be more accurate than conventional MRI or assessment of brain-water apparent diffusion coefficient. This prospective study compares a structural and diffusion weighted magnetic resonance imaging (MRI) grading system, with proton MR spectroscopy, in newborn babies with hypoxic ischaemic injury. Sixteen term babies with hypoxic ischaemic injury underwent structural and diffusion MRI and proton MR spectroscopy at baseline as part of a randomised trial evaluating the effects of neurotrophic nutritional supplementation. On structural and diffusion weighted imaging, brain injury was graded mild, moderate or severe by a paediatric neuroradiologist. Using 2D chemical shift imaging, voxels within the basal ganglia, thalamus and supratentorial white matter were selected and metabolite ratios calculated. These were rated as normal or abnormal by the same assessor who was blind to the structural imaging data. Analysis investigated the relationship between the MR spectroscopy rating, and the structural MRI grading system. Preliminary results will be presented.

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intraparenchymal diverticula development that might require prompt surgery to avoid irreversible brain damage.

INTRAPARENCHYMAL VENTRICULAR DIVERTICULA: A NEW ENTITY

P-83 Valentina Citton1, Maria Chiara Zanotti 2 , Annalisa Traverso 3 , Sandro Dal Pos2, Alessandro Salvalaggio2, Giacomo Cester2, Laura Milanese2, Roberto Faggin4, Marta Rossetto4, Riccardo Perini4, Stefano Sartori3, Debora De Carlo3, Paola Drigo3, Marco Zerbo5, Renzo Manara1 ,2 1 Neuroradiology Unit, Ospedale San Camillo, AlberoniVenezia, Italy, 2Neuroadiology Unit, University Hospital of Padua, Padua, Italy, 3Department of Pediatrics, University of Padua, Padua, Italy, 4Neurosurgery, Department of Neurosciences, University Hospital of Padua, Padua, Italy, 5 S. Bassiano Hospital, Bassano del Grappa, Italy INTRODUCTION Ventricular diverticula, well-known outpouching in the subarachnoid spaces, occur in up to 25 % of severe obstructive hydrocephalus cases. We outlined the features, evolution and clinical impact of a new form of intraparenchymal ventricular diverticula. MATERIALS AND METHODS MRI scans of 126 patients (age-range: 2 mths-67 yrs; meanage: 11 yrs; 58 females) featured by chronic-obstructive hydrocephalus were analyzed. Classical ventricular outpouching in the subarachnoid spaces, post-hemorrhagic parenchymal malacia, paths of ventricular shunting and cavities not communicating with the ventricles were not considered. RESULTS Four male patients had intraparenchymal ventricular diverticula (mean-age: 19.5 yrs; age-range: 9-30 yrs) sprouting from temporal horns; two left and right unilateral diverticula were relatively small and confined to the temporal pole. Bilateral diverticula (two cases) were larger and progressed over time: two reached the posterior part of the temporal lobes, one the parietal lobe, one spread to the entire hemisphere parallel to the lateral ventricle; the latter, due to ventricular shunt dysfunction, caused mild progressive hemiparesis. Six patients had intraparenchymal cavities communicating with the ventricles (2 and 3 in frontal and parieto-occipital regions, respectively, 1 in parieto-occipital region bilaterally) but showed no evolution. DISCUSSION Intraparenchymal ventricular diverticula likely represent cavities caused by continuous CSF pressure waves, leading to white matter bundles progressive dissection. The "cortical" barrier likely determine the growing of intraparenchymal diverticula parallel to the ventricular walls. CONCLUSIONS Dealing with chronic severe obstructive hydrocephalus, neuroradiologists should be aware of ventricular

CAN PRE-OPERATIVE PERFUSION MRI IDENTIFY CHILDREN AT RISK OF POST-OPERATIVE CEREBELLAR MUTISM? A RETROSPECTIVE ANALYSIS Rob Dineen1, Daniel Rodriguez Gutierrez1 ,2, Richard Grundy2, Dorothee Auer1 ,2 1 Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, UK, 2Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK Reduced cerebral gray matter perfusion, interpreted as cerebello-cerebral diaschisis, is described in cerebellar mutism (CM) occurring after posterior fossa tumour resection. A recent case report has identified preoperative cerebral perfusion reduction in an adult subsequently developing CM. We perform a retrospective analysis of fourteen individuals (range 5.3-19.6 years) with posterior fossa tumours (7 pilocytic astrocytoma, 6 medulloblastoma, 1 ependymoma), to test whether pre-operative dynamic susceptibility contrast perfusion MRI (DSC-MRI) can distinguish those who did (CM+, n 05) and did not (CM-, n 09) develop post-operative CM. All individuals had 3 Tesla MRI including axial T2 and DSC-MRI. Cerebral blood flow (CBF) maps were produced using JIM5.0 software. Subsequent image processing was performed with FSL. Partial volume corrected CBF values for the cerebral cortex were extracted based on automated cortical segmentation of the coregistered T2 images. Atlas-based regions-ofinterest (ROIs) were defined for the right frontal, left frontal and occipital poles. For each individual, cortical CBF values were normalised by converting to z-scores based on occipital ROI CBF values (a cortical region not previously identified as hypoperfused in postoperative perfusion studies in CM). Normalised CBF values from the frontal ROIs were compared between CM + and CM- groups using Mann-Whitney U Test. No differences in normalised CBF values were found between CM+and CM- groups for right (mean 0.27 v 0.24, p0 1.0) or left (0.35 v 0.30, p0.80) frontal cortex. Based on this cortical perfusion analysis using pre-operative DSC-MRI it was not possible to distinguish individuals at risk of developing CM.

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P-84 A NEW REPORT OF CLN5 IN AN ITALIAN CHILD WITH LEARNING DISABILITIES AND VISUAL LOSS Simona Fiori2, Annamaria Valleriani1, Raffaello Canapicchi1, Francesca Moro1, Filippo Santorelli1, Giovanni Cioni1 ,2, Roberta Battini1 1 Dpt. Developmental Neuroscience - IRCCS Stella Maris, Pisa, Italy, 2University of Pisa, Pisa, Italy Neuronal ceroid-lipofuscinosis (CLN) include a group of inherited neurodegenerative diseases of childhood diffusely involving the CNS. CLNs determine neuronal death, resulting in cerebral and cerebellar atrophy and photoreceptor loss. Autofluorescent material accumulates in brain and other tissues. Clinical unifying hallmarks include blindness, cognitive and motor delay and seizures. 10 or more clinical and genetic variants are described. CLN5 is a rare variant in italian population. MRI findings in CLN5 shows early severe cerebellar atrophy whereas in other form cerebral atrophy progresses similar to cerebellar involvement. Clinical features include typically early visual loss, clumsiness, cognitive and motor decline and seizures. We report the case of a 10 years italian old boy affected by CLN5 genetically defined. He presented an early language delay but by the age of 6 years a gradual cognitive and neuromotor decline became evident with learning disabilities and progressive visual loss. MRI performed at age 7 showed a marked cerebellar atrophy and a white matter abnormalities which oriented for diagnosis. At age 9 seizures started. He proved heterozygous for W224X and V263E mutations in CLN5 gene. Second MRI study at age 10 years shows a severe cerebellar atrophy involving both the vermis and emispheres with thin cerebellar folia and subarachnoid spaces enlargement. Signal hyperintensity is observed on T2W images in periventricular white matter, extending to the internal capsula bilaterally. Pericerebral CSF spaces are mildly enlarged. Proton MRS shows reduction of NAA due to neuronal loss togheter with elevated mI peak due to gliosis. P-85 MRI AND MRS FINDINGS IN PATIENTS WITH UREA CYCLE DISORDERS Bozena Goraj1, Maaike de Vries2, Mirian Janssen3, Marinette van der Graaf1 ,2 1 radboud University Nijmegen Medical Center. Dept of Radiology, Nijmegen, The Netherlands, 2Radboud Univerity Nijmegen Medical Center. Dept of Pediatrics, Nijmegen, The Netherlands, 3Radboud University Nijmegen Medical Center. Dept of Internal Medcine, Nijmegen, The Netherlands

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Deficiency of one of six enzymes of urea cycle results in hyperammonemia which affects brain and causes clinical symptomatology. Urea cycle disorders clinical presentation depends on the type and degree of the deficiency and can be severe. Magnetic resonance spectroscopy (MRS) can depict metabolite content of parenchyma, allowing to asses damage caused by hyperammonemia. We aimed to investigate brain pathology by Magnetic Resonance Imaging (MRI) and MRS in patients with different urea cycle disorders and to show the spectrum of pathological changes on both MRI and MRS in correlation with clinical symptoms at different stages of the illness. Two young children, one infant and one young adult are presented. All underwent at least twice brain MRI and once MRS. Examinations were performed on a 1.5 T and/or 3 T scanner. The scanning sequences included T1IR; T2W, FLAIR, DWI; no contrast agent was administered. MRS was performed with PRESS single voxel technique. Different findings were observed in individual patients at various disease phases. In two patients no distortions in MRS were noted while abnormalities on the MRI were evident. In one patient scanned at acute and subacute stage, both MRI and MRS showed aberrations. In one patient with a chronic course MRS revealed relevant abnormalities, while MRI showed mild cerebral atrophy. Brain MRS in patients with urea cycle disorders can show metabolite derangements, which underlie pathological processes affecting cerebral parenchyma. The combination of MRI/MRS allows more complete evaluation of the damage to the brain caused by urea cycle enzymes deficits. P-86 MAGNETIC RESONANCE IMAGING (MRI) OF CALLOSAL AGENESIS WITH INTERHEMISPHERIC CYST TYPE RAYBAUD OR BARKOVICH: IS T H E R E A C L A S S I F I C AT I O N F O R A L L PATIENTS? Thorsten Schmidt1, Astrid E. Grams1, Elke R. Gizewski1 ,2 1 Neuroradiology, University Hospital, Gießen, Germany, 2 Neuroradiology, University Hospital, Innsbruck, Austria PURPOSE Presentation of diagnostic MRI criteria for callosal agenesis with interhemispheric cyst and evaluation of two established classifications of the condition regarding applicability. Presentation of a MRI protocol for concise and conclusive

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diagnostic imaging of the condition and its relevant differential diagnoses. MATERIALS AND METHODS MRI scans of six patients with callosal agenesis and interhemispheric cysts were analyzed regarding morphology and key criteria to the diagnosis. In two patients, the scans were performed prospectively with adjustment of MR protocols. On the basis of Raybaud’s and Barkovich’s classification, an attempt to assign patients to the respective diagnostic classes was performed. RESULTS On the basis of Raybaud’s classification, 4/6 patients could be assigned to one of the three types of callosal agenesis with interhemispheric cyst. With Barkovich’s classification, 2/6 patients could successfully be assigned to one of the three types. Crucial imaging criteria for the diagnosis and differential diagnosis were visualized using standard MR sequences adding multiplanar high resolution MR sequences. CONCLUSION MRI of the brain is the modality of choice for imaging brain anomalies. Its multiplanarity and tissue contrast allow the diagnosis and differential diagnosis of callosal anomalies with associated interhemispheric cystic changes. Using two established classification systems, not all of our patients could be assigned exactly to the discrete classes. This is due to great variations in the combination of malformations in these patients. Further studies on the basis of pathogenesis, i.e. time of the underlying insult, are necessary for understanding this complex group of malformations. P-87 STERILE BRAIN ABSCESS DUE TO JUVENILE XANTHOGRANULOMA: MRI CHARACTERISTICS Ellie Kwak1, Daniel Marrero1, Sami Erbay1, Rolf Pfanni2 1 Lahey Clinic, Burlington, MA, USA, 2Tufts Medical Center, Boston, MA, USA Juvenile xanthogranuloma (JXG) is a form of histiocytosis that usually presents as a solitary cutaneous lesion in children. Rare systemic involvement can present with CNS, orbit, lung, kidney, liver, and spleen lesions. A small number of cases have been reported with intracranial MR findings. Imaging characteristics of intracranial JXGs have been variable. Although there has been a single case report describing MR spectroscopy (MRS) findings of intracranial JXG, information on diffusion-weighted imaging (DWI) has been lacking. In our case report, we have provided DWI and MR spectroscopy (MRS) findings of a unique intracranial lesion in an infant with systemic JXG.

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P-88 PAEDIATRIC ORBITAL AND PERI-ORBITAL CELLULITIS: 10-YEAR EXPERIENCE WITH CT AT A TERTIARY-LEVEL CHILDREN'S HOSPITAL Anup Mathew1, Emma Craig1, Reham Al-Mahmoud1, Ruth Batty1, Ashok Raghavan2, Dan Connolly1 1 Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK, 2 Department of Radiology, Sheffield Children's Hospital, Sheffield, UK AIMS To assess the incidence and complications of peri-orbital (POC) and orbital cellulitis (OC) over 10 years. POC and OC are also known as pre-septal and post-septal cellulitis respectively. METHODS Retrospective analysis of CT scans. Data included presence of POC and OC, paranasal-sinus disease (PNS) and complications. RESULTS 125 patients; 67 had both POC and OC, 37 had POC, 4 had OC; 17 normal scans. 110 had PNS. 68/71(96 %) patients with OC had PNS. OC complications included orbital and/ or sub-periosteal abscess (50/71: 30 medial orbital, 10 supero-medial, 3 lateral, 2 antero-medial, 2 infero-medial, 1 superior and 1 antero-superior), cavernous sinus thrombosis (1), SOV thrombosis (4) and subdural empyema (2); 1 patient had both SOV thrombosis and empyema. CONCLUSIONS 71/125 (57 %) had OC. 50/125 (40 %) patients imaged for POC/OC had orbital abscess, of which 88 % involved the medial orbit. Patients can develop solely superior or inferior abscess which are difficult to identify by axial imaging alone, hence coronal imaging is essential. 5/125 (4 %) patients developed major complications (SOV/CST/empyema), hence imaging review of the head and cavernous sinus region is essential. A diagnosis of OC on CT should alert the radiologist as it is associated with an increased incidence (5/71, 7 %) of complications. P-89 MEGALENCEPHALY, MEGA CORPUS CALLOSUM AND PSHYCOMOTOR RETARDATION SYNDROME: CONFIRMATION OF ASSOCIATED POLYMICROGYRIA WITH SERIAL NEUROMAGING Ioannis Nikas1, Iosif Kalegias2, Artemis Gika1, Sotirios Youroukos1, Maria Theofanopoulou3, Roser Pons1 1 agia Sofia Children's Hospital, Athens, Greece, 2general Hospital, Patras, Greece, 3diagnostic Centers Ionia Euromedica, Athens, Greece

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Megalencephaly, mega corpus callosum and pshycomotor retardation syndrome is a rare disorder of unknown origin characterized by severe developmental delay, generalized megalencephaly, a thickened corpus callosum and perisylvian polymicrogyria . We are reporting a new case of this syndrome who presented with macrocephaly, hypotonia, profound developmental delay and a seizure disorder since early life. Brain MRI performed at 3 and 6 months of age showed a cyst of the septum pellucidum with thick walls, a thick fornix and an enlarged corpus callosum. A repeat MRI at the age of 3 years, given the completion of myelination, clearly demonstrated, a perisylvian polymicrogyric pattern. This finding confirmed the diagnosis of "megalencephaly, mega corpus callosum and psychomotor retardation syndrome". In addition, the recent MRI showed peculiar white matter lesions in the periventricular areas and the centra semiovale, which could not be accounted for (of demyelinating or dysmyelinating type). These white matter findings led us to perform a comprehensive metabolic work up that was non diagnostic. The patient was followed clinically and he showed a very slow but favorable developmental progress.

METHOD The brain and spine MR examinations were performed on 1.5 T scanner using phased-array 8-channel head coil and phased-array 6-channel spine coil. T2- and T1-weighted pre and post contrast images were obtained in TSE, FLAIR, FATSAT sequences. RESULTS Gadolinium-enhanced MR examinations of the brain showed the intense meningeal enhancement of the base of frontal lobes, prominent enhancement of the optic nerves and hydrocephalus. Diffuse and nonenhancing white matter lesions, hyperintense on T2-WI were seen. Gadolinium-enhanced MR spine exams demonstrated patchy intramedullary lesions on the thoracic levels with cysts formation. CONCLUSION Contrast enhanced magnetic resonance is a method of choice in the assessment of neurologic involvement of sarcoidosis. Because of nonspecific MR manifestations the brain biopsy may benecessary, particularly in cases of isolated neurosarcoidosis.

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VEIN OF GALEN ANEURYSMAL MALFORMATION IN CHILDREN: CHALLENGES OF IMAGING IN AN AFRICAN SETTING

MAGNETIC RESONANCE IMAGING IN THE CASE OF ISOLATED NEUROSARCOIDOSIS 1

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Katarzyna Nowak , Katarzyna Kotulska , Marek Mandera , Wieslawa Grajkowska4, Malgorzata Bilska2, Katarzyna Malczyk1, Elzbieta Jurkiewicz1 1 The Children's Memorial Health Institute, Department of Radiology, Warsaw, Poland, 2The Children's Memorial Health Institute, Department of Neurology, Warsaw, Poland, 3 Silesian Medical University, Department of Pediatric Neurosurgery, Katowice, Poland, 4The Children's Memorial Health Institute, Department of Pathology, Warsaw, Poland Sarcoidosis is an idiopathic systemic disease that usually develops in the respiratory system but it may involve all parts of the body. We present a case of isolated central nervous system involvement recognized in 13-year-old girl and confirmed by brain biopsy. We describe clinical and imaging findings of neurosarcoidosis in this case. At the age of 11 the girl presented with behavioural disturbances, progressive intellectual decline and slowly progressing weakness of lower limbs. Six months later she developed acute hydrocephalus and shunt was implanted. Brain biopsy revealed granulomata typical for sarcoidosis with few Langhans cells. Extensive tests excluded lung, lymph node and skin sarcoidosis. Prednison therapy resulted in marked improvement in her behaviour, intelectuall abilities and muscle strenght.

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Godwin Ogbole1, Amos Adeleye1, Busayo Olatunji2 1 University of Ibadan, Ibadan,Oyo, Nigeria, 2University College Hospital, Ibadan,Oyo, Nigeria BACKGROUND Aneurysmal malformations of the vein of Galen (VGAM) are a rare congenital intracranial vascular disorder. It is known to occur in two main forms, we present two children with classic demonstrations of broadly recognised categories. it typically result in high-output congestive heart failure or may present with developmental delay, hydrocephalus and seizures. OBJECTIVES Understanding the challenges of imaging and management in an African setting of a rare congenital intracranial vascular disorder presenting in older African children with demonstrations of infrequently recognised associations using limited imaging techniques. METHODS AND RESULTS CT showed extensive gyriform hyperdensities at the greywhile matter junction, dilatation of a portion of the superior sagittal sinus with erosion of the inner table of the calvarium .multiple abnormal tortuous vessels in the suprasellar region. A markedly dilated vein of Galen and ventricular system MRI showed a tortuous dilated pontomesencephalic vein in the quadrigeminal cistern, dilated vein of Galen and straight

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sinus. a network of vessels in the quadrigeminal cistern draining into dilated vein of Galen. thinning of the corpus callosum is seen Chest radiograph and Electrocardiographic chart showed evidence cardiomegaly and cardiac failure. We review the literature and discuss the challenges of imaging and management in our African setting. CONCLUSION The VGAM is a recognised rare anomaly, however knowing the true prevalence and improving its management in our African environment is limited due to the challenges of available imaging technology, lack of personnel in interventional neuroradiology and inaccessibility to care of a large poor population.

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confirmed US findings in all cases and also provided additional information about cortical development that was difficult to illustrate by US. CONCLUSION Fetal MR imaging is an important diagnostic technique that we should use to demonstrate normal development and abnormalities of fetal CNS . P-93 BLAKE’S POUCH CYST: EMBRYOLOGY, IMAGING FINDINGS & DIFFERENTIAL DIAGNOSIS Ian Robinson, David Perry Starship Children's Hospital, Auckland, New Zealand

P-92 FETAL BRAIN MRI: HOW TO DO IT Elena Roa1, Francisco Salazar0 ,2, Felipe García0 ,1, Alvaro Paniagua0 ,3, Ignacio Alba0 ,3, Javier Azpeitia0 ,2 1 UCR. Hospital Infanta Leonor, Madrid, Spain, 2Hospital Infanta Leonor, Madrid, Spain, 3UCR. Hospital Infanta Sofía, Madrid, Spain OBJECTIVE To describe the procedure for performing fetal MRI. To evaluate the protocol used in fetal MRI to obtein additional information not only to evaluate cerebral development but also allowed characterization of CNS abnormalities that are not sure by US. REVIEW Ultrasonography (US) is the modality of choice for prenatal screening. In same cases RM can be performed for additional information. We performed brain MR in fetuses of 20-34 weeks of gestational age within 2-5 days after US. Fetal MR imaging was performed on 1.5 T Signa HDX GE machine with a phase-array torso coil. Especial informed consent was obtain previous to MR. Lorazepam 10 mg was orally administered ten minutes before MR was performed . Protocol used in fetal brain MRI was Single-shot FSE T2 sequence in three planes respect to fetal brain ( axial, sagittal an coronal ). It is very important to include on coronal and axial sequences fetal superior abdomen to identify right or left sides of fetal cerebral hemisferies. Single-shot FSE T2 sequence parameters were : TE 200, TR minimum as possible, slice thickness 2.0 mm, spacing 0.2 mm, F.O.V 26 and matrix 256x224. Single-shot FSE T2 imaging allowed the visualization of normal anatomy and development of fetal CNS . MR

Since being described by Tortori-Donati in 1996 as a separate entity within the Dandy Walker spectrum, Blake’s Pouch Cyst (BPC) has become an increasingly recognised cause of tetraventricular hydrocephalus. Blake’s Pouch is usually a transient structure, seen during normal development of the rhombencephalon, before fenestrating to permit communication of the intra-axial CSF space with the subarchnoid CSF space. The pouch and its vestigial remnants are commonly seen on antenatal ultrasound. Failure of adequate fenestration of the pouch leads to the formation of a Blake’s Pouch Cyst, characterised by an infracerebellar cyst, elevation of an otherwise normal cerebellar vermis, cystic dilatation of the 4th ventricle and some degree of compression on the medial cerebellar hemispheres and inferior cerebellar vermis. In this poster we first present the embryology of the Blake’s Pouch, including the latest observations from genetic research on the FOXC1 gene, and place it in context within Barkovich’s latest developmental and genetic classification for midbrain-hindbrain disorders. We perform a pictorial review of imaging findings in this entity, including antenatal ultrasound, fetal MRI and postnatal MRI. Finally we discuss the place of Blake’s Pouch cyst in relation to the Dandy Walker complex and review the major differential diagnoses including mega cisterna magna, mild Dandy Walker spectrum and communicating hydrocephalus. P-94 DOES "SHAKEN BABY SYNDROME" STILL EXIST? Dawn Saunders, Roxanna Gunny Great Ormond Street Hospital NHS Foundation Trust, London, UK

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In 2009, a 4 month baby was found unwell in his cot and taken to the GP. Over the next 8 hours, the baby developed status epilepticus and was transferred to our institution for intensive care treatment. CT head scan revealed complex depressed fracture of the parietal and occipital bones, overlying soft tissue swelling, extradural haematoma, sutural splaying, shallow bilateral subdural haematomas (SDH) and marked cerebral swelling and global infarction sparing the posterior fossa. An MRI scan performed a few hours later, confirmed the CT appearances and revealed additional posterior fossa SDH. Established infarction of the cerebral hemispheres and basal ganglia was confirmed. Ophthalmology revealed full thickness and widespread retinal haemorrhages (RHs). Skeletal survey demonstrated multiple fractures. Later, the baby sadly died and criminal and family court proceedings were instigated. Post mortem revealed that the child suffered from congenital rickets. The case engendered enormous debate, centred on the hotly debated and rather poorly substantiated "association" between hypoxia and SDHs and raised ICP and full thickness RHs and based on differing clinical experience. The fractures were considered to be secondary to normal handling in a rachitic skull, the cerebral infarction secondary to reduced perfusion during status epilepticus, and the RHs secondary to periods of sudden raised ICP. The subdural and subgaleal haematomas remain unexplained. The diagnosis of NAHI was dismissed by both courts and a public call has been made for the "shaken baby" diagnosis to be discarded. NAHI remains a challenging diagnosis and without more scientific data, will remain so. P-95 THE EXPANDING NEURORADIOLOGICAL PHENOTYPE OF COL 4 A1 GENE MUTATIONS Dawn Saunders, Roxanna Gunny, Joanne Ng, Prab Prabhakar, Lucinda Carr Great Ormond Street Hospital NHS Foundation Trust, London, UK BACKGROUND Mutations in the collagen 4 A1 gene, that leads to weakness in the vascular basement membrane, has been implicated in familial porencephaly in neonates and infants with uneventful neonatal periods, others with documented antenatal intraparenchymal haemorrhage (ICH) and “periventricular leukomalacia (PVL) and intracranial calcification (ICC). CLINICAL CASES Only one of the 6 cases had antenatal concerns and all developed seizures during infancy; 5 had microcephaly and developmental concerns. Two had cataracts; micro-

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opthalmia in one. One child had congenital hemiparesis and two had generalised spasticity. One child had an older sister with cerebral palsy and congenital cataracts. CMV was ruled out in all. NEUROIMAGING All children had MRI scans and one had a CT brain scan that revealed bilateral punctate ICC. One child had asymmetrical PVL alone and another had a unilateral haemorrhage lined porencephalic cyst. Four had bilateral asymmetrical leukoencephalopathy with haemorrhage or calcification lined porencephalic cysts. Two had diffuse and extensive scattered haemorrhage/calcification and two had closed lip schizencephaly lined with polymicrogyria. Three children had asymmetric damage to the cerebellum with a cortical malformation in one. CONCLUSION The identification of col 4A 1 mutations has diagnostic and prognostic implications and should be considered in children with appearances of asymmetrical PVL, porencephalic cysts, intracranial haemorrhage and calcification, asymmetrical cerebellar damage and schizencephaly lined with polymicrogyria particularly in the absence of a significant perinatal history. Cataracts or relevant FH need not be present. P-96 NEONATAL HYPOXIC-ISCHEMIC INJURY: NEURORADIOLOGICAL FINDINGS Andrés Server Alonso1, Till Schellhorn1, Janne Skranes2, Tom Stiris2, Marianne Thoresen3, Drude Fugelseth2 1 Neuroradiology, Oslo University Hospital, Oslo, Norway, 2 Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway, 3Neonatal Neuroscience,School of Clinical Sciences, University of Bristol, Bristol, UK PURPOSE Hypoxic-ischemic brain injury (HII) results in neonatal hypoxic-ischemic encephalopathy. The aim of this educational exhibit is to give attention to the factors such as brain maturity at time of insult, duration and severity of insult, and timing of imaging studies that all influence findings in HII and we highlight the application of advanced MR techniques, such as DWI, MRS, and ASL. METHODS We reviewed the literature concerning HII in order to actualize the different patterns of injury, including the imaging findings after hypothermia therapy. RESULTS In preterm neonates, mild hypotension causes periventricular white matter injury; severe hypotension results in

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infarction of the deep gray matter, brainstem, and cerebellum. In term neonates, mild hypotension causes parasagittal cortical and subcortical injury; severe hypotension causes injury of the lateral thalami, posterior putamina, hyppocampi, and corticospinal tracts. Hypothermia therapy is associated with a reduction in the extent and severity of lesions in the basal ganglia and thalamus. There are four patterns of brain injury that can be identified on acute neonatal DWI: boundary zone injury, total cortical injury, basal ganglia injury, and total brain injury pattern. In the first 24 hours , MRS is probably the best technique, because it shows marked lactate elevation. ASL may be useful for identifying asphyxiated neonates at risk of developing brain injury. CONCLUSION An awareness of the patterns of injury is important for the neuroradiologist to make the diagnosis of HII and to understand the significance and potential outcome of these injuries. P-97 IMAGING SPECTRUM OF PEDIATRIC TUMORS OF THE EYE AND ORBIT: A PICTORIAL REVIEW Sergio Soto1 ,2, Francisco Chiang1 ,2, Felipe Castro1 ,2, Catalina Silva1 ,2, Pedro Villarroel1 ,2, Juan Quintana1 1 Clínica Dávila, Región Metropolitana, Chile, 2Universidad de Los Andes, Región Metropolitana, Chile There is a wide variety of solid and cystic masses that involve the eye and orbit in pediatric patients. These tumors are uncommon in children and represent a different histologic spectrum than is seen in adults. While many of this tumors are benign, some of them are malignant and therefore vision and life-threatening. For this reason it is essential for radiologists to have a thorough knowledge of imaging findings of the most common nontraumatic orbital abnormalities in children in order to prevent permanent vision loss and other potentially devastating complications. The purpose of this pictorial essay is to illustrate the imaging features in CT and MRI of various eye and orbital tumors in children. We present a series of representative cases regarding a broad spectrum of pediatric tumors of the eye and orbit including chloroma, rhabdomyosarcoma, giant cell granuloma of the bone, lacrimal benign mixed tumor, retinoblastoma, lymphangioma, lacrimal gland tumors, dermoid cyst and Langerhans cell histiocytosis.

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A retrospective analysis of its main features on MRI and CT and a review of relevant literature were performed. P-98 UTILITY OF MR SPECTROSCOPY FOR EARLY DIAGNOSIS IN ACUTE ENCEPHALOPATHY WITH BIPHASIC SEIZURES AND LATE REDUCED DIFFUSION (AESD) Hiroko Tada1, Jun-ichi Takanashi0 ,2 1 Chibaken Saiseikai Narashino Hospital, department of pediatrics, Chiba-ken, Narashino-shi, Japan, 2Kameda Medical center, department of pediatrics, Chiba-ken, Kamogawa-shi, Japan INTRODUCTION AESD is clinically characterized by biphasic seizures, i.e., a febrile seizure (usually lasting longer than 30 minutes) as the initial symptom, followed by secondary seizures at days 4 to 6 often seen in Japanese children. MRI shows no acute abnormality during the first two days; but reveals subcortical reduced diffusion during days 3 to 9. Between the biphasic seizures, some patients have clear consciousness, which may lead to an initial misdiagnosis of febrile seizure (FS) status, and delay in starting appropriate therapies. CASE A previously healthy 1-year 7-month-old boy presented with a seizure lasting >1 hour on the 2nd day of fever. After stopping first seizures, he had mild consciousness disturbance, leading to a diagnosis of encephalopathy and starting methylprednisolone therapy. Second seizures were seen on day 5. The initial and second MRI on days 2 and 5 didn't show any abnormality, however, MRI on day 9 demonstrated subcortical T2 prolongation and reduced diffusion, which disappeared on day 19. The initial MR spectroscopy (MRS) on day 2 revealed mildly increased glutamine/glutamate complex (Glx) and mildly reduced N-acetyl aspartate (NAA). The second MRS on day 5 showed markedly increased Glx, which became normal on day 19. On the other hand, markedly decreased NAA was continuously observed on day 5, 9, 19, 35 and65. CONCLUSION MRS in AESD revealed increased Glx and decreased NAA even in the acute stage with normal MRI, which would differentiate AESD and FS status, and enable us to perform early treatment.

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RADIOLOGICAL FEATURES OF 16 JAPANESE PATIENTS WITH SEVERE PHENOTYPE WITH CASK MUTATIONS

NEUROIMAGING FINDINGS IN PATIENTS WITH FGFR3 (N540K) MUTATION-VERIFIED HYPOCHONDROPLASIA

Jun-ichi Takanashi1 ,2, Hiroko Tada3, Nobuhiko Okamoto4, Shin Hayashi5, Johji Inazawa5, Hitoshi Terada2, A. James Barkovich6 1 Kameda Medical Center, Kamogawa, Japan, 2Toho University Sakura Medical Center, Sakura, Japan, 3Chibaken Saiseikai Narashino Hospital, Narashino, Japan, 4Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan, 5Tokyo Medical and Dental University, Tokyo, Japan, 6University of California San Francisco, CA, USA

Sanna Toiviainen-Salo1, Outi Mäkitie2, Leena Valanne1, Tarja Linnankivi2 1 Helsinki University Hospital, Dept. of Radiology, Helsinki, Finland, 2Hospital for Children and Adolescents, ´Dept of pediatrics and pediatric neurology, Helsinki, Finland

INTRODUCTION Mutations of the CASK gene at Xp11.4 cause severe mental retardation (MR) and microcephaly with pontine and cerebellar hypoplasia (MICPCH) in females. PURPOSE To evaluate the longitudinal clinical and radiological courses of affected patients. PATIENTS Imaging information was retrospectively reviewed for 16 Japanese (15 female and 1 male) patients with MR and MICPCH associated with CASK mutations. The area of the cerebrum, cerebellum, pons, midbrain tegmentum, and corpus callosum in each patient was measured; patients ranged in age from 4- to 156-months-old at the time of their MRI. The results of these measurements were compared with those of 62 female patients (0.5- to 180-months-old). RESULTS The area of the cerebrum overlapped with that of the controls when measured before age 8 months, but became reduced afterwards. The areas of the pons, midbrain tegmentum, and cerebellar hemisphere were much reduced in size when compared with controls, even in early infancy, and showed little size increase with aging. The midline corpus callosum area was normal or in the low-normal range in all patients, leading to an impression of being abnormally thick compared with the small cerebrum. The cerebellum/ corpus callosum ratio was low-normal or low in all patients. CONCLUSIONS These uniform radiological features should facilitate an early diagnosis in patients with MR and MICPCH associated with CASK mutations.

OBJECTIVES Hypochodroplasia (HCH), an autosomal dominant skeletal dysplasia caused by mutations in FGFR3 gene, has not been commonly associated with neurological or cognitive problems but epilepsy with temporal lobe dysgenesis has previously been described in a few patients. This study aimed to assess neurological, cognitive, and neuroimaging aspects in a national cohort of HCH patients. METHODS Clinical and imaging data of all FGFR3 (N540K) mutation verified patients (N013, 5 males, 0.9-18 years at the latest follow-up) in our country were retrospectively analyzed. RESULTS Altogether 3 patients (23 %) had a diagnosis of temporal lobe epilepsy, and 3 had had seizure-like events as neonates, 46 % had severe cognitive impairment. Eight patients (61 %) had undergone brain MRI examination, all (8/8) of them had structural abnormalities consistent with medial temporal lobe dysgenesis, 6/8 had peritrigonal white matter reduction, and 4 had abnormally shaped lateral ventricles. CONCLUSIONS This study shows that all N450K mutation-verified HCH patients with neuroimaging had a uniform pattern of medial temporal lobe dysgenesis similar to that in 4 patients described in the literature suggesting that this structural abnormality could be intrinsic to N450K mutation. Medial temporal lobe dysgenesis may lower the threshold for seizures. In addition, epilepsy and cognitive problems are much more common in these patients than previously reported. Therefore development should be closely followed in patients with HCH and a low threshold for neuroimaging is recommended.

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P-101 3.0 TESLA IMAGING AND VOXEL-BASED MORPHOMETRY IN ASPARTYLGLUCOSAMINURIA Anna Tokola1, Eero Salli1, Laura Aberg3, Taina Autti2 1 Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland, 2Ministry of Social Affairs and Health, Helsinki, Finland, 3Division on Child Neurology, Hospital for Children and Adolescents, Helsinki University Hospital, Helsinki, Finland BACKGROUND Aspartylglucosaminuria (AGU) is an autosomal recessive lysosomal disease caused by a deficiency of aspartylglucosaminidase. Previous 1.5 T MRI studies have shown a thalamic T2 signal intensity decrease, delayed myelination and increased T2 signal intensity in periventricular white matter. Later, patients with AGU show slowly progressive brain atrophy. OBJECTIVE To evaluate the signal intensity changes with 3.0 T and for the first time in AGU patients to investigate regional gray and white matter differences using voxel-based morphometry (VBM). MATERIAL AND METHODS 13 patients (5 male, 8 female, age between 9 and 45 years) and 39 age-and-sex-matched healthy control subjects were imaged with 3.0 T MRI. Examinations included T2 TSE axial (TR 4000, TE 80, slice thickness 4 mm), T1 3D TFE (TR 8.19, TE 3.79, slice thickness 1 mm) and DTI sequences. After evaluation of signal intensity changes in T1 and T2 images, the T1-weighted 3D images were analyzed using VBM. RESULTS The previously reported signal intensity changes are noticed also in 3.0 T images. Bilateral pulvinar nuclei signal intensity decrease on T2-weighted images was found in all patients. Delayed myelination and periventricular T2 signal intensity increase are evident with 3.0 T. A comparison between the findings in 1.5 T and 3.0 T MRI will be presented, as well as the results of VBM demonstrating focal alterations in gray and white matter. P-102 DELAYED TRANSIT TIME WITH ARTERIAL SPIN LABELING (ASL) AS INDICATOR OF INTERNAL CAROTID STENOSIS IN PEDIATRIC PATIENTS Robert Zimmerman, Erin Schwartz, Avrum Pollock, Arastoo Vossough, Tamara Feygin, Karuna Shekdar, Larissa Bilaniuk, Deborah Zarnow Children's Hospital of Philadelphia, Philadelphia, PA, USA

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PURPOSE To use routine ASL as indicator of delayed transit time in pediatric patients with known or unsuspected carotid vascular disease. MATERIAL METHODS 5 pediatric patients, age 9 to 18 years, 3 male, 2 female, were studied on 3 T MRI with ASL perfusion as well as conventional MRI. RESULTS 4 of 5 patients had known or suspected vascular disease, while on one the ASL findings lead to the recognition of the internal carotid stenosis. 3 of 5 patients had sickle cell disease (2 with Moya-moya), one NF1 and one post-op tumor resection and treatment. CONCLUSION Delayed transit time on ASL perfusion is a striking abnormality that relates to severe compromise of carotid circulation and can be easily recognized. THEME: SKULL BASE AND CRANIAL NERVE ADVANCED IMAGING TECHNIQUES P-103 OCULOMOTOR NERVE VASCULAR COMPRESSION AND UNILATERAL ISOLATED MYDRIASIS ; A 18 MONTH MRI PROSPECTIVE STUDY Francois Legou1, Fanny Trechot3 ,2, Romain Tonnelet1 ,2, Marc Braun1 ,4, Karine Angioi3 ,2 1 Neuroradiology department CHU Nancy, Nancy, France, 2 IADI Inserm U 947, Vandoeuvre-les Nancy, France, 3 Ophtalomology department CHU Nancy, Nancy, France, 4 CIC-IT CHU Nancy, Vandoeuvre-les Nancy, France PURPOSE We demonstrated the accuracy of MRI in vascular compression of the oculomotor nerve. PATIENTS A prospective single center study from November 2010 to March 2012 was carried including five consecutive patients all presenting with a pure and isolated dilated pupil suggestive of a tonic (Adies)pupil. All patients, aged from 20 to 41 years , mean age was 33.8 years, were asymptomatic ; complete eye, systemic and neurological examination were normal. 3 T MRI was performed using 3D steady state (GE FIESTA), Flair, post-contrast 3D T1 and 3D TOF sequences to determine the site of conflict, to exclude a mesencephalic lesion and a arterial vascular malformation respectively. RESULTS All patients with Adies pupil demonstrated a neurovascular compression. Two types were present. For type I, none of them were related to an vascular duplication

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(Albayram Neurosurgery 58:582, 2006 ) but to a vascular conflict with a fetal type of posterior communicating artery in 3 cases (with criterias of neurovascular conflict in REZ : a direct contact at right angle, at the level of the first millimeters of the nerve and displacing its course). For type II, the two cases showed the posterior communicating artery displacing the CN III just before it penetration into the cavernous sinus against the posterior clinoïd process. CONCLUSION Unlike a commun fact, truly isolated pupillary mydriasis from neurovascular compression of CN III is not rare and this prospective study shows the accuracy of MRI in pointing the compression. Other postganglionic lesions causing mydriasis should then be documented. P-104 IMAGING OF HEARING LOSS Liam Kavanagh1, Leo Galvin1, Sarah Power 1, Joanna Pearly-Ti1, Paul Brennan1, John Thornton1, Seamus Looby1 1 Beaumont Hospital, Dublin, Ireland, 2Royal College of Radiologists in Ireland, Dublin, Ireland PURPOSE Radiology can play an important role in the diagnosis of hearing loss. An awareness of the radiological features of associated conditions leads to a more accurate diagnosis. MATERIALS METHODS We discuss the optimal modalities in the evaluation of hearing loss including CT temporal bones, MRI internal auditory canals and MRI skull base. Several examples of causes of conductive and sensorineural hearing loss are illustrated. Related to conductive hearing loss, these include congential anomalies, acute and chronic otitis media, acute and chronic mastoiditis, cholesteatoma, otosclerosis and temporal bone trauma. Related to sensorineural hearing loss, these include vestibular schwannomas, skull base tumours, infectious and inflammatory diseases of the vestibulocochlear nerve complex and inner ear structures, vestibular schwannomas and vascular causes such as superficial siderosis. RESULTS CT and MRI can both have a role to play in the diagnosis of causes of hearing loss. We illustrate, with multiple examples from selected cases, the classic features of many of these conditions. CONCLUSION While the radiological assessment of hearing loss can often be negative, there are many conditions with pathognomonic radiological features relevant to this entity which the radiologist can diagnose. We illustrate many of these in this pictorial review.

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P-105 FEATURES OF MAGNETIC RESONANCE IMAGING AND DETECTION OF TRIGEMINAL NERVE RADIAL ANATOMY CHARACTERISTICS USING MRI Vladimir Bychenko1, Vadim Shimanskii2, Yurii Grigoryan3 1 Research center of obstetrics, gynecology and perinatology named Kulakov V.I., Moscow, Russia, 2Scientific-Research Institute of Neurosurgery named Burdenko N.N.,, Moscow, Russia, 3Federal centre of medicine and rehabilitation., Moscow, Russia The purpose of the research was to determine the optimal methods of tomography (MRI) and to reveal possible age or sex regularities and structure peculiarities of cisternal parts of the trigeminal nerves in the posterior cranial fossa. We examined 292 patients using MRI without any face pain during their life to estimate the radiological anatomical characteristics of trigeminal nerve related to the differences depending on the age and sex. We examined 584 trigeminal nerves. MRI in the mode 3D-T2FSE and its variety3D-T2SPACE enables to obtain simultaneous images of neurovascular structures, the conflict between which is the etiological agent of trigeminal neuralgia (TN). The anatomy of the trigeminal nerve depends both on the age and the sex of the patients. The contact between a blood vessel and the trigeminal nerve is not a pathological state and does not cause a pain syndrome. The origin of TN needs the availability of some additional conditions. The diagnosis TN is clinical diagnosis which is made out on the basis of theclinical presentation of the disease. Carrying out an MRI of TN enables to improve diagnostics by means of the exact verification of possible compressing agent, which is a blood vessel in 95 % cases. The detected trigeminal nerve cistern part MR anatomy law and characters, and vein and artery vessels structure and position variants allow us to improve the trigeminal nerve neurovascular conflict diagnostics during MRI and to reduce false-positive results quantity according to data from MRI. P-106 IMAGING STRATEGIES FOR ACQUIRED HORNER'S SYNDROME: THERE'S MORE THAN MEETS THE EYE Alison Corr, Jane Cunningham, Paul Brennan, John Thornton, Seamus Looby Beaumont Hospital, Dublin, Ireland PURPOSE To provide a review of the anatomy of the oculosympathetic pathway and the clinical features of the three subtypes of

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Horner's syndrome, outlining the appropriate imaging pathways for investigation of oculosympathetic palsy. MATERIALS AND METHODS Horner's syndrome is a rare condition that affects the sympathetic fibres to the eye anywhere along its tri-neuron circuit. We review the anatomy of the central, preganglionic and postganglionic neurons of the oculosympathetic pathway. The correlation between subtle clinical sub-features of this syndrome and potential lesion location is made, reviewing neurological, cervical and upper thoracic imaging from a large tertiary referral radiology department. RESULTS Imaging findings in acquired Horner's syndrome correlate well with the expected lesion location if a thorough clinical examination is performed. Targeting the most appropriate imaging modality can be achieved by considering the oculosympathetic pathway as a tri-neuron circuit. CONCLUSION The sympathetic pathway to the eye and its anatomical relations is an important consideration when undertaking radiological evaluation of an acquired Horner's syndrome in order to encompass a targeted investigation of the causative pathologies. P-107 CEREBROSPINAL FLUID LEAKS - WHAT THE RADIOLOGIST NEEDS TO KNOW Jane Cunningham, Edel Kelliher, Joanna Pearly-Ti, Sarah Power, John Thornton, Paul Brennan, Seamus Looby Beaumont University Hospital, Dublin 9, Ireland BACKGROUND Imaging is of vital importance in the evaluation of cerebrospinal fluid leaks which may occur either spontaneously or secondary to intracranial infection, tumours, trauma, ENT or neurosurgical procedures. In this pictorial essay, we highlight what radiologists need to know in order to make the diagnosis which is crucial to avoid complications of meningitis, cerebral abscess and encephalitis. CONTENT Leakage of CSF occurs when there is communication between the subarachnoid and extracranial spaces through defects in the dura and skull base. Patients present clinically with CSF rhinorrhea or otorrhea. Although the diagnosis can be confirmed by beta-2 transferrin assay of the fluid, radiological evaluation is critical to localise and characterise the osseous defect, exclude any underlying cause and evaluate for associated meningocele or encephalocele. MDCT of skull base with multiplanar reformats is the preferred modality for initial evaluation, with CT cisternography reserved

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for complex cases with multiple osseous defects. MRI is useful in the assessment of meningoencephalocele. We present a number of illustrated examples of cases of CSF leaks to highlight the key imaging features and discuss optimal imaging strategies and scanning protocols. RESULTS We provide a comprehensive overview of the etiology, diagnosis and management of CSF leaks, as well as a pictorial review highlighting the key imaging features and potential pitfalls. CONCLUSION This educational exhibit aims to help radiologists accurately diagnose cerebrospinal fluid leaks which is essential to guide endoscopic and neurosurgical repair and thereby reduce the likelihood of serious infectious complications. P-108 EVALUATION OF MORPHOLOGIC CHANGES IN OPTIC NERVE IN GLAUCOMA USING 3 T MRI Sabrilhakim Sidek ¹, Fadzlina AR ², Norlisah Ramli¹, Kartini Rahmat¹, Norlina Ramli² Sabril Hakim¹ ¹Departments of Biomedical Imaging, University Malaya Research Imaging Centre and ²Ophthalmology, University Malaya , Malaysia. PURPOSE Glaucoma is thought to be an ocular problem. Here we asses if glaucoma disease causes anterograde degeneration of the optic nerve by using volumetric assessment with 3 T MRI. METHOD AND MATERIALS Forty four subjects (12 normal subjects, 18 mild glaucoma, 14 severe glaucoma, age 40 to 80 y.o) underwent 3Tesla MRI . Images were acquired with FSPGR EDR Fast IrP 512 Freq 256 Phase 256 ZIP Gradient Zoom Mode 3D. The mean duration of glaucoma disease from time of diagnosis to imaging was 14 days. The acquired images were post processed using DICOM (Digital Imaging and Communications in Medicine) format , converted to NIFTI (Neuroimaging Informatics Technology Initiative) format by MRI Convert version 2.0. Optic nerve volume was measured using NeuRoi software . RESULTS Mean bilateral optic nerve average volume are 361.2 mm3 (normal), 290.5 mm3 (mild) with -19.6 % reduction and 186.9 mm3 (severe) with -48.3 % reduction. Multiple comparisons show significant difference between normal and severe glaucoma groups (p 00.00) and between mild and severe glaucoma groups (p00.004). No significant difference between normal and mild glaucoma groups (p00.075).

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CONCLUSION Antegrade degeneration of optic nerve occurs in glaucoma and the volume loss correlates with disease severity. This findings highlight the importance of aggressive therapy for those patients at highest risk. P-109 VISUAL LOSS AND MRI: A PROSPECTIVE MRI AND CLINICAL STUDY Françoise Heran, Clément Watel, Romain Deschamps, Antoine Gueguen, Catherine Vignal, François Lafitte Fondation A. de Rothschild, Paris, France PURPOSE MRI of anterior optic pathways (AOP) is mandatory in the diagnosis of visual loss without obvious ophthalmological cause. Poor knowledge of this pathology, of the MRI technique and interpretation leads to lesions misdiagnosis. We aimed, with an optimal MRI protocol, to propose a guide of images analyzis and to study relationship between clinical data and MRI results. METHODS In collaboration with neuro ophtamolologists and neurologists, 6 months prospective study of 102 patients who underwent a MRI to explore a visual loss without obvious ophthalmological cause. Minimal MRI protocol: coronal T2 and T1 enhanced with fat suppression slices and axial diffusion of AOP, brain study. Imaging (anterior optic pathway and brain) and clinical (ophthalmological and neurological) data recorded and correlated to final diagnosis. FINDINGS AND DISCUSSION Difficult depiction of some lesions and need of excellent quality MRI obliged to rule out diffusion sequence (many artifacts), to repeat blurred sequences, to look for small abnormalities. Final diagnosis: no cause found 16 %, optic neuritis 27 % (mainly MS), atrophy 38 % (glaucoma: 16 %, other origin: 22 %), compression of AOP 7 %, (mainly meningiomas), and misdiagnosed ophthalmological lesions 12 % (ischemia 6 %, ocular lesions 6 %). Correlations between results of MRI and final diagnosis excellent for neuritis, atrophy, compression. Normal MRI related to normal patients, ophthalmological causes or atrophy at an initial stage. CONCLUSION Easy and rapid MRI protocol, careful images interpretation (shape and signal AOP and surrounding structures) mandatory for the diagnosis of visual losses, narrow collaboration between radiologist and clinician still needed.

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P-110 NORMAL MEASUREMENTS OF THE ORBITAL MUSCLES WITH 3 TESLA MRI Thanos Paschalis, Theodora Tsirouki, Alexandra Bargiota, Evangelia Tsironi, Eftychia Kapsalaki University of Thessaly, Larissa, Greece PURPOSE The purpose of our study was to measure the normal transverse and cross sectional area dimensions of the extraoccular superior, inferior, medial and lateral rectus - muscles (EOM). METHODS MRI of the orbits was performed on a 3Tesla MR scanner. Fourty normal volunteers, aged 18-52 years old (mean 42 years), 28 females and 12 males were included in our study. Coronal and axial T2 fat saturated images (2 mm slice thickness and 0.2 interslice gap) were obtained. Axial T1 images were also obtained. Axial images were obtained parallel to the optic nerve at its posterior part and coronal images were obtained perpendicular to the axial plane. The transverse diameter and the cross sectional areas of the EOM, in the thickest part of the muscles, at its mid part, were measured on the coronal plane. The transverse diameter of the medial and lateral rectus muscles was also measured on the axial plane. All measurements were performed by two neuroradiologists independently. RESULTS Our measurements were: superior rectus 2.7(+/-0.7) mm, inferior rectus 3.2(+/-0.8) mm, medial rectus 3.2 (+/0.5)mm, and lateral rectus 2.8 (+/-0.5)mm. The cross sectional areas of these muscles in their thickest part were superior rectus 23.49 (+/-3.3) mm2, inferior rectus 30.4(+/6.2) mm2, medial rectus 29.76 (+/-6.7) mm2, and lateral rectus 25.76 (+/-7.2)mm2. CONCLUSIONS Our study reports the normal dimensions of the EOM in 40 normal volunteers. These measurements could be of significant value when evaluating extraocular muscle pathology. P-111 IMAGING SPECTRUM OF CONGENITAL OR DEVELOPMENTAL NEUROPATHIC STRABISMUS USING HIGH-RESOLUTION MR IMAGING Eunhee Kim1, Dong Hoon Lee2 1 Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea, 2Seoul Medical Center, Seoul, Republic of Korea

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Radiologists typically are unfamiliar with detailed extraocular muscle (EOM) and ocular motor nerve pathologies because imaging study for strabismus rarely has been conducted. Overall survey for neuropathic strabismus by high-resolution MR imaging had been rarely reported, therefore we will demonstrate overall MR imaging abnormalities related to neuropathic strabismus. Pathologies detected by highresolution MR imaging in patients with neuropathic strabismus are to be classified into the ocular motor nerve abnormalities, orbital abnormalities, and brain abnormalities, respectively. In detail, ocular motor nerve abnormalities include congenital 4th nerve aplasia, Duane retraction syndrome (cranial nerve 6th aplasia or hypoplasia), congenital fibrosis syndrome (cranial nerve 3 aplasia or hypoplasia), and combined ocular motor nerve abnormalities. Secondly, orbital abnormalities related to strabismus include EOM hypoplasia or hyperplasia, or intraorbital mass. Lastly, brain abnormality such as periventricular leukomalacia can cause strabismus as well. High resolution MR imaging can give us much information about pathologies related to neuropathic strabismus. P-112 USEFULNESS OF ADC VALUE OF EPI-DWI IN THE DIAGNOSIS OF CHOLESTEATOMAS AT 3 T MRI Takao Kodama, Takanori Yano, Shozo Tamura University of Miyazaki, Miyazaki, Japan INTRODUCTION Diffusion weighted imaging (DWI) is known to be useful for the evaluation of cholesteatomas. However, DWI using echo-planar imaging (EPI) is very vulnerable to susceptibility effects especially with a higher magnetic field unit. This study aimed to evaluate whether ADC value can improve the diagnostic utility of EPI-DWI for cholesteatomas at 3 T MRI. METHODS Images and ADC values on EPI-DWI were retrospectively analyzed in 125 patients who had undergone middle ear surgery (102 cholesteatomas and 23 other middle ear pathologies). All studies were performed with a 32-channel head coil and EPI-DW images were obtained with a slice thickness of 1.5 mm and b-value of 800 sec/min2. RESULTS In cases whose lesions can be detected on EPI-DWI, ADC value of cholesteatomas (0.83 +/- 0.15) was significantly lower than that of other tissues such as granulation tissue, cholesterol granuloma, and so on (1.88 +/- 0.45). By using a cut-off level of 1.1, sensitivity, specificity and accuracy of ADC value for cholesteatomas was 97.7 %, 88.9 % and 95.7 % respectively.

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Sensitivity, specificity and accuracy of EPI-DWI (75.5 %, 73,9 %, and 75.2 %) improved with the ADC value (86.3 %, 87.0 %, and 86.4 %). CONCLUSION ADC value can improve the diagnostic utility of EPI-DWI for cholesteatomas on 3 T MRI. P-113 MR IMAGING OF SUPERIOR OBLIQUE MYOKYMIA CAUSED BY VASCULAR COMPRESSION Dong Hoon Lee1, Eunhee Kim2 1 Seoul Medical Center, Seoul, Republic of Korea, 2Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea Superior oblique myokymia is an acquired abnormality of superior oblique muscle innervations causing episodic torsional oscillation of an eye. It resulted from vascular compression of the trochlear nerve. However, there have been a few reported cases of MR imaging of compression of the trochlear nerve by vessel. We will demonstrate high resolution MR imaging in two patients with superior oblique myokymia. High-resolution MR imaging using 3D-balanced turbo-field echo (bTFE) successfully demonstrated vascular compression of the trochlear nerve. Advanced MR imaging now permit us to visualize the neurovascular relationships of cranial nerve (CN) 4 as well as CN 7 and 5. P-114 TYPICAL AND ATYPICAL FEATURES OF FIBROUS DYSPLASIA ON CT AND MRI Patrick Navin, J Cunningham, S Power, J PTi, M Thornton, P Brennan, S Looby Beaumont Hospital, Beaumont Road, Dublin 9, Ireland PURPOSE To illustrate the diversity of CT and MRI features of “Fibrous Dysplasia”. Fibrous dysplasia is a genetic, noninherited disorder typically affecting adolescents and young adults. It has a monostotic or polyostotic form and typically presents incidentally as it is often asymptomatic. Complications are possible in the form of pathological fracture, deformity or malignant transformation MATERIALS AND METHODS Numerous CT and MRI studies of fibrous dysplasia were reviewed. Typical and atypical features of Fibrous Dysplasia were found. Particular focus was attributed to possible complications and their imaging characteristics. The use of CT

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and MRI to distinguish Fibrous Dysplasia from other possible diagnoses was also investigated RESULTS This educational pictorial essay demonstrates a multitude of manifestations of Fibrous Dysplasia both on CT and MRI. CONCLUSION The imaging features of Fibrous Dysplasia are important in creating an accurate diagnosis and allowing more rapid management of complications

treatment becomes more common. As the lesions are very small, imaging needs to be performed with attention to detail. Radiology is also essential in staging and follow up.

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Mufudzi Maviki, Benjamin Salt, Anastastassia Gontsarova, Lorna Woodbridge, Bernadine Murtagh, Farrah Jabeen, Peter Cowley Royal Free London NHS Foundation Trust, London, UK

CHOROIDAL MELANOMA: FROM DIAGNOSIS TO TREATMENT Catherine Mandel, Noelene Bergen, Claire Phillips Peter MacCallum Cancer Centre, Melbourne, Australia INTRODUCTION Radiology is important in the management of choroidal melanoma. This paper describes our approach to this disease, and focuses on optimising imaging. BACKGROUND Choroidal melanoma, whilst rare, is the commonest primary ocular tumour. It is usually less rapidly progressive than skin melanoma. Treatment options are no longer confined to enucleation. Imaging is important in managing these patients and needs to be performed very precisely because of the small size of the tumours and need to precisely target radiotherapy. RADIOLOGY Initial imaging of choroidal melanoma is typically ultrasound. Magnetic resonance imaging (MRI) is important for defining the extent of the tumour, treatment planning and follow up, especially in those patients having eyepreserving treatments. We perform whole head volumetric acquisitions for treatment planning and targeted, thin-section imaging of the globe to define the site, size and extent of tumour. This is essential for planning and performing stereotactic radiotherapy, an eye-preserving treatment. Diagnostic computed tomography is usually only used in patients unable to have MRI. Computed tomography is also used by radiation oncologists for planning radiotherapy. As the anatomy of the globe determines the pattern of spread, knowledge of this is important for performing staging investigations prior to treatment of the primary and in post-treatment monitoring. CONCLUSION Radiology is increasingly important in the management of patients with choroidal melanoma as eye-conserving

P-116 MULTIMODAL IMAGING OF CEREBROSPINAL FLUID LEAKS; AN INTRIGUING JOURNEY FROM TOP TO BOTTOM

The investigation of cerebrospinal fluid leaks (CSF) leaks is a controversial topic and several imaging strategies employed by different institutions. Clinical presentations are varied and may include post traumatic nasal drip, otorrhoea and intracranial hypotension. There are life-threatening complications such as recurrent meningitis whose associated morbidity and mortality increases with each episode. This raises the need for prompt accurate diagnosis and clinical management. Various imaging modalities have been used including plain CT, radionuclide studies, multimodality MR, as well as cisternography combined with any of the above. This educational review stresses the need to identify the nature of fluid leaking from the ears or nose by testing for CSF specific proteins such as Beta transferrin in the first instance. A method of performing CSF cisternography is described and typical diagnostic features in positive cases are illustrated. Finally, a simple diagnostic algorithm is presented, which we hope will aid in prompt assessment of patients and lead to early definitive management. P-117 MIDDLE EAR "PYOGENIC GRANULOMA" (CAPILLARY HEMANGIOMA) Tomoya Nakatsuka, Hideyasu Kudo, Tsutomu Inaoka, Hitoshi Terada Toho University Sakura Medical Center, Sakura, Japan Hemangiomas are common benign vascular tumor, which occur in any region. But they have rarely been reported in the middle ear. Glomus tumors are the most common vascular lesions of the middle ear. Correct diagnosis is essential for appropriate treatment. Case report: A 60-year-old man was presented with ear

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bleeding and headache. Otoscopic examination revealed protruding lesion in external auditory canal. High resolution computed tomography (CT) of the temporal bone revealed the tympanic cavity and the mastoid air cells contained a diffuse soft tissue density lesion. There's thinning of mastoid septa without frank bone destruction. The ossicles and the scutum were intact. This lesion showed low signal on T1-weighted images, very high signal on STIR images, and marked enhancement on post-contrast T1-weighted fat suppression images. The enhanced area corresponded to the site of soft tissue density on CT scans. The lesion extended from the tympanic cavity to the mastoid air cells. T2-high signal in the mastoid air cells wasn't the influence of obstructive changes. There's no frank bone destruction corresponding to the extension of this lesion. The protruding lesion in the external auditory canal was biopsied, revealing pyogenic granuloma. The tumor was totally resected. Final histopathological examination confirmed the clinical diagnosis of capillary hemangioma. Discussion: The most important differential diagnosis is glomus tympanicus tumor. In this case STIR images showed no "salt and pepper" appearance but it couldn't exclude glomus tumor. This case suggests that the absence of frank bone destruction corresponding to tumor extension could be helpful to exclude glomus tumor. P-118 PREVALENCE OF ANATOMICAL VARIATIONS IN CRIBRIFORM PLATE AND CRISTA GALLI PROCESS. A RETROSPECTIVE STUDY – 1 YEAR EXPERIENCE OF PARANASAL SINUSES CT César Nunes, Inês Carreiro, Cristina Moura Neuroradiology sector, Radiology Service, H.U.C. – C.H.U.C. Coimbra, Portugal INTRODUCTION The anterior cranial fossa floor is formed by three bones - frontal, ethmoid and esphenoid. Knowing the different anatomical variations, in particular, from the etmoidal portion of the neurocranium, its of the outermost importance for performing a safe Endoscopic Sinus Surgery. The pneumatized Crista Galli and specially the different kind of junctions between the cribriform plate and the planum ethmoidale, represents the most important variations frequently observed. OBJECTIVE Evaluate the anatomical variations of the ethmoidal portion of the anterior fossa and its theoretical risk in performing endoscopic sinus surgery.

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MATERIALS E METHODS Retrospective study of 672 paranasal sinuses computed tomography (CT) in the coronal plane, made since January to December of 2011. To classify the union between the cribriform plate and the cranium floor we used the Keros classification. We also perform another three measures - the length of the middle turbinate, the maximal height of the orbit and the distance between the ethmoid roof and the nasal floor. RESULTS Keros type II was the most common finding in the reviewed CTs (approximately 48 %), Keros type I represent 41 % and Keros type III the last 11 %.The maximum olfactory fossa depth was 16 mm. The length of the middle turbinate was negatively associated with the Keros type. The distance between the ethmoid roof and the nasal floor was positively correlated with the olfactory fossa depth. The Crista Galli process was pneumatized in approximately 7 % of the patients CONCLUSION Concordantly with other studies we found that the Keros II type was the most frequent observation. Greater depths are constantly associated with greater risk of intracranial penetration when performing endoscopic surgery, so the ENT surgeon must know the kind of relationship between the cribriform region and medial ethmoid roof. It´s also important to correctly identify the aeration of the Crista Galli, since as we now know the pneumatization process come from the frontal sinuses, and the inflammatory frontal diseases can extend to that process. P-119 RELATIVE DIAMETER OF VESTIBULOCOCHLEAR NERVE WITH BALANCED STEADY-STATE FREE PRECESSION MR IMAGES; IT CAN PREDICT VESTIBULOCOCHLEAR NERVE ANOMALY Dong Woo Park, Young Jun Lee, Seung Ro Lee, Choong Ki Park Hanyang University, Seoul, Republic of Korea PURPOSE This study is to determine the MRI findings of vestibulocochlear nerve (VCN) anomaly with balanced steady-state free precession (bSSFP) MR images. METHODS AND MATERIALS 10 patients with internal auditory canal (IAC) stenosis and 55 patients without IAC stenosis as a control group were evaluated. They all underwent bSSFP MR images. Ten patients with IAC stenosis have unilateral (90 %, 9/ 10) or bilateral (10 %, 1/10) IAC stenosis.

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We evaluated and statistically analyzed diameters of both side VCN and facial nerve (FN), VCN/FN diameter index (VCN/FN), and anomalies of VCN . RESULTS The mean diameters of VCNs and FNs, and VCN/FN index are 1.213 ± 0.223, 0.825± 0.257 mm (p < 0.001); 0.723 ± 0.154, 0.727±0.186 mm (p00.993); 1.731±0.388, 1.174± 0.406 mm (p<0.001) in control and IAC stenotic groups, respectively. AUCs (average area under the receiver operating characteristic curve) of VCN and VCN/FN index by the ROC curve for predicting IAC stenosis show 0.894 and 0.845, respectively When the cutoff value of VCN diameter are set at 1.0 mm, sensitivity and specificity are 78.0 % and 90.9 %. When cutoff values of VCN/FN are set at 1.0 and 1.5, sensitivity and specificity are 95.8 %, 54.5 % and 72.0 %, 81.8 %, respectively. CONCLUSION For the prediction of IAC stenosis, both VCN diameter and VIII/VII index are valuable. If VCN diameter is lesser than 1 mm or VCN/FN index is lower than 1.5 in routine axial bSSFP MR image, VCN anomaly should be suspected and then further evaluation with multiplanar reconstruction would be needed.

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with T1-,T2-(2D turbo spin-echo, axial, thickness05 mm), contrast-enhanced T1-weighted (axial, thickness02 mm), T2 weighted 3D VISTA (thickness 00.6 mm), and contrast-enhanced T1 weighted FFE WATS (thickness0 0.6 mm) sequences. For visualization of CN IV, additional T2 weighted 3D balanced turbo field echo (bTFE) sequence (thickness00.25 mm, FOV01024x1024) was performed. RESULTS In all 7 cases, on T2 VISTA, T1 FFE WATS images and bTFE, the cranial nerves could be precisely delineated. In 4 cases with suspected neuritis, the involved segments of the cranial nerves showed abnormal enhancement and mild thickening. Absence of the cisternal segment of the right CN III was noted in one patient with congenital CN III palsy. MR imaging of another patient with a traumatic right CN IV injury exhibited absence of cisternal segment. One patient with the left CN IV palsy showed the displacement of the nerve by the left posterior inferior cerebellar artery. CONCLUSION Thin thickness 3D VISTA and FFE WATS and bTFE sequences can depict the cranial nerve segments in greater detail and thus provide valuable insights to pathologic processes involving the cranial nerves. THEME: SPINE

P-120 P-121 THE USEFULNESS OF HIGH RESOLUTION MR IMAGING IN THE EVALUATION OF UPPER CRANIAL NERVE NEUROPATHY Soo chin Kim2, Sun-Won Park1, Hwa Seon Shin2, Jeong A Yeom2, Inseon Ryoo2, Seung Chai Jung2, Eunhee Kim3, Ji-hoon Kim2, Jae Hyoung Kim3, Hyobin Seo4, Chul-Ho Sohn2, Seung Hong Choi2, Kee-Hyun Chang2 1 Boramae Medical Center, seoul, Republic of Korea, 2Seoul National University Hospital, seoul, Republic of Korea, 3 Seoul National University Bundang Hospital, bundang, Republic of Korea, 4Healthcare System GangNam Center, Seoul National University Hospital, seoul, Republic of Korea PURPOSE We investigated the ability of the thin slice high resolution techniques including 3D Volumetric isotropic TSE acquisition (VISTA) and fast-field echo water only selection sequence (FFE WATS), to delineate cranial nerve pathology in clinically suspected patients. METHODS We evaluated seven cases with clinical neuropathy, which had with positive findings on high resolution cranial nerve MRI. Imaging was performed on a 3 T MR imaging system

SPONTANEOUS INTRACRANIAL HYPOTENSION MAY CAUSE INTRACRANIAL DURAL SINUS THROMBOSIS AND INTRACRANIAL HEMATOMA–A CASE OF VICIOUS CYCLE OF IATROGENIC INTRACRANIAL HYPOTENSION— Izumi Anno1, Tomonori Isobe0 ,2, Akira Matsumura0 ,2 1 IBARAKI Prefectural University, Ami/IBARAKI, Japan, 2 University of Tsukuba, Tsukuba/IBARAKI, Japan The etiology of Spontaneous intracranial hypotension (SIH) has not been still unclear. Recently, there are several reports about intracranial venous and dural sinus thrombosis. However, the etiology of venous thrombosis is still not unclear. We have experienced a case of iatrogenic intracranial and intraspinal hypotension and presumably which may cause dural sinus thrombosis and consequently caused intracerebral hematoma and small subdural hematoma. A sixty one years old female patient was admitted to a hospital by lumbago. She was treated by epidural anesthesia. The epidural anesthesia was completely uneventful. Few hours later she complained severe headache. CT examination

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revealed right medial parietal hematoma. MRI was also performed to find the cause of hematoma. Then we found not only right medial parietal hematoma but also left medial parietal T2WI high intensity edema. Then, we found the straight sinus filling defect and superior sagittal sinus irregularities on MR venography, indicative of representing dural sinus thrombosis. The headache had been gradually improved. However , high back pain was gradually increased and finally grew up intolerable within a week. Then we performed thoracolumbar MRI and found subdural hematoma ( not epidural hematoma) in the whole spine. RESULT A case report of probable iatrogenic intracranial hypotension with dural sinus obstruction and consequent intracranial hematoma will be presented. We must stress that there could be occur intraspinal subdural hematoma. There is no reason that intraspinal subdural hematoma does not occur, as is quite usual in the intracranial space. We should be aware of these intraspinal findings and this vicious cycle.

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Craniocaudal diameter of lesion is about 8 cm.The lesion has a MRI characteristics of intadural lipoma. There is tethered spinal cord due to intradural lipoma, with low insertion of conus medullaris at low third of corpus L4.Conus medullaris and cauda equina are displaced anteriorly. CONCLUSION Adult patients with persistent back/leg pain should be investigated with MRI to establish an early diagnosis.Surgery should be performed once the diagnosis is established. P-123 DIFFERENTIATION BETWEEN SYMPTOMATIC AND ASYMPTOMATIC EXTRAFORAMINAL STENOSIS IN LUMBOSACRAL TRANSITIONAL VERTEBRA: THE ROLE OF THREE-DIMENSIONAL MR LUMBOSACRAL RADICULOGRAPHY Woo Mok Byun Departments of Diagnostic Radiology, College of Medicine, Yeungnam University, Daegu, Republic of Korea

P-122 TETHERED SPINAL CORD DUE TO INTRADURAL SPINAL LIPOMA IN ADULTS –A CASE REPORT Vesna Boskovic, Katarina Kacar, Gordana Milenkovic, Biljana Georgievski Brkic Special hospital "Sveti Sava", Belgrade, Serbia INTRODUCTION The tip of the conus medullaris lies at the L2 level or above in 98 % of people.Therefore if the conus is at or below the L2-L3 disc space it should be considered abnormal and search for a cause of tethering should be performed. Many spinal lesions had been reported to be the cause of tethered spinal cord in adults.Tethered spinal cord is often associated with intradural spinal lipoma. Its clinical manifestaction include back ache and leg pain, bowel and bladder dysfunction, lower limb weakness, sensory changes. MATERIALS AND METHODS We are presenting a 52 year old female patient with complaints of low back/leg pain.MRI(1,5 T GE) exam was performed ussing routine protocol which include T1W, T2W, STIR. RESULTS MRI showed a hyperintense T1W fusiform intradural lesion in spinal canal, posteriorly, which is extending from superior end plate L4 to midline of S2.

OBJECTIVE To investigate the role of lumbosacral radiculography using 3-dimentional (3-D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. MATERIALS AND METHODS The study population consisted of 18 patients with symptomatic (n 010) and asymptomatic extraforaminal stenosis (n08) in lumbosacral transitional vertebra. 3-D coronal fast-field echo sequences with selective water excitation were acquired using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3-D MR rendered images of the lumbosacral spine. RESULTS Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3-D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases while swelling of the nerve roots was seen in eight cases. Location of indentation was the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative

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osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3-D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in all cases with asymptomatic extraforaminal stenosis. CONCLUSION Results from 3-D MR lumbosacral radiculography indicated indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on this, 3-D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis. P-124 MRI OF NON DISCOGENIC SCIATICA Alberto Cabrera Zubizarreta, Oscar Casado Verdugo, Ibone Saralegui Prieto, Iñigo Vicente Olabarria, Jose Maria Ontañon Garces OSATEK. MR Unit Hospital Galdakao, Galdakao, Bizkaia, Spain Our aim is to evaluate the MRI findings in non discogenic sciatica. Sciatica is very common and is one of the most frequently encountered symptoms in neurosurgical practice and in spinal imaging. It manifests as pain extending from lumbar region to the hip and to the lower extremity. It is present in almost 45 % of adults at some point in their lives. It is secondary to a spectrum of pathologies that affect the sciatic nerve both in its intraspinal or extraspinal course. In most ocasions it is caused by lumbar disk herniation and in 20 % of cases, the sciatica is of both discogenic and non-discogenic origin. Many intraspinal (non dicogenic) or extraspinal pathologic processes along the lumbar plexus, nerve roots and the sciatic nerve may also cause sciatica. We review both intraspinal and proximal extraspinal disorders that may cause sciatica. We present a series of intraspinal cases including processes such as intradural cysts, neural tumors, vascular malformations and radicular vein varix, spinal epidural abscesses and hematomas, facet syndrome, and lumbosacral instability that presented clinically as sciatica. Extraspinal disorders with sciatica as main clinical feature include metastatic lesions, lymphoma, liposarcoma, rabdomyosarcoma, fibromatosis, endometriosis, nerve compression after surgery and muscular diseases such as cuadratus femoralis edema and pyramidal syndrome wich may also compress the sciatic nerve along the sciatic notch and its proximal pelvic course. Special emphasis is given on the value of high resolution MR Neurography including diffusion weighted imaging.

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P-125 TRANSORAL APPROACH FOR THE TREATMENT OF OSTEOLYTIC TUMOR LESIONS OF THE LATERAL MASS OF THE ATLAS: FEASIBILITY AND INITIAL EXPERIENCE IN TWO PATIENTS Frédéric Clarençon1, Evelyne Cormier1, Hugues PascalMoussellard2, Jean-Baptiste Maldent3, Soizic Pichon3, Lise Le Jean4, Léon Ikka5, Jacques Chiras1 1 Department of Interventional Neuroradiology. Pitié-Salpêtrière Hospital, Paris, France, 2Department of Orthopedic Surgery. Pitié-Salpêtrière Hospital, Paris, France, 3Department of Otorhinolaryngology. Pitié-Salpêtrière Hospital, Paris, France, 4Department of Anesthesiology. Pitié-Salpêtrière Hospital, Paris, France, 5Department of Neuroradiology. Beaujon Hospital, Beaujon, France SUMMARY OF BACKGROUND DATA Percutaneous vertebroplasty has gained acceptance for the treatment of osteolytic lesions of the spine. However, only scant data are available on the PV of the C1 lesions. We present our early experience of PV via a transoral approach of the lesions of the lateral mass of C1. METHODS 2 patients (one 74-y-o female and one 53 y-o male) presenting respectively a metastasis of the left lateral mass of C1 from a pancreatic adenocarcinoma and a hemangioma of the left lateral mass of C1 underwent a PV via a transoral approach in a hybrid angio suite associating a monoplane flat panel and a CT, using PMMA bone cement. For the second patient, a non-detachable balloon was used to protect the vertebral artery from cement leakage. RESULTS Satisfying filing of the lesions was obtained in both patients. No complication was recorded. Both patients experienced pain improvement. CONCLUSION Transoral approach for the treatment of osteolytic tumor lesions of the lateral mass of the atlas is feasible and seems to be a safe and effective technique. P-126 SPONTANEOUS TRANSDURAL SPINAL CORD HERNIATION (STSCH): SPECTRUM OF POSTOPERATIVE MRI FINDINGS Raffaella Colantonio, Chiara Schiarelli, Matia Martucci, Emma Gangemi, Simona Gaudino, Tommaso Tartaglione, Cesare Colosimo Catholic University of Sacred Heart, Hospital "A.Gemelli", Rome, Lazio, Italy

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PURPOSE STSCH, defined as the prolapse of the spinal cord through a dural defect, is a rare but treatable cause of thoracic myelopathy. Various procedures are used to treat STSCH and they are primarily: Duroplasty (DP), with or without a dural patch, and Dural Defect Enlargement (DDE). We provide a comprehensive description of postoperative MRI findings of STSCH, focusing on early and long-term complications. METHODS We retrospectively reviewed MRI postoperative studies of 9 patients with intraoperatively confirmed diagnosis of STSCH. 6/9 patients were treated with DP, 3/9 with DDE. MRI protocols included sagittal and axial FSE T2-w and FSE or SE T1-w images pre and post-gadolinium with at least one T2-w high-resolution sequence. MRI follow-up range from 2 to 12 years and included brain studies with GRE T2-w images in 3 cases. RESULTS Post-surgery MRI follow-up showed realignment of the spinal cord in the spinal canal in all cases. High T2 signal intensity within the spinal cord was found in 2/9 cases. Dural patch appeared hypointense on sagittal T2-w images associated with variable C.E. 3/3 patients who underwent DDE developed extradural CSF collections and superficial siderosis of the brain and 1/3 also of the spine. All complications were correctly depicted by MR. CONCLUSION MRI follow-up with high resolution T2-sequences is mandatory in the evaluation of postsurgical STSCH since it allows the detection of possible early/long-term complications. For patients undergoing DDE we suggest long term MRI follow-up of the spine and brain, including T2* wi for detection of possible superficial siderosis P-127 PICTORIAL REVIEW OF THE IMAGING FEATURES OF SPINAL LYMPHOMA. LOOKING BEYOND THE BONES Jane Cunningham, Edel Kelliher, Sarah Power, Alan O'Hare, Paul Brennan, John Thornton, Seamus Looby Beaumont Hospital, Dublin 9, Ireland PURPOSE To illustrate the diversity of imaging appearances of "spinal lymphoma". 85 % of these extranodal cases are Non Hodgkins subtype. Patients are typically middle aged males who present with back and radicular pain.

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Spinal cord compression is rare occurring in only 1 % of cases. MATERIALS AND METHODS Numerous spinal MRI studies were reviewed for characteristic and rarer appearances of lymphoma involving each of the anatomical spinal components. While it is relatively well known that vertebral lymphomatous involvement typically demonstrates hypointense lesions on T1 weighted MRI, cases of epidural, leptomeningeal, intramedullary and nerve root lymphoma were also identified to increase awareness of the versatility of imaging appearances on MRI. RESULTS This educational pictorial essay demonstrates a multitude of manifestations of lymphoma involving the spine both on CT and MRI. Differential diagnoses that can mimic imaging appearances are also considered. CONCLUSION Lymphoma of the spine is a rare but crucial diagnosis to consider when evaluating spinal MRI of patients with back pain. We discuss typical findings and distinguishing characteristics to help with diagnosis as early implementation of appropriate therapy can have important prognostic implications. P-128 TARGETED RADIOFREQUENCY ABLATION (T-RFA) OF MALIGNANT SPINE LESIONS USING A BIPOLAR NAVIGATIONAL DEVICE: INITIAL CLINICAL EXPERIENCE Bassem Georgy1, Andreas Kurth2, Douglas Coldwell3, Allan Brook4, Jack Jennings5 1 University of California, San Diego, San Diego, CA, USA, 2 University of Mainz, Frankfurt, Germany, 3University of Louisville, Louisville, KY, USA, 4Albert Einstein School of Medicine, New York, NY, USA, 5University of Washington, St. Louis, MO, USA PURPOSE Report first experience in t-RFA of malignant lesions of the spine using a novel bipolar RF ablation system, purpose built for minimally invasive procedures in the axial skeleton. MATERIAL/METHOD 26 spinal lesions in 21 patients were included. Lesion etiology and location included multiple myeloma and a variety of metastatic malignant solid tumors in T2- S1, sacral ala and ileum. The STAR Tumor Ablation System includes a navigationally robust, articulated osteotome which serves as a bipolar electrode containing two active thermocouples (TC) positioned to permit real time monitoring of the

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peripheral edge of the ablation zone. Treatment is controlled by adjusting power while monitoring TC temperature. Pre-op planning used CT and thermal distribution curves. Cement augmentation via the same guiding cannula was performed when required. RESULTS Procedures were performed safely with no complications or thermal injury. Sequential, targeted areas of ablation were achieved via the same access following articulation of the electrode under image guidance and TC monitoring. All patients reported considerable pain relief and significantly reduced disability post treatment. CONCLUSION The STAR Tumor Ablation System, the first purpose-built, bipolar RF device for targeted ablation of spinal malignant lesions, functioned as designed. Malignant lesions, regardless of location were easily accessed. Proximal and distal thermo-couples allowed accurate monitoring of the temperature inside the vertebral body to avoid complications of nearby vital structures. High viscosity cement could be delivered after ablation from the same guiding cannula.

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weighted imaging, 14 patients were diagnosed with spinal CSF leaks and the floating dural sac sign was observed in 17 patients. There were 13 patients with spinal CSF leaks and 4 without CSF leaks (sensitivity, 92.9 %; specificity, 92.9 %). Of 86 patients examined MR myelography, extradural fluid was observed only 3 patients (sensitivity, 21.4 %; specificity, 100 %). CONCLUSION The floating dural sac sign was a sensitive sign that can be used to find out CSF leakage. Spinal axial T2-weighted imaging might be a good screening method for spinal CSF leakage that can help to avoid a lumbar puncture. P-130 EFFICIENCY OF OSTEOPATHIC THERAPY IN A COMPLEX WITH TRADITIONAL CONSERVATIVE TREATMENT OF INDIVIDUAL PROTRUSION OF LUMBAR INTERVERTEBRAL DISKS Alexander Ivankov, Andrey Grossman, Alla Tolstykh Irkutsk City Hospital 1, Irkutsk, Russia

P-129 A SENSITIVE MAGNETIC RESONANCE FINDING OF SPINAL CEREBROSPINAL FLUID LEAKAGE: FLOATING DURAL SAC SIGN Takaaki Hosoya1, Jun Hatazawa2, Shinya Sato1, Masafumi Kanoto1, Akira Fukao1, Takamasa Kayama1 1 Yamagata University, Yamagata, Yamagata, Japan, 2Osaka University, Suita, Osaka, Japan PURPOSE We would like to show a floating dural sac sign, which is observed as high signal intensity band or rim around the spinal dural sac on axial T2WI, as a sensitive sign to find out cerebrospinal fluid (CSF) leakage. MATERIALS AND METHODS One hundred patients with orthostatic headache were prospectively registered in 11 hospitals under the Cerebrospinal Fluid Hypovolemia Research Group. These patients were examined with follows: brain MRI (n089), RI cisternography (RIC) (n089), MR myelography (MRM) (n086), axial T2WI of the spine (n070), and CT myelography (CTM) (n02). In this study, we evaluated separately about imaging findings of intracranial hypotension and spinal CSF leakage. RESULTS Among 100 patients, 16 patients were diagnosed having spinal CSF leakage. Of 70 patients examined axial T2-

PURPOSE to compare effect of complex therapy including a course of osteopathic therapy with traditional conservative treatment of lumbar disks protrusion. METHODS the assessment of MRI (Toshiba of 1,5 T.) lumbar of 500 patients aged 18 - 60 years with MRI signs of one protrusion of intervertebral disk. The assessment disk protrusion was made by means of a ratio of width and depth of a protrusion. Patients were divided into two groups depending on the treatment. Standard conservative treatment prescribed by the neurologist or the neurosurgeon was performed to patients of the first group, in the second group - osteopathic therapy in a complex with traditional treatment. Groups were representative on a sex, age, localization of protrusion, duration of a disease. Efficiency of treatment was estimated by measurement of disk prolapse depth at mm. The assessment was carried out before and after treatment. RESULTS There were no statistically significant differences between studied groups on the protrusion size before treatment. The average size of a protrusion before treatment in both groups was 3,5 mm. Significant decrease of protrusion size in the first group after treatment was not founded (р>0,05). Considerable reduction of the protrusion size to 2 mm was marked at all variants of protrusion localization after treatment in the second group (р00,02).

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CONCLUSION According to the performed research osteopathic therapy course in a complex with traditional conservative treatment is an effective method of treatment all variants localization lumbar disk protrusion. P-131 SPINAL INFECTION – A RADIOLOGICAL PICTORIAL REVIEW Liam Kavanagh1, Leo Galvin1, Sarah Power 1, Joanna Pearly-Ti1, Paul Brennan1, John Thornton1, Seamus Looby1 1 Beaumont Hospital, Dublin, Ireland, 2Royal College of Radiologists in Ireland, Dublin, Ireland PURPOSE To provide a concise radiological pictorial review of the common as well as more unusual radiological manifestations of spinal infections. MATERIALS METHODS Using selected images from patients with spinal infection from our own and other institutions, we illustrate plain film, CT, MRI and other radiological modality features of spinal infection. These include examples of bacterial and granulomatous osteomyelitis and discitis and related complications, subdural empyema, epidural abscess, meningitis and meningeal sequelae. Examples of some rarer intramedullary and intradural, extramedullary infections are also included such as HIV, toxoplasmosis and neurocysticercosis. RESULTS MRI is the workhorse radiological modality in the evaluation of spinal infection but pathognomonic features can also be demonstrated on plain film and CT. CONCLUSION This illustrative pictorial essay is a concise collection of many of the common spinal compartment infections. P-132 IMPROVING EFFICIENCY OF DIAGNOSIS IN ACUTE CERVICAL SPINE INJURY: A TRAUMA CENTRE EXPERIENCE Kate Mahady 1 ,2 , Jeremy Macmullen-Price 2 , Kathryn Davies2, Heather Yoxall2 1 National Hospital for Neurology and Neurosurgery, London, UK, 2Leeds General Infirmary, Leeds, UK BACKGROUND NICE recommends immediate cross sectional cervical spine imaging for suspected polytrauma patients, or

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those who are intubated or GCS ≤13. Initial plain XR can mean unjustified radiation, prolonged immobilisation and delayed diagnosis. We aim to identify patients who qualified for urgent CT and underwent prior plain XR in order to assess change in plain XR use following local implication of NICE guidance. STANDARDS 1.No patient qualifying for urgent polytrauma CT should undergo prior C-spine XR. METHODS Patients retrospectively identified who: 1.Presented between 05/2009-01/2010 and 05/2010-01/ 2011 2.Underwent polytrauma CT (unenhanced CT Head, enhanced CT chest, abdomen and pelvis, CT bony pelvis/ whole spine) In patients where C-spine XR preceded CT, we recorded: 1.GCS score 2.Intubation status 3.Imaging times RESULTS OF 1st ROUND May 09-Jan 10 · 8/59 (13 %) polytrauma patients underwent prior cervical XR · Mean time delay - 106 mins May 10-Jan 11 · 16/200 (8 %) underwent cervical XR · Mean time delay - 233 mins ACTION PLAN Standards were not met – in both time periods, polytrauma patients underwent prior C-spine X and a time delay of >1 hour was demonstrated. Through publication of our findings, we aim to eliminate unjustified cervical spine XR for polytrauma patients. P-133 ANALYSIS OF CERVICAL SPINAL CORD VOLUME IN PRESYMPTOMATIC AND SYMPTOMATIC CARRIERS OF SCA1 AND SCA2 GENE MUTATION Grzegorz Makowicz1, Maria Rakowicz2, Anna Sułek3, Rafał Rola4, Renata Poniatowska1, Elżbieta Zdaniecka3, Leszek Czerwosz5 1 Department of Neuroradiology, lnstitute of Psychiatry and Neurology, Warsaw, Poland, 2Department of Clinical Neurophysiology, lnstitute of Psychiatry and Neurology, Warsaw, Poland, 3 Department of Genetics, lnstitute of Psychiatry and Neurology, Warsaw, Poland, 4Department of Neurology, lnstitute of Psychiatry and Neurology, Warsaw, Poland, 5Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland

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BACKGROUND AND PURPOSE Neurodegeneration in spinocerebellar ataxias type 1 and type 2 (SCA) is associated with well documented cerebellar and brainstem atrophy. There have also been rare reports of cervical spinal cord atrophy. The purpose of this study was to perform quantitative assessment of whole cervical spinal cord volume in presymptomatic and symptomatic carriers of SCA1 and SCA2 gene mutation. PATIENTS AND METHOD 23 presymptomatic carriers of SCA gene mutation (mean age 25.3±5 years, SCA1 n020, SCA2 n03, SARA 1.5±0.75, range[0-3]), 12 symptomatic patients (mean age 49±7.6 years, SCA1 n09, SCA2 n03, mean SARA017±8.) and 13 healthy control subjects (mean age 25.6±6.2 years) underwent MRI with acquisition of a high resolution T1 weighted sequence. We performed quantitative volumetric analysis of cervical cord using manual segmentation. The spinal cord volume was normalized for subject height in meters. RESULTS With respect to control (mean-5569±470 mm3/m), the normalized spinal cord volume in presymptomatic (mean-4598± 523 mm3/m) and symptomatic (mean-3818±324 mm3/m) carriers was significantly reduced (p<0.00002; p<0.0000005, respectively). There was also significant difference between group of presymptomatic and symptomatic subjects in terms of normalized spinal cord volume (p<0.002). CONCLUSION To our knowledge, this is the first in vivo volumetric analysis of the whole cervical spinal cord in SCA1 and SCA2. Volumetric analysis revealed significant cervical spinal cord atrophy in presymptomatic and symptomatic carriers of SCA gene mutation. P-134 USEFULNESS OF DYNAMIC MR IMAGING OF THE CERVICAL SPINE Ammar Mallouhi1, Wolfgang Marik1, Michaela Wagner2, Matthias Starzinger2, Fredrik Waneck1, Daniela Prayer1 1 Vienna Medical University, Vienna, Austria, 2Innsbruck Medical University, Innsbruck, Austria MR imaging, performed in the neutral position, is a standard imaging technique of the cervical spine. Nevertheless, some patient's symptoms may not correlate with MR findings. Dynamic MR imaging of the cervical spine in anteflexion, retroflexion allows detection and quantification of spinal and foraminal stenosis and to characterize neural and ligamentous involvement. The dynamic technique is particularly useful in evaluating spinal cord involvement in patients with degenerative spinal stenosis, instability, posttraumatic abnormalities,

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postoperative instability and vertebral segmentation failure. An important role of dynamic imaging is the preoperative planning. In conclusion, dynamic MR imaging of the cervical spine may help in the diagnosis of some abnormalities that are not appreciated on routine static imaging. This would prevent from developing myelopathy and from performing further operations on adjacent cervical levels. P-135 CLINICAL CORRELATION OF A NEW PRACTICAL MRI METHOD FOR ASSESSING LUMBAR FORAMINAL STENOSIS Hee-Jin Park, So-Yeon Lee, Eun-Chul Chung Kangbuk Samsung hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea PURPOSE To evaluate whether a new MR grading system correlated with symptoms and neurologic signs and could replace the previous grading system. MATERIAL AND METHODS We examined 91 cases of MRI of L-spine and assessed grade of the foraminal stenosis according to the new grading system suggested by Lee et al(Lee system) and Wildermuth grade system. Results were correlated with clinical manifestations. Statistical analysis was performed using kappa statistics, categorical regression analysis. RESULTS Interobserver agreement in the grading of foraminal stenosis was substantially correlated(0.767, 0.734). The correlation coeefficients (R) for reader 1 and 2 between Lee system and Widermuth system were 0.880 and 0.885, between Lee system and positive neurologic menifestation (PNM) were 0.715 and 0.604, and between Widermuth system and PNM were 0.800 and 0.680. For cases <50, the R between Lee and Wildermuth system was higher than for cases >50, but the Rs between the grading system and PNM were lower in the younger group than in the older group. The Rs of the Wildermuth system with PNMwere higher in the older group than the younger group, and the differences between the Rs of the Lee system with PNM, and the Wildermuth system with PNM were higher in the older group. CONCLUSION Interobserver agreement of Lee system was slightly higher than Wildermuth system and substantially correlated. Both systems are good for evaluation of the lumbar spinal foraminal stenosis but Lee system show slightly better interobserver agreement and good clinical correlation in the younger group of patients.

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P-136 LUMBOSACRAL NERVE ROOT ANOMALIES: THREE DIMENSIONAL MR LUMBOSACRAL RADICULOGRAPHY Woo Mok Byun, Won Kyu Park Departments of Diagnostic Radiology, College of Medicine, Yeungnam University, Daegu, Republic of Korea PURPOSE The purpose of this study is to investigate usefulness of 3dimmentional (D) MR radiculography depicted by rendering imaging using Proset for diagnosis of the lumbosacral nerve root anomalies. MATERIALS AND METHODS Our study included 13 patients (age range, 19-82 years; mean ages, 57.8 years; 5 men, 8 women) who all had lumbosacral nerve root anomalies. The diagnosis and types of a conjoined nerve root was determined by two radiologists in consensus if the anomalous morphology of the lumbosacral nerve roots on 3-D MR lumbosacral radiculography. 3D coronal fast-field echo (FFE) sequence with selective water excitation by using the principles of the selective excitation technique (Proset imaging) were acquired. RESULTS In 3 of the 13 cases, the presence of a conjoined nerve root was also confirmed by operative findings. The location of the conjoined nerve root was noted at the L5-S1 (12 out of 13, 92.4 %) and S1-S2 (1 out of 13, 7.6 %). The most common location of a conjoined nerve root was at the L5-S1 level. Width of two nerve roots in conjoined nerve root was different in eleven cases; the cephalad nerve root component was more thicker than that of the inferior nerve root component in seven cases and the cephalad nerve root component was more thinner than that of the inferior nerve root component in four cases. CONCLUSION 3-dimmentional (D) MR radiculography depicted by rendering imaging using Proset imaging is very useful for detail evaluation of lumbosacral nerve root anomalies. P-137 Abstract withdrawn P-138 THORACOLUMBAR DUPLICATION OF THE SPINE IN A CHILD WITH ITS RADIOLOGIC FINDINGS Suzan Saylisoy, Cigdem Oztunali, Taylan Kara, Baki Adapinar Department of Radiology, Eskisehir Osmangazi University, Medical Faculty, Eskisehir, Turkey

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BACKGROUND Split cord malformations encompass a wide spectrum of spine abnormalities. Classically these malformations are defined as diastematomyelia (a simple cleft splitting two hemicords) and diplomyelia (a true doubling of the spinal cord). The latter, is at the severe end of these malformations. When present, this rare malformation is usually associated with severe vertebral, gastrointestinal and genitourinary tract abnormalities. The aim of this report is to present a case of duplication and seperation of the spine with its clinical and radiological futures. CASE REPORT A 2-year-old girl was admitted to pediatric clinic with growth retardation. Neurologic examination revealed flaccid paralysis of the left lower extremity, pes equinovarus deformity of left foot and a bulging anterior fontanelle. Her history revealed a surgical repair of a lumbosacral myelomeningocele. She was referred to the radiology department for the evaluation of any present spinal anomalies. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed. Multiple hemivertebrae anomalies were detected at the upper to mid-thoracal region. At midthoracal to upper lumbar level, two separate spinal canals, each containing a thecal sac and a hemicord were present. The vertebra bodies were not fully duplicated but were partially fused, with doubling of the posterior elements of the vertebrae was CONCLUSION True duplications of the spinal cord are rarely seen and represent the severe form of split cord malformations. Although neurologically intact adolescent and adult cases have been published, early surgery is recommended to all cases because of the increased risk of neurological defects with age. P-139 SPINAL MR FINDING OF NEUROMYELITIS OPTICA AND NEUROMYELITIS OPTICA SPECTRUM DISORDER Keisuke Suzuki1, Masahumi Kanoto0 ,2, Takaaki Hosoya0 ,2, Sakiko Kageyama 0 ,2 , Yuuki Toyoguchi 0 ,2 , Fumika Watarai0 ,2 1 Yamagata Prefectural Central Hospital, Yamagata, Japan, 2 Yamagata Universuty, Yamagata, Japan PURPOSE Neuromyelitis optica (NMO) and NMO spectrum disorder (NMOSD) are the demyelinating diseases differing from the multiple sclerosis (MS). Although comparatively characteristic findings of the spinal cord in NMO/NMOSD have been reported, we have experienced patients who showed atypical

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findings. Our purpose is to disclose the wide variety of imaging findings of the spinal cord in NMO/NMOSD. METHODS The subjects, who were diagnosed as NMO/NMOSD in our hospital from Sep. 2007 to Dec. 2011, are 4 patients (all women), aged 11 to 56 years (mean, 38.5 years). We retrospectively reviewed MRI findings especially in spinal cord. RESULTS The spinal cord lesions were seen at C2-Th11 level, that were particularly frequent in cervical cord to upper-thoracic cord, while those were seen in low-thoracic cord (Th9-11 level) with 2 patients. The longitudinally extensive transverse myelitis was seen in only 2 of 4 patients. The short segmental myelitis was seen in 3 patients, 2 of whom did not show longitudinal extensive spinal cord lesions. On axial images, the lesions were seen in lateral and/or posterior region in 3 patients and were seen in central lesions in 3 patients. Thus, over 50 % patients showed atypical findings on spinal MRI. CONCLUSION On spinal MRI, NMO/NMOSD often showed atypical findings similar to those of MS. We should take into consideration NMO/NMOSD in diagnosing the demyelinating disease. P-140 DURAL ECTASIA IN A PATIENT WITH ANKYLOSING SPONDYLITIS Vojtech Sychra1, Steffen K. Rosahl2, Christoph Strasilla1, Joachim Klisch1 1 Department of diagnostic and interventional Radiology and Neuroradiology, Helios Klinikum, Erfurt, Germany, Erfurt, Germany, 2Department of Neurosurgery, Helios Klinikum, Erfurt, Germany, Erfurt, Germany Dural ectasia is a rare complication of long-standing ankylosing spondylitis leading to destruction of the vertebral arch or rarely of the vertebral body. Usually it is associated with fixation of the nerve roots to the dura or to the wall of the defect resulting in a cauda equina syndrome. This kind of destruction occurs in the late ankylosing stage of the disease. CT/MRI depict a wide spinal canal and multisegmental destruction of the vertebrae with dislocation of the cauda equina into the defect. The diagnosis is easy if one is aware of this entity. Sometimes an inflammatory mass can be found. Because treatment with infliximab leads to neurological improvement, inflammation is a likely cause of this destruction. On the other hand, a lumboperitoneal shunt may also lead to clinical improvement, suggesting that cerebrospinal fluid pulsations may bulge a dural sac with reduced elasticity.

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P-141 ARTERIOVENOUS MALFORMATIONS OF THE SPINAL CORD:CHOICE OF CONTEMPORARY ENDOVASCULAR METHOD FOR TREATMENT Teodor Tissen, Sergey Yakovlev, Evgeniy Bukharin, Alexsey Bocharov, Sergey Arustamyan, Bogdan Tissen Federal State Neurosurgical Institute by N.N.Burdenko, Moscow, Russia The aim is to determine the optimal endovascular method and its features in the treatment of arteriovenous malformations (AVM) of the spinal cord. METHODS over 500 patients with AVM of the spinal cord were treated in period over 30 years. Among them were men 68 %, women 32 %, including 185 children.The endovascular occlusions of afferent AVM`s vessels using the different methods from the first balloon-occlusion method by F. Serbinenko to with the coils. RESULTS Occlusion of spinal afferent vessels and AVM‘s stroma was mainly performed by using PVA-emboli, glue Hystoacryl and coils. Dural arteriovenous fistulae (DAVF) localized on the posterior spinal cord surface had great extension in veins and slow blood velocity. Endovascular occlusion for this type of DAVF consists in direct injection of the glue into the vessel and intercostal artery. When dealing with endovascular occlusion of the AVM supplied by the artery of Adamkiewicz, it is necessary first to extinct accessory sources of blood supply and only then if possible to extinct an aneurysm from the Adamkiewicz artery system by using glue or coils. The technique used resulted in outcome improvement in 90 % of cases, 7 % of patients revealed no dynamics, and 3 % showed neurological impairment. CONCLUSION The choice of using a method of endovascular occlusion should be based on thorough analysis of spinal angiography and MRI data, haemodynamic characteristics of the AVM and DAVF spinal cord. P-142 OUT OF HOURS SPINAL MRI SCAN FOR SUSPECTED CORD COMPRESSION - SINGLE CENTRE RESULTS Laura Zilinskiene, Latha Senthil Queen Elizabeth Hospital Birmingham, Birmingham, UK OBJECTIVE Spinal cord or cauda equina compression causes significant neurological disability, if not treated promptly. The NICE

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(UK) guidelines state that MRI is the main assessment tool. Outside normal working hours, MRI is reserved for clinical situation dictating emergency treatment. The aim of the current study was to evaluate our current practice against proposed standards and to analyse the practical issues in delivering a sustainable good service. METHODS Requests, reports and subsequent clinical management of all out of hours spinal MRI scans performed over 4/12 (JulyOctober 2010) were analysed retrospectively. RESULTS There has been 30 % increase in the demand for this clinical indication, compared with the previous 4/12. During the study period, total of 87 out-of-hours scans were performed; 66 % female patients, average age 47 (17-83) years. Majority of requests (38 %) were from the Accident and Emergency department. More than 2/3 of the scans were performed within four hours of the request, and 100 %within 24 hours. 17 (20 %) patients were found to have cord or cauda equina root compression. Out of the positive scans, only 3/17 (18 %) had undergone treatment overnight and 8/17 (47 %)-within 24 hours from the scan. CONCLUSION The out of hours imaging of suspected cord compression is carried out in timely manner, but clinical impact remains suboptimal for various reasons. With increasing demand and decreasing resources/support, we discuss and propose coordinated care pathways existing in our unit, engaging all involved multi disciplinary team members, ensuring best medical practice and at the same time managing financial implications.

blood" MRI (BB MRI) in detection and evaluation of the carotid arteries (CA) lesions. MATERIAL AND METHODS 88 patients with carotid artery stenosis (>70 %) and occlusion were taken in analysis aged 48-85, men -61, women - 27. These patients were undergoing surgical treatment. Complex diagnostics included DUS, CTA, 2DTOF and PC MRA (54 patients), BB MRI (21), DSA (23). We calculated the sensitivity and specificity of each methods in the detection of critical stenosis (relatively DSA) and in comparison with postoperative histological data. RESULTS Total number of CA was 176 (21 normal). CTA revealed 99 affected CA, (occlusion - 16). 2DTOF MRA revealed 86 affected CA, occlused -16. Sensitivity and specificity for the CTA and TOF MRA were 100 % vs 93 % and 90 % vs 80 %, respectively. CT density, measured in the plaques, demonstrated better correlation with postoperative histological data than intensity of MR-signal by BB MRI technology. CONCLUSION Algorithm of complex diagnostics stenotic and occlusive lesions of the carotid arteries defines the use of different diagnostic methods for preoperative diagnosis and determines the individual approach to the treatment of each patient. DUS is a screening method for the detection of stenosis. CTA is the most effective method of critical stenosis detection and evaluation of plaques structure. MRA and BB MRI provide additional information for location and structure of the plaques, including hemorrhage.

THEME: STROKE

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MOYAMOYA SYNDROME SPONTANEOUS ANASTOMOSIS

Abstract Withdrawn P-144 COMBINED DIAGNOSTICS OF STENOTIC AND OCCLUSIVE LESIONS OF THE CAROTID ARTERIES Nikita Arutyunov1, Tatiana Melnikova-Pitskhelauri1, Farid Mamedov1, Elena Belysheva0 ,2, Valery Kornienko1 1 Federal State Neurosurgical Institute by N.N.Burdenko, Moscow, Russia, 2The First State Medical University by I.M.Sechenov, Moscow, Russia The aim of this work is presented algorithm of complex diagnostics stenotic and occlusive lesions of the carotid arteries by CT and MR angiography, high resolution "black

Raquel Carvalho1, Miguel Afonso0 ,2, João Fernandes1, Carlos Alegria0 ,2, Jaime Rocha1 1 Hospital de Braga, Imaging/Neuroradiology Department, Braga, Portugal, 2Hospital de Braga, Neurosurgery Department, Braga, Portugal PURPOSE Moyamoya syndrome (MMS) is characterized by bilateral progressive steno-occlusion of the terminal internal carotid arteries with associated development of network collateral vessels. It most commonly presents in childhood, but is also frequent in adults, especially in the third or fourth decade of life. Adults more commonly present with hemorrhage, while children mostly present with ischemia. METHODS Case-Report.

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RESULTS A 37-year-old female presented with history of transient neurologic deficits associated with exercise 6 years ago. She has one brother with MMS in childhood. The Magnetic Resonance revealed old ischemic lesions in anterior and medial cerebral arteries (ACA/MCA) territories, and watershed bilaterally, with correspondent areas of hypoperfusion on perfusion study, and subtle left centum semiovale hemorrhagic foci. The angiographic study showed bilateral supra-cavernous carotid occlusion, immediately after ophthalmic arteries emergence. There were compensation of the ACA and MCA territories by retrograde filling of posterior communicating arteries by posterior circulation and trans-dural anastomosis between internal and external carotids by middle meningeals and right superficial temporal. The lenticulostriate vessels look like typical "puff of smoke". CONCLUSIONS The efficacy of cerebral revascularization for reducing the incidence of strokes and transient ischemic attacks in pediatric and adult patients presenting with cerebral ischemia has been accepted for many years, and it's controversial for prevention of re-hemorrhage. However, paucity of data on selection criteria and global outcome measures means that the impact of surgical revascularization in natural history remains uncertain. In our case, MMS underwent a benign natural course without surgical revascularization.

on admission was 7 for the BA patient, 10 and 11 for the two M1-M2 cases respectively. A 10 mg i.v. bolus of Abciximab was injected prior to thrombecotmy. The procedure was performed by using the Solitaire stent in two cases and Solitaire+Penumbra system in the BA case. A further10 mg dose of rTPA was injected intra-arterially (i.a) in absence of recanalisation at 6 hours.

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DELAYED RECANALISATION AFTER RESCUE INTRA-ARTERIAL INJECTION OF RTPA IN THREE CASES OF THROMBECTOMY FAILURE IN THE SETTING OF ACUTE ISCHEMIC STROKE

ROUTINE MRI IN DIFFERENTIAL DIAGNOSIS OF ACUTE STROKE TYPE

Federico Di Maria1, Frédéric Clarençon1, Nader Sourour1, Sandrine Deltour2, Gurkan Mutlu2, Jacques Chiras1 1 Neuroradiology - Pitié Salpetrière Hospital, Paris, France, 2 Cerebrovascular neurology - Pitié Salpetrière Hospital, Paris, France PURPOSE we present three cases of delayed recanalisation of occluded cerebral arterial branches after failed rmechanical thrombectomy. METHODS we identified 3 patients (2 male, 1 female, mean age 63) treated between June 2011 and March 2012, who were referred to mechanical thrombectomy at 5 hours since symptom onset. Intravenous (i.v.) fibrinolysis was contraindicated due to chronic anticoagulation. One patient presented with a basilar artery (BA) occlusion, the other two with a left M1-M2 segment occlusion. NIHSS

RESULTS Mechanical thrombectomy failed in all cases. The angiographic run performed 30 minutes after i.a. rTPA injection at 6 hours, showed aTICI 1 recanalisation grade in one M1-M2 case. Follow-up MRI performed at 12 hours after onset showed complete recanalisation of the occluded segments in all patients. Hemorrhagic transformation occurred in the patient with BA stroke at 24hours. At 3 months, the modified Rankin Score was 0 to 2 in all patients. CONCLUSION after rescue or combined stroke therapy, delayed spontaneous recanalisation of the occluded arterial segments can occur beyond the 6-hour window. Favourable outcome may be observed even in those patients who recanalise beyond 6 hours.

Burenchev Dmitry, Guseva Oxana Clinic #2 of Ministry of Economic Development of the Russian Federation, Moscow, Russia INTRODUCTION AND PURPOSES There is no any common approach of ability to use magnetic resonance tomography (MRI) in differential diagnosis of acute stroke type within first days of onset. There is an whole opinion of small MRI efficacy. According to literature data the great advantages to solve this task will be connected with high field MRI modalities (combination of perfusion and diffusionweighted images). However, there is no any reason to think that the ability of conventional MRI is completely exhausted. METHODS The aim of the present study was to assess an ability of conventional MRI in differential diagnosis of acute stroke type. The prospective study was conducted at the low-field MR tomography, B00.15 T. MRI protokol: FLAIR, T1 WI,

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T2 WI, T2* WI. The data of autopsy was used to verify MRI findings. 53 patients with intracerebral hematoma and 42 patients with acute ischemic stroke were included in this study. The average period of MRI investigation after stroke onset was 6.3 hours. RESULTS It has been shown that conventional MRI has an high specificity and sensitivity in acute intracerebral hematoma detection (Se098,26 %, Sp099,87 %, PVP099,23 %). The semeiotic pattern of intracerebral hematoma is differ from acute stroke MRI images. CONCLUSION Routine MRI can be used as an all-sufficient method in differential diagnostics of acute stroke type within first days of onset.

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aneurysm on the right AV,which was localized 1 cm distal of the PICA's origin, and constricts AV. Then, stent (Enterprize) was applied. Patient was released from the Hospital in good health. After a month, we performed control MR angiography, which was normal. CONCLUSION Vascular dissection of the AV should be considered when stroke occurs in patient without significant risk factors. Adequate diagnostic and therapeutic modalities must be performed to decrease mortality. P-149 ANGIOGRAPHIC REGIONAL ARTERIAL TRANSIT TIME CORRELATES WITH MEAN TRANSIT TIME IN MOYAMOYA DISEASE

P-148 DISSECTING ANEURYSM OF THE INTRACRANIAL VERTEBRAL ARTERY-CASE REPORT Biljana Georgievski-Brkic 1 , Magdalena RadovicStefanovic0 ,2, Gordana Milenkovic1, Vesna Boskovic1 1 Stroke Hospital “Sveti Sava”, Belgrade, Serbia, 2Clinical Center “Bezanijska kosa”,, Belgrade, Serbia INTRODUCTION Vascular dissection of the vertebral artery (AV) is an often overlooked cause of stroke. Dissecting aneurism of the intracranial AV is rare and its frequency increases among younger adults. MATERIAL AND METHODS A 45-year-old male patient had experienced sudden onset of severe occipital headache, rightsided hemiparesis, dysarthria and dysphagia. He was admitted in Stroke Hospital. Medical history revealed no prior illness. Patient is a smoker and he practices judo. At the admission in the Hospital, we performed CT of the brain, Doppler ultrasound of neck, transcranial Doppler and echocardiography. After 48 hours, MR and MR angiography of the brain, lumbar puncture and conventional cerebral angiography were done. RESULTS Imaging modalities that were performed at the admission were normal. MR of the brain shows no parenhimal lesions. MR angiography of the brain shows 4, 6x 9, 3 mm aneurysm of the intracranial right AV, which compress right aspect of the medulla oblongata.At the same part of the AV, axial T1 fatsaturated image of the cranial posterior fossa shows crescent intramural signal which come from intramural methemoglobin.Conventional cerebral angiography confirmed dissecting

Sheng-Che Hung1 ,2, Chung-Jung Lin1 ,2, Wan-Yuo Guo1 ,2, Feng-Chi Chang1 ,2, Chao-Bao Luo1 ,2, Wei-Fa Chu1 ,2 1 Taipei Veterans General Hospital, Taipei, Taiwan, 2National Yang Ming University, Taipei, Taiwan BACKGROUND AND PURPOSE Intracranial hemodynamics is important for management of moyamoya disease (MMD). Quantitative hemodynamic studies, such as perfusion-weighted MR imaging (PWI), are often necessitated by the discrepancy between the morphological angiographic staging and the degrees of hemodynamic impairment. With the advances of flatdetector angiography, this study aimed to evaluate hemodynamics in patients with moyamoya disease (MMD) by using PWI and regional arterial transit time (rATT) derived from quantitative digital subtraction angiography (DSA). METHODS We retrospectively identified all patients with MMD, who all received both DSA and PWI, from March 2011 to December 2011. The color-coded DSA was used to define the Tmax of selected intravascular ROI. rATT was defined as the Tmax of MCA M2 segment minus the Tmax of ICA. Hemodynamics parameters in each MCA territory obtained by PWI were compared with the angiographic findings. RESULTS We excluded four operated hemispheres. rATT was obtained successfully in 22 hemuspheres. rATT significantly correlated with angiographic Suzuki's staging and MTT in the anterior and posterior MCA regions (p<0.01). CONCLUSIONS Without extra contrast medium and radiation dosages, rATT of quantitative DSA can provide a surrogate indicator of cerebral hemodynamics beyond morphological information in MMD.

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P-150 AN ISCHEMIC STROKE LOCALIZATION ANALYSIS IN PATIENTS OF NEURO-VASCULAR DEPARTMENT OF IRKUTSK CITY HOSPITAL №1 Alexander Ivankov, Alla Tolstykh, Andrey Grossman Irkutsk City Hospital 1, Irkutsk, Russia PURPOSE to estimate a ratio of an ischemic stroke frequency depending on the area according to MRI of patients of neurovascular department of Irkutsk city hospital. METHOD the data of MRI of a brain of 2500 patients aged 24 - 90 years with the diagnosis of acute ischemic stroke within 20092011 years were analyzed. All patients underwent standard MRI (Magnetom Toshiba, 1,5 T., T2, FLAIR, T1, DWI, sl. 45 mm, MRA-3D-TOF). Ischemic defeat localization assessment was studied. RESULTS Distribution of patients: carotid artery area (59 %), vertebrobasilar area (41 %). In group of the carotid artery area - a projection of internal carotid artery area- 9 %, the middle brain artery area - 39 % (including the area of lenticulostriatal arteries (12 %)), the anterior brain artery area - 11 % (including the area of an artery of Gyubner - 1,5 %). Vertebro-basilar area: a projection of a basilar artery area 22 %, the posterior brain artery area - 7 %, the posterior inferior cerebellar artery - 10 %, the superior cerebellar artery - 1 %, the anterior inferior cerebellar artery - 1 %. CONCLUSION According to the received data defeat of the vertebro-basilar area (41 %) essentially increased in comparison with the general tendencies of distribution of an ischemic stroke in Russia and abroad. P-151 A REVIEW OF THE IMAGING IN CEREBRAL AMYLOID ANGIOPATHY Edel Kelliher, Alison Corr, Sarah Power, Joanna Pearly-Ti, John Thornton, Paul Brennan, Seamus Looby Beaumont Hospital, Dublin 9, Ireland PURPOSE To illustrate the imaging findings of cerebral amyloid angiopathy. MATERIALS AND METHODS A literature review was performed to outline the current imaging findings associated with cerebral amyloid

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angiopathy. Images from our institution are utilized to demonstrate these findings. RESULTS Cerebral amyloid angiopathy (CAA) results from the deposition of β-amyloid in the media and adventitia of small arteries and capillaries of the leptomeninges and cerebral cortex. It is responsible for approximately 1 % of the total number of strokes and up to 20 % of primary intracranial haemorrhages in patients aged>60 years. Cerebral amyloid deposition occurs in three patterns; cerebral amyloid angiopathy, amyloidoma and diffuse encephalopathic white matter involvement. The imaging findings associated with cerebral amyloid angiopathy are microhaemorrhages, lobar haemorrhages, subarachnoid haemorrhage and confluent white matter abnormality. CONCLUSION Cerebral amyloid angiopathy is an important and common cause of primary intracranial haemorrhage in the older population and has a variety of associated imaging findings which are illustrated in this educational exhibit. P-152 CARDIAC AND AORTIC ARCH FINDINGS ON CT ANGIOGRAPHY HEAD AND NECK STUDIES Edel Kelliher, Leo Galvin, Sarah Power, Joanna Pearly-Ti, John Thornton, Paul Brennan, Seamus Looby Beaumont Hospital, Dublin 9, Ireland PURPOSE To review the incidence of clinically significant findings within the heart and aortic arch on CT angiography neck and head studies. METHOD All CT angiographic studies of the neck or neck and head performed at our institution since August 2011 (when a PACS system was introduced) were retrospectively reviewed. We specifically reviewed the studies for significant findings in the heart and aortic arch. RESULTS The majority (but not all) of the studies were performed in the setting of suspected acute large vessel ischaemic stroke. A total of 57 studies were performed in this time period. We found significant findings in 5 of the studies. One demonstrated acute thrombus in the left atrium. Four others demonstrated thrombus in the aortic arch. These findings had all been prospectively reported. CONCLUSION Aortic arch and left atrial thrombus is a recognised cause of acute stroke. Studies in the literature quote 0.2 % incidence

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of left atrial thrombus and 2.6 % of aortic arch thrombus in transoesophageal echocardiograms in the evaluation of poststroke patients. There was an incidence of 1.75 % for both aortic arch and left atrial thrombus in our institution in CT angiography performed for acute stroke. These diagnoses are important as they can alter both the acute and chronic management of these patients. It may be of benefit to include the heart on the field of view for these studies.

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enhancement, occurred at subacute stage, and 4. Diffuse petechiae hemorrhage at SWI, persisted from acute to chronic stage, were reflecting free fatty acid toxicity inducing BBB breakdown. 5. Chronic sequela at T2, occurred at late stage (>14 days), are mainly demyelinating change, sequela of infarction or necrosis. CONCLUSION We proposed that MR imaging patterns of CFE can evolve over time in the disease course.

P-153 P-155 Abstract Withdrawn P-154 EVOLVING PATTERNS OF MR IMAGING OF CEREBRAL FAT EMBOLISM OVER TIME: A SYSTEMIC REVIEW Kuei-Hong Kuo1, Yen-Jun Lai1, Wing-Keung Cheung1, Yi-Ju Pan3, Feng-Chi Chang2 1 Division of Medical Image, Far Eastern Memorial Hospital, New Taipei city, Taiwan, 2Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, 3Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei city, Taiwan PURPOSE Different MR patterns of cerebral fat embolism (CFE) had been reported in the existing literature which is somewhat bewildering without a systematic review. Our goal was to describe the patterns, and explore the relationship between disease course and the imaging patterns. METHODS Literature search with PubMed database was performed to include all papers or case reports written in English and published from January 1996 to April 2012, using key words of fat embolism and magnetic resonance image. Cases were summarized, and images were re-read, assigned to patterns, and correlated with the timing in the disease course. RESULT 21 papers with 26 cases and 43 MR examinations were included in this review. Five distinctive MR imaging patterns were revealed: 1. Scattered embolic ischemia at DWI (starfield pattern) occurred at acute stage (04 days), which reflected fat vacuole mechanical obstructive damage. 2. Confluent cytotoxic edema at DWI located at bilateral white matter symmetrically, occurred at subacute stage (5-14 days), and was believed to be related to neuron/glia injury from free fatty acid chemical toxicity. 3. T2 vasogenic edematous lesions with

3T HIGH B-VALUE DIFFUSION-WEIGHTED MR IMAGING IN HYPERACUTE ISCHEMIC STROKE Michael Lettau1, Mona Laible2 ,3 1 University of Freiburg Medical School, Neuroradiology, Freiburg, Germany, 2University of Freiburg Medical School, Neurology, Freiburg, Germany, 3University of Heidelberg Medical School, Neurology, Heidelberg, Germany BACKGROUND AND PURPOSE In patients with hyperacute ischemic stroke, early demonstration of infarction is essential. Diffusion-weighted imaging (DWI) is the key method for detecting hyperacute infarction. The value of high b-value DWI in hyperacute ischemic stroke is controversial at 1.5 T, and is unknown at 3 T. The aim of this study is to explore the value of high b-value versus standard bvalue DWI at 3 T in hyperacute stroke with quantitative and qualitative analysis. MATERIALS AND METHODS This study prospectively included 104 consecutive patients with hyperacute stroke. At 3 T, conventional MR sequences and DWI were performed. The examination included a standard DWI (b 01000 s/mm2) and two high b-value DWI (b03000 s/mm2 and b05000 s/mm2). Qualitative and quantitative analysis was performed. RESULTS With increasing b value, DW images appeared noisier. The number of detected lesions was significantly higher on b03000 images than on the other DW images and higher on b05000 images than on b01000 images. The number of lesions>1 cm was not significantly different. Lesion conspicuity was higher, boundary better seen, lesion extent bigger, and estimation of final infarct size was better on high b-value than on standard b-value DWI. Contrast-to-noise-ratio (CNR) and signal-to-noise-ratio (SNR) decreased and contrast ratio (CR) increased on high bvalue DWI compared to standard b-value DWI. CONCLUSIONS At 3 T, high b-value DWI was superior to standard bvalue DWI in detection of hyperacute infarction and prediction of final infarct size in spite of increasing imaging artifacts.

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P-156 DIAGNOSIS, CLASSIFICATION AND MANAGEMENT OF INTRACRANIAL DURAL ARTERIOVENOUS FISTULAS Leo Galvin, Kevin Pennycooke, Liam Kavanagh, Joanna Pearly-Ti, Paul Brennan, John Thornton, Seamus Looby RCSI, Dublin, Ireland PURPOSE This is a pictorial review of intracranial dural arteriovenous fistulas (DAVF), emphasising common imaging features, classification and treatment options. BACKGROUND DAVF is a collective term given to a heterogeneous group of conditions that share fistulas connecting the branches of dural arteries to dural veins or a venous sinus. They comprise approximately 10 - 15 % of all arteriovenous shunting intracranial vascular malformations and are typically acquired as a result of neovascularisation induced by previously thrombosed dural venous sinus. Presentations include tinnitus, cranial nerve palsies, orbital symptoms, symptoms of venous hypertension, raised intracranial pressure and focal neurological deficits. METHODS Multiple cases of DAVF from our institution were retrospectively reviewed. A multi-modality imaging strategy was employed in all cases including CTA, MRA and digital subtraction angiography. Angioarchitecture and the two most common radiological classification systems (Borden & Cognard) are reviewed. Treatment strategies are also discussed, with an emphasis on endovascular techniques. CONCLUSION Although relatively rare, DAVF is an important consideration in the evaluation of intracranial haemorrhage. Since many of these lesions are curable, prompt diagnosis is crucial to avoid early rebleeding and reduce morbidity and mortality. While DAVF should be managed in a multidisciplinary fashion by an endovascular neurosurgeon and interventional neuroradiologist, this review serves to outline important imaging features and management aspects, which is of value to all general radiologists. P-157 PRIMARY POLYCYTHAEMIA VERA ASSOCIATED WITH SAGITTAL SINUS THROMBOSIS AND CEREBRAL ARTERIOVENOUS MALFORMATION: A CASE REPORT S B L Low, S Chawda, J Lansley, S Derakhshani Department of Diagnostic, Interventional and Therapeutic Neuroradiology, Essex Centre for Neuroscience, Queens University Hospital, Romford, Essex, UK

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To our knowledge, it is extremely rare that polycythemia patients present themselves with symptoms suggestive of intracranial haemorrhage. Here we illustrate and discuss neuroimaging features in a case with polycythemia vera presenting with headache and associated with cerebral arteriovenous malformation. A 43-year-old female presented with persistent headache of moderate severity, 2 weeks after the sudden onset of her "worst ever" headache. Patient had right-sided nuchal rigidity; otherwise, there were no clinical abnormalities. Patient denies any prior head injury and visual disturbances. There were no reports from family members of behaviour or personality changes in the patient. Non-contrast computed tomography of the brain showed high density signal in the right sylvian fissure. Lumbar puncture was normal. Computed tomography angiography showed a sagittal sinus thrombosis with an arteriovenous malformation of the right middle cerebral artery. Routine haematological investigations revealed increased haemoglobin level and packed cell volume. Patient has a personal and family history of polycythaemia vera treated with regular venesection. The patient was started on life-long anticoagulation, initially with both IV heparin and warfarin. Heparin was later stopped when INR reached the therapeutic level of 2 - 3. She was listed for gamma-knife surgery in 3 months. This case presents a diagnostic dilemma as both polycythemia vera and cerebral arteriovenous malformation can present with headaches. However, given that the risk of an occlusive event from polycythemia is higher than that of bleeding from an incidental finding of a cerebral arteriovenous malformation, the treatment of polycythemia was prioritised. P-158 ACUTE CEREBRAL ISCHEMIA AS A COMPLICATION OF TUBERCULOUS MENINGITIS – A CASE REPORT Gordana Milenkovic, Biljana Georgievski Brkic, Svetlana Djokovic Special hospital "Sveti Sava", Belgrade, Serbia INTRODUCTION Meningitis is the most frequent manifestation of neurotuberculosis, usually basilar, varies from mild form with no neurologic deficit to comatose. Arteries can be directy involved by basilar exsudate or indirectly by reactive arteritis, so it can resulting in thrombosis and stroke in 30 % of all patients, most common in basal ganglia, cerebral cortex, brainstem. BACKGROUND A 68-year-old men five days before hospitalisation became confused and forgetful. In emergency department he was subfebrile and hypotensive, other baseline vital signs were normal. He has slightly demaged power of all extremities,

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rigor and mental disorientation. Blood laboratories findings were normal. He already has done CT in other hospital, there is hypodense leasion frontal parasagital left. We done lumbal puncture: the cerebrospinal fluid was opalescent, with decreased level of glucose: 0,4 mmol/lit (with normal glycemia) and increased protein: about 2,22 g/l. Magnetic resonant imaging ( GE, 1,5 T) was done in standard protocol, we found T2/FLAIR hyperintense lesions frontal parasagital left, parahipocampal right and in medulla oblongata left, with restriction of diffusion and postcontrast enhancement. Also, hydrocephalus was present, with transependimal resorpcion. There is postcontrast enhancement of basilar meningeas. MR angiography showed initial atherosclerotic changes. without significant stenosis. CONCLUSION We present the patient with several early subacute cerebral ischemia, with postcontrast enchansement of basilar meningeas. These results indicate on tuberculous meningitis, with arteritis and consequent stroke on different localization of the brain. Patient has been sent to Clinic for Infectious deseases and neurotuberculosis was confirmed. P-159 CLINICAL UTILITY AND IMPLICATIONS OF FINDINGS ON CRANIAL CT ANGIOGRAPHY (CTA) IN THE SETTING OF ACUTE STROKE: A REVIEW OF THE LITERATURE Alex Mortimer, Marcus Bradley, Shelley Renowden Frenchay Hospital, Bristol, UK We review the implications of findings on CTA images in the setting of stroke to evaluate its use in decision making prior to stroke intervention. CTA allows assessment of local thrombus burden: quantification of this has been shown to predict functional outcome, final infarct size and parenchymal haematoma risk. Furthermore, the presence of specific patterns of collateralisation has implications for outcome: a prominent anterior temporal artery in M1 occlusions identifies a group of patients with reduced case fatality. Additionally, the extent of leptomeningeal collateralisation is an independent predictor of final infarct volume in those treated with intraarterial therapy. While many patients with proximal MCA occlusions will recruit more leptomeningeal collaterals, there is a subgroup who do not and these patients may develop a"malignant" pattern of few collaterals, tending to do poorly despite intervention. Additionally, CTA provides some perfusion information when acquired in the steady state. CTA source images (CTASI) may reflect cerebral blood volume and are more sensitive to detection of early irreversible ischaemia than non-enhanced

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CT. Furthermore, CTASI may help more accurately predict final infarct size and independently predict neurological outcome in both anterior and posterior circulations. The degree of hypoattenuation on initial CTASI is also a risk factor for haemorrhagic transformation following intervention. However, it has recently been recognised that the extent of hypoattenuation overestimates infarct extent on images obtained using a fast-acquisition protocol. Therefore, the utility of CTASI in the estimation of irreversible ischaemia in the acute setting on a patient by patient basis remains experimental. P-160 DEVELOPMENTAL VENOUS ANOMALY ACCOMPANIED BY WHITE MATTER ABNORMALITIES: REPORT OF THREE CASES CONFUSED WITH BRAIN TUMOR OR OTHER ENTITIES Takaki Murata, Shunji Mugikura, Mata Mbemba Daddy, LI LI, Shoki Takahashi Tohoku university, Sendai City, Japan White matter abnormalities within the drainage territory of the developmental venous anomalies (DVAs) are less commonly found. According to our hospital data, their incidence is 12 % (21 out of 178 cases of DVAs). Even fewer, as we show here, there are cases to be difficult to differentiate from other brain parenchymal abnormalities such as brain tumor, infarction and demyelinating disease. We describe our experience with three patients (two females and one male, ages from 17 to 60) initially given a diagnosis of other than DVAs. Three-dimensional contrast-enhancing T1-weighted imaging (3D-CE-T1WI) and/or susceptibilityweighted imaging (SWI) were helpful in delineating fine venous angioarchitecture of DVAs, leading to the correct diagnosis. Assessment of chronological changes in white matter abnormality on T2-weighted imaging as well as diffusionweighted imaging was also helpful to diagnose DVAs. P-161 MR FINDINGS OF INTRAMURAL HEMATOMA IN ACUTE PHASE OF CEREBRAL ARTERY DISSECTION USING 3D T1-WEIGHTED BLACK-BLOOD IMAGING Atsuko Oda, Takaaki Hosoya, Masafumi Kanoto, Yuuki Toyoguchi, Yukio Sugai Yamagata University School of Medicine, Yamagata, Yamagata, Japan

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PURPOSE Diagnosing cerebral artery dissection is often difficult especially in acute phase, as high resolution vessel wall imaging is required for evaluating small vessels, and the effect of changes in signal intensity due to age of intramural hematoma . Aim of this study is to describe the imaging features of intramural hematoma in acute phase of cerebral artery dissection using 3D T1-weighted black-blood imaging. MATERIAL AND METHOD MSDE-T1TFE imaging was performed using 3 T MR machine(Phillips Intera Achieva;Best,Netherland) within 1 week after symptom onset of cerebral artery dissection in 7 patients(6 males; 1 female; mean age 52.9 years) between April 2008 and October 2011. Signal intensity, morphology of intramural hematoma and its change during the time course was assessed. RESULT Clinical features were headache only in 2 cases, subarachnoid hemorrage in 1 case, ischemic stroke in 4 cases. Affected vessels were vertebral artery in 5 cases, PICA in 1 case, MCA in 1 case. In 6 out of 7 cases, intramural hematoma was detected; high intensity in 2 cases, slightly high intensity in one case, iso intensity in 3 cases. The 3 cases which presented iso intensity intramural hematoma showed no signal change during the time course. In 6 cases morphological change was observed during 6 months from onset. CONCLUSION Imaging findings of iso intensity and crescent shaped intramural hematoma can be diagnosed as cerebral artery dissection in acute phase. MSDE-T1TFE was useful technique for diagnosis of cerebral artery dissection. P-162 SPINAL CORD ISCHEMIA: A DIFFICULT AND UNDERESTIMATED DIAGNOSIS Diana Quiñones, Juan Viaño RM ROSARIO, MADRID, Spain PURPOSE Spinal cord ischemia is rare, but should be considered in all abrupt onset medullary syndromes. Early imaging by MRI can aid, but may be negative in the first few days. Diffusion is particularly sensitive in the acute phase, permitting a differential diagnosis from other causes of acute myelitis. MATERIALS A retrospective review of 14 cases from the last 4 years. Early MRI (before a week) with Diffusion techniques can support the clinical suspicion of cord ischemia. All patients had 1.5 T MRI, additionally Diffusion, MRA, CTA and DSA were obtained in some cases. The small size of spinal

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cord is a handicap for imaging and differential diagnosis of cord lesions. Spinal cord vascularization and watershed zones are reviewed. Different etiologies of spinal cord ischemia are presented: vertebral dissection, embolic, related to abdominal aneurysm, degenerative disc disease, precipitated by straining or anesthesia. SUMMARY Cord ischemia should be suspected in all acute medullary syndromes. Diffusion may highlight this diagnosis. Prior trauma or abnormal vertebral posturing are frequent in younger patients (related to vascular occlusions, dissection, or fibrocartilage embolism). Older patients usually have classic vascular risk factors, or spondylosis. Adding noninvasive vascular imaging MRA or CTA may further improve our knowledge of spinal cord infarction. P-163 CAROTID NEAR-OCCLUSIÓN, CTA AND PARENCHYMOGRAM Diana Quiñones1, Aitziber Aleu2, Leopoldo Guimaraens2, Alfredo Casasco2, Jaques Theron2 1 resonancia magnetica hospital del rosario rosario, madrid, Spain, 2terapia Endovascular, Rosario, Madrid, Spain CASE REPORT A 63 yo patient with multiple vascular risk factors and a cochlear implant presents with a left hemispheric TIA. CT was artefactuated by metal from the choclear implant, and only detects a small hypodense lesion in the left centrum semiovale. MRI is contraindicated. Carotid Doppler Ultrasound was considered unremarkable on the L side. But transcranial B mode Ultrasonography (2 MHZ) demonstrated reversal of flow in the left ophthalmic artery and abnormal curve in the L M1 and M2 (TIBI 3), suggesting occlusion of the distal LICA. During the following days episodes of left hemispheric deficit occured when the patient standed (worsening of aphasia and oscillating right arm deficit). CTA was obtained with a 64 multislice scanner(50 cc 370 mg iodinated contrast) with standard protocol. A left sided ICA origin near occlusion was documented. The left extra and intracranial carotid artery was less opacified (difference of aprox. 50UH) on the CTA, compared with the contralateral side. The sign of "lower signal" is frequent in MRA in carotid subocclusion, but unsusual on CTA. The COW was incomplete. Angiography demostrated a near occlusión and a Stent was placed without dilatation. The parenchymogram on the Left was delayed 4 s. CTA is not a dynamic phase study, but in the case of “near vascular occlusion” an hemodynamic effect of contrast dilution is evident.

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P-166

CT AND MRI PATTERNS OF FOCAL HYPEREMIA IN VENOUS INSULT

MEASUREMENT OF HYPOPERFUSED LESION VOLUME USING PERFUSION-WEIGHTED MRI: COMPARISON OF TIME-TO-MAXIMUM (TMAX) AND TIME-TO-PEAK (TTP) MAPS

Stanislav Semenov, Irina Moldavskaya, Maria Shatokhina, Anna Nekhorosheva, Anton Khromov, Elena Zhuchkova, Andrey Kovalenko, Leonid Barbarash Research Institute for Complex Issues of Cardiovascular Diseases under the Siberian Branch of the Russian Academy of Medical Sciences, Kemerovo, Russia BACKGROUND A distinguishing feature of venous insult (VI) compared with ischemic stroke (IS) is focal hyperemia. OBJECTIVE To evaluate MSCT and MRI patterns of focal hyperemia and early vasogenic edema in VI and their impact on disease's course. MATERIAL AND METHODS 33 patients with non-hemorrhagic VI aged 51.6±14.45y and 33 patients with IS aged 68.69±12.78y were examined. All the patients had MSCT (LightSpeedTMVCT 64 GE: native, MSCTA, PCT at day 1 and native control at days 5-7) and MRI (Excelart Vantage 1,5 T Toshiba: T2WI, FLAIR, DWI, ADC, 3DToFMRA, ASL during the first day) performed. RESULTS Symptom-related CVT or arterial occlusion was verified in all cases by MSCTA and/or MRA. Subacute onset of disease was observed in VI vs. IS (51.5 % vs. 15 %); focal CT-density during the first day (57.6 % vs. 39.4 %); infarction's necrosis (55 % vs. 79 %). There were significant (p<0.05) differences observed in VI vs. IS focal non-necrosis perfusion patterns: rMTT(+ vs. ++), rCBF (± vs. –), rCBV (+ vs. ±) and diffusion pattern: rDWI (± vs. +) and rADC (+ vs. -). The tendency was different (p>0.05) for rASL (+ vs. -). Hemorrhagic transformation was observed in 27 % of VI and 9 % of IS at days 5-7. CONCLUSIONS Non-ischemic focal hyperemia in non-infarcting venous insult area is characterized by a more often CT-density decrease during the first day, increase in time, blood flow and volume of focal perfusion and is accompanied with earlier (first day) vasogenic edema and more often hemorrhagic transformation different from stroke. P-165 Abstract Withdrawn

Hwa Seon Shin2, Chul-Ho Sohn1 ,2, Soo Chin Kim2, Jeong A Yeom2, Inseon Ryoo2, Seung Chai Jung2, Tae Jin Yun1 ,2, Byung-Woo Yoon3, Seung Hong Choi1 ,2, Ji-hoon Kim1 ,2, Moon Hee Han1 ,2 1 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea, 2 Department of Radiology,Seoul National University Hospital, Seoul, Republic of Korea, 3Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea BACKGROUND AND PURPOSE Although time-to-maximum(Tmax) maps of the residue function has been suggested as a very promising parameter, processing for Tmax map is complex. In clinical routine, non-deconvoluted time-to-peak (TTP) maps are used to calculate hypoperfused area. We evaluated the correlation of TTP maps to calculate hypoperfused lesion volume by comparison with Tmax maps. METHODS MRIwas performed in 44 patients with acute ischemic stroke (within 6 hours after stroke onset). The volume of hypoperfusion defined by increasing TTP thresholds (relative TTP delay of >4, >6 and >8 seconds) were compared with the volume of hypoperfusion assessed by Tmax (Tmax delay of >4, >6, >8 seconds). For the calculation of lesion volume, the mean value of gray matter (TTPGM), white matter (TTPWM), and gray-white combined area (TTPmeanGW) covering the contralateral MCA territory were subtracted from the absolute TTP values.Comparisons were performed with Pearson correlation coefficients and paired t-test. RESULTS The mean hypoperfusion volume at Tmax > 6 and TTPmeanGW >6 seconds was 80.81 ± 65.54 and 77.69 ± 62.89 cm3respectively.There is no statistically significant difference between the two values(p>0.411).The hypoperfusion volume at TTPmeanGW >6 seconds best correlated with hypoperfusion volume at Tmax 6 (r00.925). CONCLUSION TTP maps still remained suitable for evaluation of hypoperfused lesion volume for clinical routine studies.

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P-167 DIFFUSION TENSOR IMAGING (DTI) IN ASSESSMENT OF MOTOR RECOVERY IN ACUTE ISCHEMIC STROKE PATIENTS Elena Kremneva, Lyudmila Chernikova, Rodion Konovalov, Marina Krotenkova, Alexander Suslin Research Center of neurology, RAMS, Moscow, Russia PURPOSE of our investigation was to link DTI data for corticospinal tract (CST) and motor recovery rate of lower limbs in patients with acute stroke. MATERIALS AND METHODS we examined the motor deficit for the paretic leg (FuglMeyer scale) of 13 acute ischemic middle cerebral artery stroke patients on 1st and 21st days from the onset (7 male, 3 female; average age 58 [49;60] years). On 21 day DTI scans were performed to all the patients on Avanto, Siemens, 1.5 T scanner. Fractional anisotropy (FA) of CST was assessed in 3 regions of interest (ROI), both on affected and unaffected side: posterior limb of internal capsule (PLIC), cerebral peduncle (CP) and pons (P). RESULTS median Fugl-Meyer value for the group on 1st and 21st days was 10 [3;12] and 24 [12;29], correspondingly, with difference 11,5 [4;15,5]. Median FA value for affected and unaffected side was: in PLIC - 0,522 [0,329;0,582], 0,713 [0,690;0,760], in CP - 0,514 [0,455;0,652], 0,793 [0,744;0,813], in P - 0,383 [0,352;0,544], 0,596 [0,552;0,648], correspondingly. The correlation was performed between motor deficit difference and FA for affected side in all 3 ROI, and a direct correlation was revealed: for PLIC R00,54 (p00,013), for CP R00,56 (p00,009), for P R00,53 (p00,013). CONCLUSION FA can be used for the assessment of motor recovery in acute stroke patients and thereby for the determination of the optimal neurorehabilitation program. The best ROI for making such correlations is the CP. P-168 SMALL VESSEL DISEASES OF THE BRAIN: A PICTORIAL REVIEW Shoki Takahashi, Shunji Mugikura, Takaki Murata Tohoku University School of Medicine, Sendai, Japan

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PURPOSE To illustrate MR imaging findings of small vessel diseases and their mimics. APPROACH/METHODS The cases were selected from our collection of brain MRI series. Pathological correlates will be presented when available. FINDINGS/DISCUSSION Selected examples include: lacunar infarcts, branch atheromatous disease, striatocapsular infarct, leukoaraiosis, Binswanger disease, cerebral amyloid angiopathy with and without white matter changes, hereditary vasculopathy of CADASIL and CARASIL, Fabry disease, homocysteinemia, and so on. MRI leukoaraiosis indicates a more wider spectrum of white matter changes than CT leukoaraiosis, and is an non-specific radiologic sign, being found as well in normal elderly as in pathological conditions. However, leukoaraiosis linked with vascular risk factors (and also with age) called arteriolosclerotic leukoaraiosis may be related with transient repeated events of moderate drops in cerebral circulation in territories of structurally altered medullary arteries. The mimics of small vessel diseases include: dilated perivascular space, hypereosinophilic syndrome, discrete infarcts along the course of medullary arteries seen in intravascular lymphoma, Susac syndrome, fat embolism, infectious and neoplastic aneurysms, diffuse axonal injury. Furthermore, several of the diseases display cerebral microbleeds, differential diagnosis of which will be discussed. SUMMARY/CONCLUSION Recognizing MR imaging findings of small vesel diseases that may contribute to development of cognitive deficits is clinically important. P-169 Abstract Withdrawn P-170 PERSISTENT HYPOGLOSSAL ARTERY AND ITS VARIANTS DIAGNOSED BY MR AND CT ANGIOGRAPHY Akira Uchino, Naoko Saito, Yoshitaka Okada, Eito Kozawa, Naoko Nishi, Waka Mizukoshi, Kaiji Inoue, Reiko Nakajima, Masahiro Takahashi Saitama Medical University International Medical Center, Hidaka/Saitama, Japan

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INTRODUCTION Persistent hypoglossal artery (PHA) is the second most common anastomosis between the carotid and vertebrobasilar systems and demonstrates some variations. The most important diagnostic criterion for PHA is the passage of the anomalous artery through the hypoglossal canal, and magnetic resonance (MR) and computed tomography (CT) angiographic source images both clearly demonstrate the canal. We evaluated the prevalence and characteristic features of PHA and its variants on MR angiography and CT angiography. METHODS We retrospectively reviewed our database of MR angiographic images obtained using either of two 1.5-tesla or one 3.0-tesla imager and our database of CT angiographic images obtained using either of two 64-slice multidetector CT scanners. Most patients had or were suspected of having cerebrovascular diseases, but we could not determine the exact number of patients whose MR angiography included the hypoglossal canal. RESULTS We found 12 usual PHAs arising from the cervical internal carotid artery(right/left06/6, male/female03/9), 3 right PHAs originating from the external carotid artery (ECA), and 2 posterior inferior cerebellar arteries (PICA) arising from the ECA without connection to the vertebral artery. Six usual PHAs were detected by CT angiography among 2074 patients. CONCLUSIONS The prevalence of usual PHA diagnosed by CT angiography was 0.29 %. We propose naming usual PHA "Type 1"; PHA originating from the ECA, of which we found three, "Type 2"; and PHA arising from the ECA, of which we found 2, "Type 2 variant." P-171 ARE IMAGING AND CLINICAL SERVICES FOR SECONDARY STROKE PREVENTION AFTER TIA OR MINOR STROKE ADEQUATE IN THE UK? Miriam Brazzelli1, Martin Dennis1, Paul McNamee2, Hector Miranda 1 , Zahid Quayyum 2 , Kirsten Shuler 1 , Joanna Wardlaw1 1 University of Edinburgh, Edinburgh, UK, 2University of Aberdeen, Aberdeen, UK BACKGROUND Effective secondary prevention of TIA/minor stroke requires highly organised services. We surveyed UK clinical and imaging secondary stroke prevention services to see if they met recent guidelines. METHODS: In April 2011 we sent online questionnaires to all clinical leads of stroke services and imaging departments in

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the UK. We sought information on clinic frequency, staff, type, and timing of brain/carotid imaging, and endarterectomy. RESULTS 114 stroke services and 146 imaging services surveys were completed (response rate 45 % to both). A specialist service was available for TIA/minor stroke in 97 % of centres; 4060 % of patients had a final diagnosis of TIA/minor stroke. Services were consultant-lead in 80 % of centres but nurseslead in 20 %. Most radiology departments offered CT (94 %) and MRI (88 %) for TIA/minor stroke in office hours but CT was used more often (84 % versus MRI 51 %). Most centres performed CT on the same day, during working hours, for inpatients (87 % of centres) and outpatients (59 %), but not MRI (37 % for inpatients; 23 % for outpatients). CT was available out of hours in 82 % of the centres but MRI in only 20 %. Most departments routinely performed TI/T2, DWI, FLAIR but only 48 % performed GRE/T2* sequences for TIA/minor stroke, so may miss haemorrhage. CONCLUSIONS Stroke prevention and imaging services varied considerably across centres. CT is still the commonest investigation for TIA/minor stroke. Although MRI is available in most centres during week days, far fewer patients have MR than CT and relevant MR sequences for TIA/minor stroke are omitted in over 50 %. P-172 USEFULNESS OF ACZ(ACETAZOLAMIDE)PERFUSION MRI FOR EVALUATING CEREBRAL VACULAR RESERVE(CVR) ON SYMPTOMATIC ICA OR MCA OCCLUSION OR SEVERE STENOSIS, COMPARED WITH 99MTC-HMPAO SPECT Inkyu Yu1, Seungyoung Jung1, Suju Lee1, Heegirl Park1, Changjun Song2, Sanghun Cha3, Byunghee Lee1 1 eulgi University Hospital, Daejeon, Republic Of Korea, 2 chungnam National University Hospital, Daejeon, Republic of Korea, 3chungbuk National University Hospital, Chungju, Republic of Korea INTRODUCTION Impaired cerebral vascular reserve (CVR) in patients with symptomatic ICA or MCA occlusion or stenosis is regarded as a possible indication for performing extra-/intracranial (EC/IC) bypass surgery or exocranial or intracranial stenting. As perfusion MR imaging (MRI) can demonstrate cerebral haemodynamics at capillary level, perfusion MRI, using MTT map is used in these patients for the evaluation of CVR, before, and after ACZ challenge in a similar way to single photon emission CT (SPECT). In this exhibition we

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will demonstrate usefulness of ACZ-MTT perfusion MRI for CVR evaluation in patients with ICA, MCA severe stenosis or occlusion , compared with brain-SPECT. METHODS In 20 patients with symptomatic unilateral ICA(or MCA) occlusion or severe stenosis. both perfusion MRI and 99mTc-HMPAO SPECT were performed before and after injection of acetazolamide (Diamox ,1000 mg i.v.). CVR parameters including regional cerebral blood flow (rCBF) and volume (rCBV), mean transit times (MTT), time to peak concentration(TTP) were measured by perfusion MRI. RESULTS The patients with impaired CVR proven by SPECT all showed delayed MTT on the occluded or stenotic side. Even. three patients with no impaired CVR by SPECT showed delayed MTT(impaired CVR) on perfusion MR following the ACZ injection. CONCLUSIONS Perfusion MRI, using MTT map, before and after ACZ administration is same useful or some superior to SPECT for evaluation of CVR, the treatment decision in patients with ICA or MCA occlusion or severe stenosis. THEME: WHITE MATTER DISEASE P-173 DELAYED LEUKOENCEPHALOPATHY AFTER ACUTE CARBON MONOXIDE INTOXICATION: THE IMPORTANCE OF RESTRICTED DIFFUSION 1

1

1 ,2

Ana Filipa Geraldo , Lia Lucas Neto , Dulce Neutel , Cristiana Silva1 ,2, Leonor Guedes1 ,2, Luísa Albuquerque1 1 Neuroradiology DepartmentCHLN- HSM, lisboa, Portugal, 2 Neurology Department CHLN-HSM, lisboa, Qatar INTRODUCTION In the setting of CO poisoning, a small percentage of the surviving patients develop delayed neuropsychiatric signs and symptoms, associated with diffuse brain demyelination depicted on MRI. CASE REPORT A 40-year-old man was admitted after two weeks of progressive disorientation and incoherent speech. There was a recent history of hospital admission one month previously, with coma and carbon monoxide poisoning and discharged a week later with no apparent deficits. At admission he was alert, with grasping, choreiform movements of the lower limbs, myoclonias of the trunk and bizarre behavior. CSF analysis was unremarkable. Brain MR performed on day 39 post-intoxication showed confluent bilateral symmetric white-matter hyperintensity on T2 sequences with restricted diffusion. On single voxel spectroscopy there was a

decrease of NAA and elevation of Cho. Hyperbaric oxygen therapy was started despite limited evidence of clinical improvement in the subacute phase of CO intoxication. DISCUSSION/CONCLUSION Delayed post-anoxic leukoencephalopathy is a rare syndrome that can occur after any prolonged cerebral hypo-oxygenation. Most cases are caused by carbon monoxide poisoning, but other conditions may cause similar symptoms and the exact pathophysiologic mechanism is still unknown. There is usually a biphasic pattern: full-recovery after the initial toxic event (from 2 to 40 days) followed by neuropsychiatric signs. The diagnosis is based on typical imaging features in the appropriate clinical setting. Diffusion plays an important role, characteristically showing low ADC signal that persists for several weeks, suggesting intramyelinic edema. Clinical and neuroradiological recovery has been reported and may be complete. P-174 POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: A POSSIBLY UNDERESTIMATED SERIOUS COMPLICATION OF GUILLAIN-BARRÈ SYNDROME Giada Gola, Matteo Precerutti, Carla Francesca Arbasino, Maria Sole Prevedoni Gorone, Fabrizio Abelli, Giovanni Piccolo, Maria Grazia Egitto Ospedale Civile, Voghera, Italy Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical-radiological entity of CNS. Magnetic Resonance imaging is of great importance in the diagnosis of this heterogeneous syndrome, which typically shows bilateral signal hyperintensity in posterior cortical and subcortical regions. We describe a nearly asymptomatic PRES associated with Guillain-Barrè Syndrome (GBS). A 58 y.o. woman was admitted with distal paraesthesia, lower limb weakness and low back pain; twenty days before admission she suffered a flu-like syndrome and two days before admission the weakness worsened along with repeated falls and excessive daytime sonnolence. A brain Computed Tomography showed bilateral hypodensity in occipital-parietal lobes and a corresponding MRI showed bilateral white matter hyperintensity on T2w images. Diffusion Weighted images were normal, otherwise ADC map showed signal hyperintensity. Routine laboratory examination was normal except a reduced serum albumin level; cerebrospinal fluid examination disclosed increased protein content with normal cell count. Nerve conduction study was consistent with demyelinating peripheral neuropathy.

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Diagnosis of GBS associated with PRES was made. Eventually neurological condition stabilized and the patient improved progressively in strength; a newly performed brain MRI showed a nearly complete disappearance of T2w hyperintensity. Reduced albumin serum level might have favoured vasogenic cerebral edema. PRES in GBS may represent an underestimated condition, which needs a careful management to avoid possible permanent neurological sequelae.

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CONCLUSION PRES is more frequent than previously thought. Neuroimaging plays a crucial role, as it can be a difficult clinical diagnosis. Better understanding of this condition will help us diagnose and manage this condition more effectively. P-176 REVIEW OF IMAGING FINDINGS IN NEUROCYSTICERCOSIS

P-175 A PICTORIAL REVIEW OF THE VARIOUS CLINICAL, PATHOLOGICAL AND RADIOLOGICAL APPEARANCES OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) Priya Bhatnagar, Ahmed Iqbal, David Butteriss Royal Victoria Infirmary, Newcastle upon Tyne, UK AIMS 1.To discuss the various causes and clinical presentations of PRES. 2.To review the pathophysiology, pathology and microscopic features of PRES. 3.To illustrate the wide range of (typical and atypical) Neuroradiological appearances of PRES. BACKGROUND PRES is a neurotoxic state, the exact cause of which is not yet understood. It can be a difficult clinical diagnosis. Neuroimaging plays a crucial role in the diagnosis as it can demonstrate unique imaging appearances. It is a cerebrovascular autoregulatory disorder with multiple aetiologies, the most common being acute hypertension. Other causes include preeclampsia/eclampsia, bone marrow transplantation, autoimmune diseases and high dose chemotherapy. IMAGING FINDINGS Using case studies, we demonstrate a range of clinical and imaging features of PRES. Imaging typically demonstrates vasogenic oedema predominantly affecting the parietal and occipital regions, leading to suggest the “posterior” description. However, it can also affect the frontal lobes, cerebellum, basal ganglia and brainstem. Rarely, there can be focal areas of restricted diffusion (likely representing infarction), and associated with an adverse outcome. Haemorrhage (focal haematoma, subarachnoid blood) seen in approximately 15 % of patients. Usually shows no enhancement, rarely there can be mild patchy enhancement. We show examples of all these atypical imaging features. We also discuss the appropriate MRI protocols for optimizing the sensitivity to this condition and discuss the differential diagnoses.

Kim Jong Lim, Lim Jong Nam Hankook Hospital, Jeju, Republic of Korea OBJECTIVES Discuss the classification of neurocysticercosis according to location and disease stage. BACKGROUND Neurocysticercosis is the most common parasitic infection involving the central nervous system in developing countries, where neurocysticercosis is the most common cause of adult-onset epilepsy. IMAGING FINDINGS Neurocysticercosis has been classified according to location and disease stage. With respect to location, it has traditionally been classified into subarachnoid-cisternal, parenchymal, intraventricular, and spinal forms. Subarachnoid-cisternal neurocysticercosis manifests as space-occupying lesions that may cause hydrocephalus, although this condition may also be secondary to basilar arachnoiditis. Parenchymal neurocysticercosis is divided into five stages: noncystic, vesicular, colloidal vesicular, granular nodular, and calcified nodular. Intraventricular neurocysticercosis often leads to obstructive hydrocephalus and ventriculitis due to ependymal inflammatory response or adhesions due to prior ventricular infestation. Spiral neurocysticercosis can manifest as intradural disease or as arachnoiditis with paresis-complete paralysis or polyradiculoneuropathy. CONCLUSION Imaging findings depend on several factors, including the stage of parasites; the number and location of parasites; and associated complications such as vascular involvement, inflammatory response, and, in ventricular forms, degree of obstruction. References: [1]. Eric T. Kimura-Hayama, Jesús A. Higuera, Roberto Corona-Cedillo, Laura Chávez-Macías, Anamari Perochena, Laura Yadira Quiroz-Rojas, Jesús Rodríguez-Carbajal and José L. Criales. Neurocysticercosis: Radiologic-Pathologic Correlation. Radiographics 2010;30:1705-1719. [2]. Andrew W. Litt and Tamara Mohuchy. Case 10: Neurocysticercosis. Radiology 1999;211:472-476.

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[3]. Hector H. Garcia and Oscar H. Del Brutto. Imaging findings in neurocysticercosis. Acta Tropica 87 (2003) 71-78. P-177 CHRONIC CEREBROSPINAL VENOUS INSUFFICIENCY - IS THE PROBLEM IN CHILDREN WITH MULTIPLE SCLEROSIS? - PRELIMINARY STUDY Elzbieta Jurkiewicz 1, Katarzyna Kotulska 2 , Katarzyna Nowak1, Malgorzata Bilska2, Katarzyna Malczyk1, Dariusz Chmielewski2 1 The Children's Memorial Health Institute, Departmen of Radiology, Warsaw, Poland, 2The Children's Memorial Health Institute, Departmen of Neurolgy, Warsaw, Poland One of unproven theories of the origin of multiple sclerosis (MS) is insufficient extracranial venous drainage. Several published papers discuss the presence and significance of chronic cerebrospinal venous insufficiency (CCSVI) in MS patients. In this preliminary study evaluating children with multiple sclerosis extracranial venous drainage was assessed in pediatric MS patients and healthy controls. Our group of patients consisted of 25 children (17 girls and 8 boys), ages ranging from 7 to 16 years; mean age 14 years. All patients were referred to our Neurological Department with a diagnosis of MS. Ten patients examined for reasons other than neurological disorder were the control group. MR examinations were performed on 1.5 T scanner using neck coil. Coronal 2D TOF venography in coronal plane without contrast injection was obtained with the following parameters: TR/TE023/7.15 ms, FOV0300 mm, slice thickness03 mm, matrix:245x384. After that the 3D contrast-enhanced coronal venography was performed during the bolus administration of gadopentate dimeglumine 0.1 mmol/kg, flow rate 3 mL/s with the following parameters: TR/TE03.38/1.28 ms, FOV0 320 mm, slice thickness01 mm, flip angle030. All venograms were evaluated by two neuroradiologists independently. We estimated venous caliber at both sides of the neck separately and the presence of collaterals. We didn't find statistical significance between venography of MS and control groups. P-178 TUMEFACTIVE DEMYELINATING LESIONS – A DIAGNOSTIC QUANDARY Hannah Khirwadkar\1, Srinivasa Rao Abburu2, Margaret Hourihan1 1 University Hospital of Wales, Cardiff, UK, 2Prince Phillip Hospital, Llanelli, UK

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The diagnosis of multiple sclerosis requires demonstration of lesions in space and time, along with appropriate clinical and laboratory evidence and is dependent upon careful consideration and exclusion of alternative diagnoses. Tumefactive demyelinating lesions provide a diagnostic quandary as unfortunately, the clinical presentation and imaging appearances of tumefactive multiple sclerosis can simulate those of intracranial neoplasms, leading to unnecessary procedures, such biopsy or surgical resection and delay in treatment. Tumefactive demyelinating lesions are defined as large, usually greater than 2 cm lesions, which may be either solitary or multiple. While there are imaging features that are suggestive of tumefactive demyelinating lesions, such as incomplete/open ring enhancement, lack of mass effect or vasogenic oedema, central necrosis and involvement of grey matter, these are all non-specific features that may be shared by gliomas. Noncontrasted computed tomography and advanced magnetic resonance imaging techniques may be used to aid diagnosis, but may not give a definitive diagnosis. We present a series of cases demonstrating the diagnostic dilemma posed by tumefactive demyelinating lesions and the problem solving steps taken to reach the diagnosis. P-179 DEFICIENT MYELIN WATER FRACTION MAPPING I N U N T R E AT E D R E L A P S I N G - R E M I T T I N G MULTIPLE SCLEROSIS Hagen Kitzler1, Frank Noack1, Christine Schmidt1, Tjalf Ziemssen2, Ruediger von Kummer1 1 Department of Neuroradiology, Technische Universitaet Dresden, Dresden, SN, Germany, 2Department of Neurology, Technische Universitaet Dresden, Dresden, SN, Germany INTRODUCTION Widespread changes are found in Multiple Sclerosis (MS) Normal Appearing White Matter (NAWM) with quantitative MRI. Multi-component Driven Equilibrium Single Pulse Observation of T1 and T2 (mcDESPOT) allows wholebrain evaluation of myelination by means of the myelin water fraction (MWF) and quantifying the hidden demyelination burden. The aim of this study was to probe if mcDESPOT derived measures discriminate untreated relapsing-remitting MS (RRMS) patients from controls required for investigation of drug effects on NAWM demyelination. METHODS 1.5 T scanner (Siemens Sonata, Germany) and 8-channel head RF coil were used to scan patients (n026 ; 32.2± 9.2 yrs; EDSS 2.6±0.8; disease duration 146±44.8 months)

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and age-matched controls (n026; 34.8±11.3 yrs) to derive multi-component T1 and T2 information from sets of FLASH and TrueFISP data acquired over a range of flip angles at constant TR. MWF maps were derived using mcDESPOT theory and processing method. Voxel-based analysis (VBA) was applied to calculate z-scores at every voxel and to determine deficient MWF volume fractions (DVF0VolDeficent Voxels/VolRegion). RESULTS DVF was significantly different from healthy tissue in total WM (p < 0.001) and NAWM (p < 0.001) whereas nonnormalized primary MWF measurement revealed a significant difference (p<0.05) in total WM only. CONCLUSION Whole brain high-resolution data acquisition of mcDESPOT allowed myelination assessment and clear distinction of RRMS from healthy subjects. The data again suggests an independent underlying demyelination in NAWM. We will continue longitudinal evaluation of DVF in RRMS under specific treatment induction. P-180 FUNCTIONAL MRI AND DTI INTERCONNECTION I N M O T O R D I S O R D E R S E VA L U AT I O N I N RELAPSE-REMITTING MULTIPLE SCLEROSIS Sofya Kulikova, Vasiliy Bryukhov, Anastasiya Peresedova, Olga Trifonova, Marina Krotenkova, Igor Zavalishin Research Center of Neurology RAMS, Moscow, Russia PURPOSE to evaluate functional and structural features of motor disorders in patients with relapse-remitting multiple sclerosis (RRMS). MATERIALS AND METHODS 14 patients with RRMS aged 19-50 underwent MRI (Avanto 1,5 T, Siemens) during the relapse characterized by light hand palsy and three months after it during the remission (9 of 14 patients). FMRI was performed using a simple block movement paradigm for both hands. DTI data were evaluated in the regions of interest. 10 healthy subjects aged 23-31 were included into investigation as control group. RESULTS fMRI showed differently directed changes of functional activity of primary sensorimotor cortex (SMC) in contralateral hemisphere in contrast with ipsilateral one during the relapse: 10 patients were characterized by a decrease of functional activity and 4 by an increase. These two groups differed significantly by fractional anisotropy (FA) (mean

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0,587 and 0,521 respectively) and radial diffusivity (RD) (mean 485x10-5 and 533x10-5 m2/s respectively) values in contralateral corticospinal tract (CST) (pons level), the larger group didn’t differ significantly from the control one (mean 0,587 and 0,599 for FA; mean 485x10 -5 and 454x10-5 m2/s for RD respectively) (Mann-Whitney U test, p<0,05). Remission was characterized by an increased recruitment of the contralateral SMC in the first group and/or by recruitment of additional motor areas (mostly ipsilateral SMC) in the second one, DTI data didn’t change significantly in three months. CONCLUSION for the first time an interconnection between motor areas activation pattern and structural state of corresponding CST has been shown on a small sample of RRMS patients during the follow-up. P-181 USE OF BODY-CT AND PET-CT IN THE INVESTIGATION OF PARANEOPLASTIC NEUROLOGICAL SYNDROMES: RETROSPECTIVE AUDIT OF PRACTICE IN A REGIONAL NEUROSCIENCE UNIT IN THE UK Deacon Lee, Ammar Kheder, Mhairi Forbes, Ian Craven, Marios Hadjivassiliou Sheffield Teaching Hospitals, Sheffield, South Yorkshire, UK BACKGROUND Paraneoplastic neurological syndromes (PNS) are characterised by progressive neurological dysfunction resulting from non-metastatic effects of cancer. Positron emission tomography (PET) has emerged as an effective tool for diagnosis and staging of malignancy. An advantage of PET over conventional imaging modalities such as body-CT includes demonstration of metabolically active disease in anatomically normal appearing structures. AIMS To analyse and improve use of whole-body CT and PET-CT in the investigation of PNS in a regional neuroscience unit METHODS Retrospective review of 42 patients with suspected PNS referred for imaging between April 2007-March 2008 was conducted. The data was presented locally followed by recommendations that a consultant neurologist with interest in PNS reviews each case before referral and PET-CT is considered in cases where body-CT is negative. We reaudited 44 patients referred between July 2008-June 2009

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and identified each patient's final diagnosis along with any additional investigations undertaken. RESULTS In the first cycle, 42 patients underwent whole-body CT for investigation of PNS. 4 scans were positive for malignancy and 38 were negative, of which only one was followed up with PET-CT. In the second cycle, whole-body CT was performed in 44 patients, of which 11 subsequently proceeded to PET-CT. 5/44 patients had a final diagnosis of PNS, of which only 3 had undergone PET-CT. CONCLUSION Early PET scanning in clinically suspected PNS may prevent expensive, extensive and often unnecessary investigations. Trust guidelines now advise use of PET-CT rather than conventional body-CT in clinically suspected PNS. We will re-audit our practice due course.

0,670±0,038), without significant changes in internal capsule. Front lobes WM FA was almost equal to controls, except 2 patients with gross hydrocephalus (aged 56 and 67) who had lower FA. CONCLUSIONS Internal capsule is being less compressed than corpus callosum in patients with hydrocephalus. Lower FA in elder age group can mean presence of white matter degeneration, while in young subjects periventricular WM is being compressed but preserved. Thereby DTI can probably serve as specific prognostic marker for operation planning in patients with hydrocephalus.

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Mario Sabato1, Ilaria Pesaresi2, Rossella Pasquariello1, Ilaria Desideri1, Giovanni Gori1, Michele Puglioli2, Carlo Bartolozzi1, Mirco Cosottini2 ,3 1 University of Pisa, Department of Radiology, Pisa, Italy, 2 AOUP, Unit of Neuroradiology, Pisa, Italy, 3University of Pisa, Department of Neuroscience, Pisa, Italy

QUANTITATIVE MR-TRACTOGRAPHY IN HYDROCEPHALUS: WHITE MATTER FRACTIONAL ANISOTROPY INCREASE Aleksandr Efimtsev, Vladimir Fokin, Anna Pashkova, Andrei Sokolov Military Medical Academy, Saint Petersburg, Russia INTRODUCTION Normal appearing white matter (WM) tracts damage can be defined in vivo by Diffusion Tensor imaging (DTI). We analyzed DTI data to find any changes in periventricular WM in patients with hydrocephalus, which is characterized by fractional anisotropy (FA) coefficient. METHODS In our study 11 patients with obstructive hydrocephalus were examined (age range: 5 to 67 years old). They divided into 2 groups: 7 to 14 (A) and 22 to 67 (B) years old. T1weighted images (gradient echo, voxel size 1 mm3), diffusion tensor images (DTI) were obtained. 27 healthy subjects provided control data. FA was measured in corpus callosum, internal capsule and front lobes WM. The correlation between FA and age was also studied and compared by ROI between the 2 study groups. RESULTS Patients in A group demonstrated moderate FA increase in corpus callosum (0,532±0,054) and internal capsule (0,267 ± 0,044; comparing to age matched controls – 0,383 ± 0,064). Group B patients showed lower FA in body of corpus callosum (0,615±0,055; comparing to controls –

P-183 PRES: RECURRENT LESIONS IN THE SAME REGIONS

Approximately 3,8-8 % of the patients affected by Posterior Reversible Encephalopathy Syndrome (PRES) develop a second episode, usually in association with an infectious/ inflammatory event and multi-organ dysfunction syndrome (MODS). We report three cases of recurrence of PRES. Two patients (female, 31 and male, 12), affected respectively by Lymphoblastic Lymphoma (LBL) and Acute Lymphoblastic Leukemia (ALL), developed the first episode under chemotherapy, with resolution of symptoms and MRI findings in one-four weeks. They both developed the recurrence after Bone Marrow Transplantation (BMO), in association with an infectious event. The third patient (female, 63) developed the first episode and the recurrence during hypertensive crises. We noticed that the MRI lesions in the second episodes involved exactly the same cortical and subcortical areas of the first ones, not only in parieto-occipital regions but also in less typical areas, such as in frontal and cingulated convolutions. The overlapping of cerebral areas involved in both episodes of PRES supports the hypothesis of a persistent latent microvascular damage despite resolution of signal alterations on conventional MRI. Further elements could be obtained expecially from MR Perfusion, in order to better understand the physiopathology of the recurrence of PRES.

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ADVANTAGES OF VOXEL-BASED MORPHOMETRY AND MR-SPECTROSCOPY IN COMPLEX MR DIAGNOSTICS OF MULTIPLE SCLEROSIS

PITUITARY MR IMAGING FINDINGS OF PRIMARY AND SECONDARY HEMOCHROMATOSIS

Andrei Sokolov, Aleksander Efimtcev, Vladimir Fokin, Gennadii Trufanov Medical Military Academy, Saint-Petersburg, Russia INTRODUCTION MRI is the best test to view the changes caused by multiple sclerosis. The precise image produced by MRI gives the neurologist clear evidence of scar tissue in the deep parts of the brain or spinal cord that is characteristic of MS. But it does not give quantitative data about pathological changes of the brain, such as the level of brain atrophy and metabolic changes in MS lesions - or abnormal areas on the brain - from a MRI scan. And that’s why voxel-based morphometry and MR-spectroscopy make MR diagnostics of Multiple Sclerosis more complex. METHODS 32 patients with relapsing-remitting multiple sclerosis (age from 18 to 38) and 20 healthy volunteers underwent complex MR investigation, which included conventional MRI, MR spectroscopy and MR morphometry. Investigation was repeated after 2 years of treatment. SPM8 software package was used for voxel-based morphometry procedure. RESULTS The investigation showed reduction of N-acetylaspartate (NAA)and creatine (Cr) concentrations, NAA/Cho and NAA/ Cr ratios and increase of choline (Cho) and lactate (Lac) concentrations, Cho/Cr ratio in brain lesions of patients with relapsing-remitting multiple sclerosis. VBM measures differences in local concentrations of brain tissue through a voxelwise comparison of multiple brain images. VBM showed atrophy of gray matter of both hemispheres in particular in Cingulate Gyrus, Hippocampus, Uncus, basal ganglia and increase of cerebrospinal fluid volume between baseline and year 2 point. CONCLUSIONS voxel-based morphometry and MR-spectroscopy give additional quantitative information of brain lesions in patients with multiple sclerosis, which effects on future prognosis of such patients.

Kenichi Suzuki1, Masaaki Hori2, Hideaki Suzuki1, Junichi Kodera1, Masahiro Kobayashi1, Yoshiyuki Okada1, Sunao Mizumura1, Nobuyuki Shiraga1 1 Toho University Omori Medical Center, Tokyo, Japan, 2 Juntendo University, Tokyo, Japan PURPOSE Magnetic resonance (MR) imaging is useful in assessment of patients with hemochromatosis. We describe two case of iron deposition in the pituitary gland, primary and secondary hemochromatosis. We report two cases with bibliographic consideration. CASE REPORT Case 1: A 30-year-old man. A patient with secondary hemochromatosis. He had a history of aplastic anemia and had received blood transfusions in 13 years and orally and intravenously administered iron. In laboratory investigations, serum iron and Ferritin level showed abnormal high value. (serum iron 231 μg/dl, Ferritin 8234.0 ng/ml) Pituitary hormone showed the low value only LH. Case 2: A 37-year-old man. A patient with primary hemochromatosis. (serum iron 231 μg/dl, Ferritin 8142.0 ng/ml) Pituitary hormones including ACTH, FSH, and LH showed the low values. IMAGING FINDINGS In the first patient, both T1WI and T2WI showed hypointensity in anterior lobe of pituitary gland. In the second patient, T2WI showed hypointensity in anterior lobe of pituitary gland, however, T1WI showed isointensity in this area. Both of patient's posterior lobes of pituitary gland showed hyperintensity on T1WI, as a normal findings. SUMMARY We report two cases of the primary and secondary hemochromatosis of and imaging findings of pituitary gland. Quantity of serum iron may affect the differences in imaging findings, regardless of primary or secondary. However, it

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seems that the severity of pituitary hypofunction correlates little with imaging findings. P-186 THE ROLE OF MRI IN THE PROPER THERAPEUTIC DECISION FOR PATIENTS WITH PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML) Vasileios K. Katsaros1 ,2, Stavroula Lyra3, Dimitrios Verganellakis4, Panagiotis Toulas4 1 Department of MRI and Neuroradiology, “Saint Savvas” AntiCancer - Oncology Hospital, Athens, Greece, 2Department of Neurosurgery, University of Athens, Evangelismos Hospital, Athens, Greece, 3Department of Radiology, Red Cross Hospital, Athens, Greece, 4Diagnostic Institute Encephalos-Euromedica, Athens, Greece PURPOSE PML is a subacute demyelinating inflammation of the CNS usually occurring in patients with AIDS, or after treatment with immunosuppressive drugs, hematological disease. It is due to the reactivation of a polyoma virus (usually JC), affecting the oligodendrocytes which produce myelin and results in demyelinating lesions of the brain. The prognosis is poor because of absence of targeted therapy and the only

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treatment is to restore the immunocompetency of these cases. MATERIALS AND METHODS 11 cases in a time period of the last 4 years are presented (7 males, 4 females – 26-68 years-old). Five patients were serum-positive for AIDS, 1 patient with PCNS Lymphoma and four patients with multiple sclerosis stopped the immunosuppressive treatment they were under (immunorecompetence), while one immunocompetent patient showed in the CSF study, BK51 virus. RESULTS The neuroimaging findings (mostly in MRI) are correlated with the immunological system status (immunosuppression / immunocompetency) and the CSF study/PCR results for JC virus. The typical neuroimaging findings of PML are white matter lesions with affected U- fibers, without any contrast enhancement or mass effect. In several cases though, the findings are not typical and depend on the immunological system status of the patient and the possible local inflammatory reaction. Thus the lesions may enhance after i. v. Gadolinium administration, an atypical finding of PML, making the differential diagnosis from MS, ADEM and/or IRIS almost impossible. CONCLUSION PML has occasionally atypical neuroimaging findings and the differential diagnosis is very hard. Nevertheless imaging helps in the proper therapeutic decision.

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Author Index

# Springer-Verlag 2012

A Abaei, Maryam O4A-2.5 Abburu, Srinivasa Rao P-178 Abelli, Fabrizio P-174 Aberg, Laura P-101 Abhinav, Kumar O1B-1.3 Abolmaali, Nasreddin O1B-2.2 Abramyuk, Andrij O1B-2.2 Adams, Matthew P-11 Adapinar, Baki P-138 Adeleye, Amos P-91 Aerts, Hans O3A-2.2 Afonso, Miguel P-145 Aguiar, Pedro O2A-1.4, O4A-1.5 Ahn, Kook-Jin O2A-1.3 Ahuja, Anil O3A-2.4 Al Shahi Salman, R O3B-2.9 Alba, Ignacio P-92 Albuquerque, Luísa P-173 Alegria, Carlos P-145 Aleu, Aitziber P-163 Alexandrova, Evgeniya P-63 Al-Hadithi, Eamon P-1 Al Helli, Othman P-36 Ali, Husnain O4A-2.1 Al-Kilani, Ra'ed P-71 Al-Mahmoud, Reham P-88 Almendros Blanco, Piedad P-14 Alonso, J O1A-3.4 Alshuft, Hamza P-30 Altaf, Nishath O1A-1.1, O4A-1.7 Amanakis, Emmanouil O3B-1.2 Amsalem, Yaaqov O3A-2.3 Andreadis, Nikolaos P-10 Andrew, Morag P-81 Angioi, Karine P-103 Annesley-Williams, Deborah Refresher Lecutre 3b.1 (ESNR) Anno, Izumi P-121

Anpilogov, Victor P-20 Anselmi, Monica P-39 Appold, Steffen O1B-2.2 Arablinskiy, Andrey P-64 Arana, Estanislao O1B-2.3, O2B-2.5, P-2, P-3 Arbasino, Carla Francesca P-174 AR, Fadzlina P-108 Argyrakos, Theodoros P-10 Aribisala, Benjamin O4A-1.9 Arora, Ruchi O3A-1.6 Arribas, Leoncio O1B-2.3 Arrighi, H Michael O3B-2.7, O3B-2.8 Arustamyan, Sergey P-141 Arutyunov, Nikita P-144 Asenjo, Beatriz P-2, P-3 Auer, Dorothee Lecture 2a.4 (AC), Refresher Lecture 3a.1 (ESNR), O1A-1.1, O1A-1.2, O3A-1.3, O4A-1.7, O4A-2.5, O4B-2.8, O4B-2.7, P-83, P-56, P-30, P-22, P-4, Auger, Cristina O2B-2.4, O3B-1.4, O3B-1.6 Autti, Taina P-101 Awwad, Amir O4B-2.7, P-4 Aymerich, Francesc Xavier O3B-1.4 Aziz, Tipu O3A-1.9 Azpeitia, Javier P-92 B Babic, Drazenko O3A-2.2 Backchine, Serge O2B-1.3 Bagó, Attila P-47 Bailey, Mathew O4B-2.3 Bajaj, Nin O4A-2.5, P-56 Baldeweg, Torsten O3A-1.6 Barakos, Jerome O3B-2.7 Barata Tavares, Joana O2A-1.4, O4A-1.5 Barbarash, Leonid P-164

Bargalló, Nuria O3A-1.8 Bargiota, Alexandra P-110 Barker, Robert P-61 Barkhof, Frederik Lecture 1a.3 (ESNR), O3B-2.8 Barkovich, A James P-99 Barsi, Péter P-47 Bartolozzi, Carlo O3A-1.7, P-183, P-66 Bastin, Mark O4A-1.9 Bath, Philip MW O4A-1.7 Batista Domenech, Adela P-14 Battini, Roberta P-84 Batty, Ruth P-88 Bello, Lorenzo O1A-2.3, P-6 Bell, SL O2A-1.1 Belšan, Tomáš O2A-1.5, P-35 Beltramello, Alberto O2A-2.5 Belysheva, Elena P-144 Benitez, Ana P-76 Berentei, Z Lecture 1b.1 (ESNR) Bergen, Noelene P-115 Berghoff, Martin O1A-1.6 Bert, Robert O3A-2.5 Bettini, Vera O3B-1.8 Bhatnagar, Priya O4B-1.1, P-175, P-79 Bhattacharya, Joti Lecture 2b.4 (AC), O3B-2.9 Bhuta, Sandeep O3A-1.1, P-37 Biedermann, Tatiana O2B-2.4 Bilaniuk, Larissa P-102 Bilska, Malgorzata P-177, P-90 Birch, Jill O4B-2.3 Black, Ronald O3B-2.7 Bladowska, Joanna O1A-3.2, O1A-3.5, O3B-1.7 Blanco Pérez, Esther P-14 Blasco, Jordi O1A-1.1 Bocharov, Alexsey P-141 Bockenhauer, Detlef O3A-1.6

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Bommarito, Giulia O4A-2.7 Bonaldi, Giuseppe Refresher lecture 3b.4 (ESNR) Borghammer, Per P-27 Boskovic, Vesna P-122, P-148 Boulin, Anne O4A-1.6 Bozkaya, Halil O1B-1.4 Bozzao, Alessandro P-21, P-57 Bracard, Serge Lecture 2b.3 (AC), O2B-1.2, O3A-1.5 Bradley, Marcus O1B-1.3, O3B-2.5, P-159 Brashear, H Robert O3B-2.7, O3B-2.8 Braun, Marc O3A-1.5, P-103 Brazzelli, Miriam O3A-2.8, P-171 Brennan, David O1A-2.1 Brennan, Paul O1B-1.5, O2A-2.1, O 2B - 1 .6 , O 2B - 2 .1 , O 3 A - 2. 1, O4A-2.4, P-104, P-106, P-107, P-114, P-127, P-131, P-151, P-152, P-156, P-169, P-19, P-46, P-58, P-74, P-17 Bresson, Damien O3B-2.3 Brett, FM P-17 Briani, Chiara O3B-1.8 Brindar, Nina O4A-2.9 Brisson, Melanie P-11 Brook, Allan P-128 Bryukhov, Vasiliy P-180 Bukharin, Evgeniy P-141 Buksakowska, Irena P-35 Burns, Paul O4A-1.8 Butteriss, David P-175 Bychenko, Vladimir P-105 Byrne, James O3B-2.1 Byun, Hong Sik P-5 Byun, Woo Mok P-123, P-136 C Caballero, Cristina P-28 Cabrera Zubizarreta, Alberto P-124 Cadavid, Diego O3B-1.1 Campeau, Norbert P-80 Campodonico, Daniel O1A-1.1 Campos, Jorge O2A-1.4, O4A-1.5 Canapicchi, Raffaello P-84 Canovetti, Silvia O3A-1.7, P-66 Carducci, Filippo P-57 Carmody, David P-169 Carreiro, Inês P-118 Carreño, Mar O3A-1.8 Carr, Lucinda P-95 Carvalho, Raquel P-145 Casado Verdugo, Oscar P-124

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Casasco, Alfredo P-163 Casselman, Jan State of the art Lecture 1a (ESNR), State of the art lecture 3a (ESNR) Castellano, Antonella O1A-2.3, P-6 Castro, Felipe P-97 Catalucci, Alessia P-39 Cazot, Maud P-37 Ceccato, Filippo O4A-2.7 Cellerini, Martino O3B-2.1 Cendre, Romain O3A-1.5 Cester, Giacomo P-82 Cha, Jihoon P-5 Chandra, Julie O3A-1.9, O3B-2.1, P-81 Chang, Cheng-Yen O4B-1.8 Chang, Feng-Chi O3B-2.4, O4B-1.7, O4B-1.8, O4B-2.4, P-149, P-154, P-73 Chang, Kee-Hyun P-120 Chappell, Francesca O3A-2.8 Cha, Sang Hoon P-60 Cha, Sanghun P-172 Chavarría, L O1A-3.4 Chawda, S P-157 Chawda, Sanjiv P-70, P-71 Chen, Clayton Chi-Chang O4A-2.3, P-50 Chen, Hung-Chieh O4A-2.3, P-50 Chen, Wen-Hsien O4A-2.3, P-50 Chen, Y W O4B-2.4 Chernikova, Lyudmila O1A-1.3, P-167 Cheung, Wing-Keung P-154 Chiang, Francisco P-97 Chiras, Jacques O3B-2.2, O3B-2.3, P-125, P-146 Chiti, Stefano P-9 Chmielewski, Dariusz P-177 Choi, Choong Gon O4A-1.3, P-12, P-7 Choi, Hyun-Seok O2A-1.3 Choi, Seung Hong O1A-2.4, P-120, P-166, P-29 Choi, Young Jun O2A-1.2 Chong, Kling Refresher Lecture 2a.2 (ESNR), O3A-1.6 Choo, Peter P-68 Cho, Young Dae O4B-1.3 Chumas, Paul P-1 Chung, Eun-Chul P-135 Chung, Gyung Ho P-38 Chung, Se-Yeong O3B-1.9, P-59 Chung, Wen-Yuh O3B-2.4 Chung, Won-Jung P-12, P-7 Chu, Wei-Fa O4B-1.7, P-149 Cinar, Celal O1B-1.4

Cioni, Giovanni P-84 Citton, Valentina O3A-1.4, O3B-1.8, O4A-2.7, P-82 Clarençon, Frédéric O3B-2.2, O3B-2.3, P-125, P-146 Clarke, Chris O3A-1.3 Clark, Matthew O2A-2.2, O4A-2.6 Cognard, Christophe Lecture 4b.1 (AC), Lecture 5b.2 (AC) Colantonio, Raffaella O3A-1.2, P-126 Coldwell, Douglas P-128 Collaborators, Saivms O3B-2.9 Colosimo, Cesare O3A-1.2, P-126 Colquhoun, Iain O4B-1.2 Condette-Auliac, Stéphanie O4A-1.6 Connolly, Daniel O4A-1.4, P-88 Cook, Mark P-40 Coppola, Valeria P-57 Córdoba, J O1A-3.4 Corkill, Rufus O3B-2.1 Cormier, Evelyne P-125 Corr, Alison O2A-2.1, O2B-2.1, O4B-1.9, P-106, P-151, P-19 Corral, Juan F O3B-1.6 Coskun, Oguzhan O4A-1.6 Cosottini, Mirco O3A-1.7, P-183 Counsell, CE O3B-2.9 Cowley, Peter P-116, P-41, P-62 Cox, Tim O4B-2.5 Craig, Emma P-88 Craven, Ian P-181 Cronqvist, Mats Lecture 3b.2 (AC) Cross, Helen O3A-1.6 Cunningham, Jane O1B-1.5, O2B-1.6, O3A-2.1, P-106, P-107, P-114, P-127, P-19, P-46, P-74 Currie, Stuart O1A-2.5, O2A-2.2, O4A-2.6 Czerwosz, Leszek P-133 D Daams, Marita O3B-2.8 Dakovic, Marko P-26 Dal Pos, Sandro P-82 Dam, Mauro O3A-1.4 Danchenko, IA P-64 Dardiotis, Efthymios P-32 Dassie, Francesca O4A-2.7 Daumas Duport, Benjamin P-65 Davidson, M O2B-2.6 Davies, Brendan O4A-2.1 Davies, Kathryn P-132 Deary, Ian O1A-3.1, O1A-3.3, O4A-1.9

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Deasy, Neil O2B-1.4 De Belder, F. Lecture 2a.2 (AC) De Carlo, Debora P-82 Delanote, J State of the art lecture 1a (ESNR) Delmas, Vincent O3A-1.5 Deltour, Sandrine P-146 Dennis, Martin O1A-1.5, P-171 Denolin, Vincent P-23 De Nunzio, Giorgio O1A-2.3, P-6 Derakhshani, Shahram P-70, P-71, P-157 Desal, Hubert P-65 Deschamps, Romain P-109 Desideri, Ilaria O3A-1.7, P-183, P-66 Deuchar, Graeme O1A-2.1 De Foer, B State of the art lecture 3a (ESNR) de Vries, Maaike P-85 Dhillon, Permesh Singh O1A-1.2 Dias, Anoma Lalani O4B-1.2 Di Lella, Giuseppe O3A-1.2 Di Maria, Federico P-146 Dineen, Robert O3A-1.3, P-30, P-83 Di Salle, Francesco O3A-1.4 Djokovic, Svetlana P-158 Dmitry, Burenchev P-147 Dobai, Jozsef O2A-2.6 Dolan, Eamon O2B-1.6, O3A-2.1 Dolgushin, Mikhail P-20 Donaire, Antonio O3A-1.8 Donativi, Marina O1A-2.3, P-6 Doubal, Fergus O1A-1.5 Downer, Jonathan P-81 Drigo, Paola P-82 Drzezga, Alexander Lecture 2a.5 (ESNR) Ducrocq, Xavier O2B-1.2 Dukhovsky, Alex O4B-2.9 du Plessis, Johann O1B-1.1 Dyve, Suzan P-27 E Efimtcev, Aleksander P-184, P-182, P-31 Egitto, Maria Grazia P-174 Eldevik, Petter O4A-1.1 Eljamel, Sana P-67 Elwell, Vivian O4B-2.6 Erőss, Loránd P-47 Eran, Ayelet O3A-2.3, P-8 Erbay, Sami P-87 Ermani, Mario O4A-2.7 Escobar, Beatriz P-76 Estrade, Laurent O2B-1.3

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Evanson, Jane O4A-2.2 Facchini, F O2B-2.6 Fadeeva, Ludmila O2A-1.6, P-20, P-63 Faggin, Roberto P-82 Falcon, Carlos O3A-1.8 Falini, Andrea O1A-2.3, P-6 Fallatah, Sameeha P-11 Farrell, Michael O2B-2.1, P-17 Favaretto, Francesca O3B-1.8 Favaro, Angela O3B-1.8 Felli, Valentina P-39 Fernandes, João P-145 Fernandez, Esther P-28 Ferrara, Michele P-39 Feygin, Tamara P-102 Fiebach, Jochen O3B-2.7 Filippi, Massimo O3B-1.1 Fink-Jensen, Vibeke P-44 Finnsson, Johannes O1A-3.7 Fiori, Simona P-84 Flacke, Sebastian P-55 Fokin, Vladimir P-182, P-184, P-31 Foltynie, Thomas P-36 Forbes, K O2A-1.1 Forbes, Mhairi P-181 Foroni, Roberto O2A-2.5 Forsting, Michael O4B-1.5 Fountas, Kostas P-32 Francavilla, Ivo P-72 Franz, Astrid P-55 Frascheri, Laura O2B-2.4 Fugelseth, Drude P-96 Fukao, Akira P-129 Furdal, Michal O1A-3.2, O1A-3.5 G Gabrieli, Joseph O3B-1.8, O4A-2.7 Gadda, Davide O2A-2.3, P-9 Gallego, Jmaría P-14 Gallucci, Massimo P-39 Galvin, Leo P-104, P-131, P-152, P-156 Galyan, Tatyana O4A-2.9 Ganesan, Vijeya O4B-2.5 Gangemi, Emma P-126 Gan, Siew-Min P-40 Garai, Ildiko O2A-2.6 García, Felipe P-92 Garcia, Lina Maria O1A-1.1 García-Martínez, R O1A-3.4 Gasiorowski, Jacek O1A-3.2, O1A-3.5 Gass, Achim O3B-1.1, O3B-2.7 Gaudino, Simona O3A-1.2, P-126

Gavrilov, Anton P-63 Georgievski Brkic, Biljana P-122, P-148, P-158 Georgy, Bassem O2B-2.2, O2B-2.6, P-128 Geraldo, Ana Filipa O2A-1.4, P-173 Gholkar, Anil Refresher Lecture 1b.1 (ESNR), O4B-1.1 Gidding, Corrie O4B-2.2 Gika, Artemis P-89 Gilboa, Boaz O3A-2.3 Ginestroni, Andrea O2A-2.3 Giordano, Gian Paolo O2A-2.3, P-9 Giordano, Pierluigi P-72 Girardi, Paolo P-57 Gizewski, Elke O1A-1.6, O2B-2.3, O4B-1.5, P-86 Gledson, Ann O4B-2.3 Gnanalingham, Kanna P-15 Goericke, Sophia O4B-1.5 Gola, Giada P-174 Golay, Xavier P-11 Gondek, Tomasz Maciej O3B-1.7 Gontsarova, Anastastassia P-116, P-41, P-62 Gontu, Vamsi O4A-2.5 Goraj, Bozena O4B-2.2, P-85 Gordon, Patricia O4A-1.8 Gori, Giovanni P-183 Gorozhanin, AV P-64 Gory, Benjamin O3B-2.2, O3B-2.3 Gradkowski, Wojciech P-10 Grajkowska, Wieslawa P-90 Gralla, Jan State of the art lecture 2b (ESNR) Grams, Astrid O1A-1.6, O2B-2.3, P-86 Green, Alex O3A-1.9 Griffin, Nyree P-61 Griffiths, Paul O2A-2.2, O4A-2.6, O4A-2.8 Grigoryan, Yurii P-105 Grossman, Andrey P-130, P-150 Grujicic, Danica P-26 Grundman, Michael O3B-2.7 Grundy, Richard O3A-1.3, O4B-2.7, P-4, P-83, O4B-2.8 Grundy, Tom P-15 Grunwald, Iris O3B-2.1 Gubucz, I Lecture 1b.1 (ESNR) Guedes, Leonor P-173 Guedin, Pierre O4A-1.6 Gueguen, Antoine P-109 Guida, Danilo P-57

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Guieu, Stéphanie O4A-1.6 Guillemein, Francis O2B-1.2 Guimaraens, Leopoldo P-163 Gunny, Roxana O3A-1.6, O4B-2.6 P-94, P-95 Guo, Wan-Yuo O3B-2.4, O4B-1.7, O4B-1.8, O4B-2.4, P-149, P-73 Guzinski, Maciej O3B-1.7

Hourihan, Margaret P-178 Hsu, Charlie O3A-1.1 Hughes, David P-15 Huh, Choonwoong O2B-1.7 Hui, Francis P-68 Hung, Sheng-Che O4B-1.7, P-149 Hwang, Daehyun O2B-1.7 Hwang, Seung Bae P-38

H Haas, Tanja P-42, P-43 Hadjivassiliou, Marios O1A-2.5, O2A-2.2, O4A-2.6, P-181 Hakim, Sabril P-108 Haller, Sven Lecture 3b.1 (AC), P-42, P-43 Hall, JM O3B-2.9 Hammers, Alexander O3A-1.6 Hampton, Tim O2B-1.4 Han, Moon Hee O4B-1.3, P-166 Han, Young Min P-38 Hariz, Marwan P-36 Harkness, William O4B-2.6 Hart, John O2B-1.4 Hart, Jonathan O4B-1.2 Hascsi, Zsolt O2A-2.6 Hatazawa, Jun P-129 Hatzigeorgiou, George P-32 Hayashi, Shin P-99 Heckemann, RA O3A-1.6 Hegyi, Márta P-47 Hekha, Nishini P-68 Heran, Françoise P-109 Herder, Marit O4A-1.1 Herholz, Karl Lecture 2a.3 (ESNR) Hermoye, Laurent P-10, P-51 Hietschold, Volker O1B-2.2 Hildreth, Kerry O3A-2.5 Hjørringgaard Madsen, Mette P-44 Hoeberigs, MC O1B-2.1 Hoggard, Nigel O1A-2.5, O2A-2.2, O4A-1.4, O4A-2.6, O4A-2.8 Holmes, William O1A-2.1 Honeyfield, Lesley O3B-1.5 Hong, Yong-Kil O2A-1.3 Hori, Masaaki P-185 Horínek, Daniel P-35 Horne, MA O3B-2.9 Hoshi, Kazuei P-18 Hosoya, Takaaki P-129, P-139, P-161 Hosseini, Akram A O1A-1.1, O4A-1.7 Hosseini, Kossar O2B-1.2 Hoton, Janice P-36

I Ibañez, Javier O1B-2.5 Ihn, Yonkwon P-69 Ikka, Léon P-125 Inagaki, Syunichiro O3A-2.9, P-52 Inaoka, Tsutomu P-117 Inazawa, Johji P-99 In Kyu P-60 Inoue, Kaiji P-170 Investigators, Thrace O2B-1.2 Iqbal, Ahmed O4B-1.1, P-79, P-175 Isobe, Tomonori P-121 Ivankov, Alexander P-130, P-150 Iwata, Tomonori O3A-2.9, P-52 J Jabeen, Farrah P-116, P-41 Jack, Clifford O3B-2.7 Jackson, Alan O1A-2.2 Jackson, R O2A-1.1 Jacques, Thomas O4B-2.5, O4B-2.6 Jadun, Changez O4A-2.1 Jager, Hans Rolf Refresher Lecture 3a.2 (ESNR), P-11, P-45 James, A O2A-1.1 James, R Andy P-79 Janssen, Mirian P-85 Jarosz, Jozef O2B-1.4 Jaspan, Timothy O4B-2.8, P-4 Jayakrishnan, Vijay O4B-1.1 Jennings, Jack P-128 Jeon, Pyoung P-5 Jeon, Sin-Soo O2A-1.3 Jhooti, Permi P-42, P-43 Jin, Gong Yong P-38 Johansen, Jeppe P-44 Jong Lim, Kim P-176 Jong Nam, Lim P-176 Josephson, CB O3B-2.9 Jung, Seung Chai O1A-2.4, P-120, P-166, P-29 Jung, Seungyoung P-172 Jung, So-Lyung O2A-1.3 Jurkiewicz, Elzbieta P-177, P-90

K Kabra, Ruchi P-45 Kacar, Katarina P-122 Kadodwala, Viren O1A-2.5 Kadziolka, Krzysztof O1B-1.2, O1B-1.6, O2B-1.3 Kageyama, Sakiko P-139 Kalegias, Iosif P-89 Kamaly, Ian O4B-2.3 Kanagalingam, Jeeve P-68 Kandasamy, Naga O2B-1.4 Kandiyil, Neghal O1A-1.1, O4A-1.7 Kang, Hyun-Seung O4B-1.3 Kanoto, Masafumi P-129, P-139, P-161 Kapsalaki, Eftychia P-110, P-32 Karaban', Irina O4A-1.2 Karaban', Nicolas O4A-1.2 Karabatsou, Tina P-15 Kara, Taylan P-138 Katsaros, Vasileios K P-10, P-186, P-51 Kavanagh, Liam P-104, P-131, P-156 Kayama, Takamasa P-129 Keane, John O4B-2.3 Kelemen, Anna P-47 Kelliher, Edel O2A-2.1, O2B-2.1, P-107, P-127, P-151, P-152, P-46 Kelly, Peter O2B-1.6, O3A-2.1 Khaimov, Dmitry P-31 Khandanpour, Nader O4A-1.4, O4A-2.8 Kheder, Ammar P-181 Khirwadkar, Hannah P-178 Khovrin, Valery O4A-2.9 Khromov, Anton P-164 Killer –Oberpfalzer, Monika Lecture 1b.3 (ESNR) Kim, Bum-Soo O2A-1.3, P-69 Kim, Byung-joon P-5 Kim, Dalsoo O2B-1.7 Kim, Eunhee P-111, P-113, P-120, P-13 Kim, Hengjun O4A-1.3 Kim, Ho Sung O2A-1.2, O4A-1.3, P-12, P-7 Kim, Hua Sun O3B-1.9, P-59 Kim, Hye Jeong P-5 Kim, Hyung-Jin P-5 Kim, Insoo O2B-1.7 Kim, Jae Hyoung P-120 Kim, Ji-hoon P-48, P-120, P-166 Kim, Keon Ha P-5 Kim, Myengjin P-69 Kim, Namkuk O4A-1.3

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Kim, Sang Joon O2A-1.2, O4A-1.3, P-12, P-7 Kim, Soo Chin O1A-2.4, P-120, P-166, P-29 Kim, Sung Tae P-5 Kitzler, Hagen P-179 Kleta, Robert O3A-1.6 Klisch, Joachim P-140 Knysz, Brygida O1A-3.2, O1A-3.5 Kobayashi, Masahiro P-185 Kobys', Tetyana O1A-3.6 Kodama, Takao O1A-2.6, P-112 Kodera, Junichi P-185 Kolossváry, Márton O4B-2.1 Koltowska, Anna O1A-3.2, O1A-3.5 Konovalov, Rodion O1A-1.3, O3A-2.7, P-167 Kopel, Rotem P-42, P-43 Kornienko, Valeri O2A-1.6 Kornienko, Valerij P-63 Kornienko, Valery P-144, P-20 Kotulska, Katarzyna P-177, P-90 Koutsarnakis, Christos P-10 Kovacs, Francisco M O2B-2.5 Kovalenko, Andrey P-164 Kozák, Lajos Rudolf O4B-2.1, P-47 Kozawa, Eito P-170 Kravchuk, Alexander P-63 Kremneva, Elena O1A-1.3, O1A-1.4, P-167 Kringelbach, Morten O3A-1.9 Krishnan, Anant P-11 Krombach, Gabriele O1A-1.6, O2B-2.3 Krotenkova, Marina O1A-1.3, O1A-1.4, O3A-2.7, P-167, P-180 Krumina, Gaida O3A-2.6 Kudo, Hideyasu P-117 Kuhweide, R State of the art lecture 3a (ESNR) Kuker, Wilhelm O3B-2.1 Kulcsar, Zsolt O3A-2.2, O4B-1.5 Kulikova, Sofya P-180 Kuo, Kuei-Hong P-154 Kupcs, Karlis O3A-2.6 Kurth, Andreas P-128 Kwak, Ellie P-87 Kwan, Gigi O3A-1.1 L Labrousse, Marc O3A-1.5 Lafitte, François P-109 Laible, Mona P-155 Lai, Yen-Jun P-154, P-73 Lansley, Joseph P-70, P-71, P-157

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Larrea, Jose A P-28 László, Bognár P-47 Lavrnic, Slobodan P-26 Lawton, Michael Lecture 4b.2 (AC), Lecture 5b.2 (AC) Lazzarotti, Guido Andrea P-66 Lee, Aleum P-48 Lee, Byunghee P-172 Lee, Chong Sik O4A-1.3 Lee, Deacon P-181 Lee, Dong Hoon P-111, P-113, P-13 Lee, Han Bee P-13 Lee, Jean O3B-1.5 Lee, Lucy P-49 Lee, Sang Yong P-38 Lee, Seung Ro P-119 Lee, So-Yeon P-135 Lee, Suju P-172 Lee, Won Chan P-12 Lee, Young Jun P-119 Leggate, Alex O4B-2.3 Legou, Francois P-103 Le Jean, Lise P-125 Lerut, B State of the art lecture 3a (ESNR) Lettau, Michael P-155 Liceaga, Garbiñe P-28 Li, Li P-160 Lim, Jung Wook O4B-1.3 Lim, Shen-Yang P-33, P-34 Lin, Chung-Jung O3B-2.4, O4B-1.7, O4B-1.8, P-149, P-73 Linnankivi, Tarja P-100 Lintia Gaultier, Alina P-65 Liouta, Evangelia P-10, P-51 Lirng, Jiing-Feng O4B-1.8 Litvinenko, Igor P-31 Liu, Ming-Cheng P-50 Lobotesis, Kyriakos O4B-1.2 Looby, Seamus O1B-1.5, O2A-2.1, O2B-1.6, 02B-2.1, O3A-2.1, O4A-2.4, P-104, P-106, P-107, P-114, P-127, P-131, P-151, P-152, P-156, O4B-1.9, P-19, P-46, P-58, P-74, P-17 Lovblad, Karl-Olof P-42, P-43 Low, S B L P-157 Lucas Neto, Lia P-173 Lucente, Giuseppe P-72 Luo, Chao-Bao O3B-2.4, O4B-1.7, O4B-1.8, P-149, P-73 Lu, Yuan O3B-2.7 Lu, Yueh-hsun O4B-2.4 Lyra, Stavroula P-186, P-51

M Macmullen-Price, Jeremy P-1, P-132 Macrae, I Mhairi O1A-2.1 MacSweeney, Shane T O1A-1.1, O4A-1.7 Maestro, Iratxe O3A-1.8 Maffei, Pietro O3B-1.8, O4A-2.7 Mahady, Kate P-132 Maizeroi-Eugène, Franck O3B-2.2, O3B-2.3 Makin, Stephen O1A-1.5 Mäkitie, Outi P-100 Makowicz, Grzegorz P-133 Malczyk, Katarzyna P-177, P-90 Maldent, Jean-Baptiste P-125 Mallick, Andrew O3B-2.5 Mallouhi, Ammar P-134 Mamedov, Farid P-144 Manara, Renzo O3A-1.4, O3B-1.8, O4A-2.7, P-82 Mancini, Laura P-49 Mandel, Catherine P-115 Mandera, Marek P-90 Manita, Muftah, A O4B-2.8, P-22 Marhuenda, Ana P-2 Marik, Wolfgang P-134 Maris, Thomas O3B-1.2 Marosfői, M Lecture 1b.1 (ESNR) Marrero, Daniel P-87 Marshall, Jan O3B-1.8 Martin, Bénédicte P-23 Martini, Chiara O4A-2.7 Martucci, Matia O3A-1.2, P-126 Maruta, Carolina O4A-1.5 Mas-Bonet, Antonio O1B-2.5 Masopust, Vaclav O2A-1.5 Massey, Luke P-36 Mastorodemos, Vasileios O3B-1.2 Mata Escolano, Federico P-14 Matheu, Ander P-28 Mathew, Anup P-88 Mathiesen, Ellisiv O4A-1.1 Matsue, Kosei P-18 Matsumura, Akira P-121 Maviki, Mufudzi P-116, P-24, P-41, P-53, P-62 Mazza, Monica P-39 Mazzoni, Lorenzo P-9 Mbemba Daddy, Mata P-160 McCusker, Mark O1B-1.5, P-74 McNamee, Paul P-171 McNeil, Christopher O1A-3.1, O1A-3.3 Md Shah, Mohammad Nazri P-34

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Mehta, Amrish O4B-1.2 Melancon, Denis O3B-2.7 Melberg, Atle O1A-3.7 Melnikova-Pitskhelauri, Tatiana P-144 Menjot de Champfleur, Nicolas O3B-2.2 Mews, Peter O1B-1.3 Meyer, Carsten P-55 Miaux, Yves O3B-2.7 Micallef, Caroline P-49 Micart, Emilien O3A-1.5 Miglane, Evija O3A-2.6 Mihlon, Frank O3A-2.5 Milanese, Laura O3A-1.4, O4A-2.7, P-82 Milan, Gabriela O3B-1.8 Milenkovic, Gordana P-122, P-148, P-158 Milewicz, Diane O4B-2.5 Mills, Samantha O2A-2.4, P-15 Milosevic Medenica, Svetlana O4B-1.4 Minniti, Giuseppe P-21 Miranda, Hector P-171 Mirtuono, Pasquale O2A-2.5 Mitjana, Raquel O2B-2.4, O3B-1.3, O3B-1.4, O3B-1.6 Mitra, Dipayan O4B-1.1, P-79 Miyazaki, Yuichi O3A-2.9, P-52 Mizogami, Kouji O3A-2.9, P-52 Mizukoshi, Waka P-170 Mizumura, Sunao P-185 Mohapl, Milan P-35 Mohd-Nor, Hazman P-33, P-34 Moldavskaya, Irina P-164 Moll, Apolonia O1B-2.5 Mollison, Daisy P-16 Molnar, Peter O2A-2.6 Molyneux, Andrew Refresher Lecture 1b.1 (ESNR), Lecture 1b.2 (ESNR) Monleón, Daniel P-3 Montalban, Xavier O3B-1.3, O3B-1.4 Montemezzi, Stefania O2A-2.5 Montesinos, Lluisa O2B-2.4 Moratal, David O2B-2.5, P-3 Morbelli, Silvia Lecture 2a.1 (ESNR) Moreau, Kerrie O3A-2.5 Moreno, Alejandro P-3 Moretti, Marco O2A-2.3 Morgan, Paul S O4A-2.5, O4B-2.8 Mori, Takahisa O3A-2.9, P-52 Moritz, Regina O1A-1.6, O2B-2.3 Moro, Francesca P-84 Moroney, Joan O2B-1.6, O3A-2.1, O4B-1.9

S191

Morris, Kristen O3B-2.7, O3B-2.8 Morris, Zoe O4A-1.9 Mortimer, Alex O1B-1.3, O3B-2.5, P-159 Moultrie, F O3B-2.9 Mounayer, Charbel O3B-2.2, O3B-2.3 Moura, Crisrina P-118 Mouridsen, Kim P-27 M. Santos, Carolina O4A-1.5 Mugikura, Shunji P-160, P-168 Muirhead, R O2A-1.1 Muir, Keith O2B-1.1 Mullin, Jim O1A-2.1 Munot, Pinki O4B-2.5 Munoz Maniega, Susana O4A-1.9 Muraro, Paolo O3B-1.5 Murata, Takaki P-160, P-168 Murias, Eduardo P-76 Murray, Alison O1A-3.1, O1A-3.3 Murray, Catherine O4A-1.9 Murray, E O2A-1.1 Murray, GD O3B-2.9 Murtagh, Bernadine P-116, P-41, P-62 Mutlu, Gurkan P-146 Muto, Mario Lecture 4a.2 (AC), Refresher Lecutre 3b.2 (ESNR) N Naggert, Jürgen K O3B-1.8 Nair, Shalini Rajandran P-33, P-34 Nakajima, Reiko P-170 Nakatsuka, Tomoya P-117 Nakazaki, Masahito O3A-2.9, P-52 Navin, Patrick P-114 Nayagam, Kesavan P-53 Near, Jamie P-81 Neelakantan, A O2A-1.1 Nekhorosheva, Anna P-164 Nelson, Richard Lecture 1b.4 (ESNR), O1B-1.3 Nestorovic, Dragoslav P-75 Netuka, David O2A-1.5 Neutel, Dulce P-173 Ng, Joanne P-95 Nguyen, N O2B-2.6 Nielsen, Rikke P-44 Nikas, Ioannis P-89 Nishi, Naoko P-170 Noack, Frank P-179 Nobili, Flavio Lecture 2a.1 (ESNR) Noguchi, Tomoyuki P-54 Novak, Laszlo O2A-2.6 Nowak, Katarzyna P-177, P-90 Nunes, César P-118

Nutting, C O2B-2.6 O Obert, Martin O1A-1.6, O2B-2.3 Oda, Atsuko P-161 Oertel, Matthias O2B-2.3 Offeciers, E.F State of the art lecture 3a (ESNR) Ogbole, Godwin P-91 O'Hare, Alan O1B-1.5, O2B-1.6, O3A-2.1, P-127, P-74 Okada, Yoshitaka P-170 Okada, Yoshiyuki P-185 Okamoto, Nobuhiko P-99 Olatunji, Busayo P-91 O'Leary, Suzanne O3B-2.5 Omelchenko, Oleksyi O1A-3.6 Ontañon Garces, Jose Maria P-124 Oran, Ismail O1B-1.4 O'Rourke, Killian O2B-1.6 Orru', Emanuele O4A-2.7 Osborn, Anne Lecture 1a.1(AC), Refresher Lecture 1a.1(ESNR), Plenary Lecture 6 (ESNR) O'Shea, Aileen P-17 Oshorov, Andrej P-63 Osipovskaya, A/S P-64 Ostergaarde, John O4B-2.5 Østergaard, Leif P-27 O'uchi, Eri P-18 O'uchi, Toshihiro P-18 Oxana, Guseva P-147 Ozgiray, Erkin O1B-1.4 Oztunali, Cigdem P-138 P Pandolfo, Cesare O2A-2.3 Paniagua, Alvaro P-92 Panou, Theodora O3B-1.2 Pan, Yi-Ju P-154 Papadaki, Efrosini O3B-1.2 Papanastassiou, V O3B-2.9 Pardo, Edurne P-28 Pareto, Deborah O3B-1.6 Park, Choong Ki P-119 Park, Dong Woo P-119 Parkes, Laura O1A-2.2 Park, Heegirl P-172 Park, Hee-Jin P-135 Park, Sun-Won P-120 Park, Won Kyu P-136 Parr, Jeremy P-81 Parizel, P.M. Lecture 2a.2 (AC)

S192

Pascal-Moussellard, Hugues P-125 Paschalis, Thanos P-110 Pashkova, Anna P-182 Pasquariello, Rossella P-66, P-183 Pastore, Gabriella P-6 Patankar, Tufail P-1 Patel, P O2B-2.6 Patton, Alice P-80 Pavão Martins, Isabel O4A-1.5 Ti, Joanna O2A-2.1, O2B-1.6, O2B2.1, O3A-2.1, O4A-2.4, O4B-1.9, P104, P-107, P-131, P-151, P-152, P-156, P-46, P-58, P-19, P-17 Pelletier, Daniel O3B-1.1 Pennycooke, Kevin O4A-2.4, P-156, P-58 Peresedova, Anastasiya P-180 Perini, Riccardo P-82 Perry, David P-93 Pesaresi, Ilaria O3A-1.7, P-183 Petacchi, Diana O2A-2.3 Pfanni, Rolf P-87 Pham, Mirko Plenary Lecture 1 Phillips, Claire P-115 Picado, Maria José O1B-2.5 Piccolo, Giovanni P-174 Pichon, Soizic P-125 Pierot, Laurent O1B-1.2, O1B-1.6, O2B-1.3 Pimentel, Jose O2A-1.4 Pinna, Giampietro O2A-2.5 Pino, Maria Chiara P-39 Piper, Rory O4A-1.9 Pla, Albert O3B-1.6 Plaitakis, Andreas O3B-1.2 Podemski, Ryszard O3B-1.7 Podoprigora, Alexey P-20 Poitelea, Marius O2B-1.4 Pokryszko-Dragan, Anna O3B-1.7 Pollock, Avrum P-102 Polupan, Alexander P-63 Poniatowska, Renata P-133 Pons, Roser P-89 Poon, Wai Sang O3A-2.4, P-78 Popov, Veljko P-55 Potapov, Alexander P-63 Power, Sarah O2A-2.1, O2B-1.6, O2B-2.1, O3A-2.1, O4A-2.4, O4B-1.9, P-104, P-107, P-114, P-127, P-131, P-151, P-152, , P-17, P-19, P-46, P-58, P-74 Prabhakar, Prab P-95 Prayer, Daniela P-134

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Precerutti, Matteo P-174 Prevedoni Gorone, Maria Sole P-174 Profantova, Nora O2A-1.5 Pronin, Igor O2A-1.6, P-20, P-63 Prstojevic, Branko P-75 PTi, J P-114 Pugliese, Silvia P-21 Puglioli, Michele O3A-1.7, P-183, P-66 Q Qian, Guoqi P-40 Quaghebeur, Gerardine O3A-1.9, P-81 Quayyum, Zahid P-171 Quest, Rebecca O3B-1.5 Quiñones-Tapia, Diana O1B-2.5, P-162, P-163 Quintana, Juan P-97 Quinton, Richard P-79 R Radon, Mark O3B-1.5 Radovic-Stefanovic, Magdalena P-148 Radue, Ernst-Wilhelm O3B-1.1 Radzina, Maija O3A-2.6 Raghavan, Ashok P-88 Raguso, Monica P-72 Rahmat, Kartini P-108, P-33, P-34 Raininko, Raili O1A-3.7 Rakowicz, Maria P-133 Ramalingam, Satheesh, K P-22 Ramli, Norlina P-108 Ramli, Norlisah P-108, P-33, P-34 Ramos, Carolina O2B-2.4 Rane, Neil O3B-2.1 Rásonyi, György P-47 Ray, Aaron P-56 Redondo, Pilar P-76 Reginster, Pierre P-23 Reimão, Sofia O2A-1.4, O4A-1.5 Rejchrt, Pavel P-35 Rennie, Ian O4A-1.8 Renowden, Shelley O1B-1.3, O3B-2.5, P-159 Ricciardi, Giuseppe Kenneth O2A-2.5 Richert, Nancy D O3B-1.1 Rieck, Charlotte O1A-1.6 Rigucci, Silvia P-57 Rio, Jordi O3B-1.3 Rippon, Gregory O3B-2.7 Ritchie, V O3B-2.9 Riva, Marco O1A-2.3 Roa, Elena P-92 Roberts, RC O3B-2.9

Robin, George O1B-1.2 Robinson, Ian P-93 Robinson, Stephanie O2B-1.6, O3A-2.1 Rocha, Jaime P-145 Rodesch, Georges Lecture 2b.1 (AC), Lecture 4b.3 (AC), Refresher Lecture 2b.1 (ESNR), O4A-1.6 Rodriguez Gutierrez, Daniel O3A-1.3, O4B-2.7, P-83, P-4 Rogne, Sigbjørn O4A-1.1 Rola, Rafał P-133 Rolma, Giuseppe O3B-1.8 Romano, Andrea P-21, P-57 Romanowski, Charles Lecture 4a.1 (AC), Refresher Lecture 1a.3 (ESNR) Rontogianni, Dimitra P-51 Rosahl, Steffen K P-140 Rossetto, Marta P-82 Rossi, Andrea Refresher Lecture 2a.3 (ESNR) Rossi Espagnet, Maria Camilla P-57 Rovira, Alex Lecture 1a.3 (AC), Lecture 1a.1 (ESNR), O3B-1.6, O2B-2.4, O1A-3.4, O3B-1.3, O3B-1.4, Royle, Natalie O4A-1.9 Rozhkova, Zinayida O1A-3.6, O4A-1.2, O4B-2.9 Rucco, Matteo P-6 Rudà, Roberta O1A-2.3 Rudas, Gábor O4B-2.1, P-47 Rufenacht, Daniel Plenary Lecture 1b (ESNR), O3A-2.2 Ruiz-España, Silvia O2B-2.5 Ryan, Elizabeth O4A-2.4, P-58 Ryoo, Inseon O1A-2.4, P-120, P-166, P-29 S Saatci, Isil Refresher Lecture 2b.2 (ESNR) Sabato, Mario O3A-1.7, P-183 Saito, Naoko P-170 Sala, Francesco O2A-2.5 Salazar, Francisco P-92 Salli, Eero P-101 Salloway, Stephen O3B-2.7 Salt, Benjamin P-116, P-24, P-41, P-53, P-62 Salvalaggio, Alessandro O3A-1.4, O3B-1.8, P-82 Sanchez, Nancy P-76 Sanders, Olivia P-70 Sandrikov, Valery O4A-2.9 Santonastaso, Paolo O3A-1.4

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Santorelli, Filippo P-84 Santosh, Celestine O1A-2.1 Santos, Sónia O2A-1.4 Saralegui Prieto, Ibone P-124 Sarasqueta, Cristina P-28 Sarria, Silvana O2B-2.4 Sartori, Stefano P-82 Sasiadek, Marek O1A-3.2, O1A-3.5, O3B-1.7 Sastre-Garriga, Jaume O3B-1.3 Sato, Shinya P-129 Saunders, Dawn O4B-2.5, P-94, P-95 Savvopoulos, Fotios O4B-2.7 Saylisoy, Suzan P-138 Sbarbati, Andrea O2A-2.5 Scardigli, Vania O2A-2.3 Scaroni, Carla O4A-2.7 Scharnowski, Frank P-43 Schcurova, Irina O2A-1.6 Scheffler, Klaus P-42, P-43 Schellhorn, Till P-96 Scheltens, Philip O3B-2.8 Schiarelli, Chiara O3A-1.2, P-126 Schirmer, Henrik O4A-1.1 Schlamann, Marc O4B-1.5 Schmidt, Christine P-179 Schmidt, Thorsten O1A-1.6, O2B-2.3, P-86 Schwartz, Erin P-102 Schwartz, Robert O3A-2.5 Schwarz, Stefan T O4A-2.5, P-56 Sellar, Robin Lecture 5b.2 (AC), Lecture 1b.5 (ESNR), O3B-2.9, P-67 Semenov, Stanislav P-164 Sender, Jonas O2B-2.3 Seneviratne, Udaya P-40 Senthil, Latha P-142 Seo, Hyobin O3B-1.9, P-120, P-59 Sergeev, Dmitry O1A-1.4, O3A-2.7 Serre, Isabelle O2B-1.3 Server Alonso, Andrés P-96 Shatokhina, Maria P-164 Shekdar, Karuna P-102 Shimanskii, Vadim P-105 Shin, Hwa Seon O1A-2.4, P-120, P-166, P-29 Shiraga, Nobuyuki P-185 Shreter, Roni P-8 Shuler, Kirsten P-171 Siasios, Ioannis P-32 Sidek, Sabrilhakim P-108 Sierra, Alba O3A-1.8 Sihashi, Gen O3A-2.9, P-52

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Silva, Catalina P-97 Silva, Cristiana P-173 Simonelli, Paolo O2A-2.3 Simon-Talero, M O1A-3.4 Simos, Panagiotis O3B-1.2 Sinha, Richa O2A-2.4 Siu, Deyond O3A-2.4 Siurana, Sahyly O2B-2.4 Skranes, Janne P-96 Smith, Paul O4A-2.2 Soderman, Michael Lecture 5b.1 (AC), Lecture 5b.2 (AC) Soffietti, Riccardo O1A-2.3 Soh, Calvin O2A-2.4, O4B-2.3 Sohn, Chul-Ho P-120, P-166, O4B-1.6 Soize, Sébastien Plenary Lecture 3, O2B-1.3 Sokolov, Andrei P-182, P-184, P-31 Soleiman, Hamzah P-16 Somers, T State of the art lecture 3a (ESNR) Song, Changjun P-172 Song, Chang June P-60 Soto, Sergio P-97 Sourbron, Steven P-1 Sourour, Nader O3B-2.2, O3B-2.3, P-146 Sperling, Reisa O3B-2.7 Stadler, AARS O1B-2.1 Staff, Roger O1A-3.1, O1A-3.3 Starr, John O1A-3.1, O1A-3.3 Starzinger, Matthias P-134 Stehle, Thomas P-55 Stein, Marco O2B-2.3 Stewart, W O2A-1.1 Stiris, Tom P-96 Stivaros, Stavros O4B-2.3 Stokroos, RR O1B-2.1 Stosic-Opincal, Tatjana P-26 Stranjalis, George P-10, P-51 Strasilla, Christoph P-140 Sułek, Anna P-133 Sugai, Yukio P-161 Sullivan, Peter P-81 Summers, David Refresher Lecutre 3a.3 (ESNR) Sundgren, Pia Lecture 2a.3 (AC), Refresher Lecture 3b.3 (ESNR) Sunman, Wayne O1A-1.2 Suslin, Alexander O1A-1.4, O3A-2.7, P-167 Suzuki, Hideaki P-185 Suzuki, Keisuke P-139

Suzuki, Kenichi P-185 Sychev, Alexander P-63 Sychra, Vojtech P-140 Szucs, Anna P-47 Szabó, Ádám P-47 Szabó, Miklós O4B-2.1 Szikora, Istvan Lecture 1b.1 (ESNR) Szucs, Bernadett O2A-2.6 T Tada, Hiroko P-98, P-99 Takahashi, Masahiro P-170 Takahashi, Shoki P-160, P-168 Takahashi, Yoichiro O3A-2.9, P-52 Takanashi, Jun-ichi P-98, P-99 Takush, Sergej P-63 Tampieri, Donatella O3B-2.7 Tamura, Shozo O1A-2.6, P-112 Tanashyan, Marine O1A-1.4, O3A-2.7 Tang, Vivian O4B-2.3 Tan, Huey K O1A-1.2 Tanislav, Christian O1A-1.6 Tan, Li-Kuo P-33, P-34 Tartaglione, Tommaso P-126 Tavernaraki, Aggeliki P-10, P-51 Telman, Gregory O3A-2.3 Teng, Michael MH O3B-2.4, O4B-1.7, O4B-1.8, P-73 Terada, Hitoshi P-117, P-99 Theofanopoulou, Maria P-89 Theron, Jaques P-163 Thomas, David P-36 Thompson, Gerard O1A-2.2 Thoresen, Marianne P-96 Thornton, John O1B-1.5, O2A-2.1, O 2 B - 1 . 6 , O 2 B - 2 .1 , O 3 A - 2 . 1 , O4A-2.4, P-104, P-106, P-107, P-127, P-131, P-151, P-152, P-156, P-169, P-19, P-46, P-58, P-74 Thornton, M P-114 Thorton, J P-17 Thurnher, Majda Refresher Lecture 1a.2 (ESNR) Thust, Stefanie O4A-2.2, P-61 Tietze, Anna P-27, P-44 Tintoré, Mar O3B-1.3, O3B-1.4 Tissen, Bogdan P-141 Tissen, Teodor P-141 Tisserand, Marie Plenary Lecture 2 Toiviainen-Salo, Sanna P-100 Tokola, Anna P-101 Tolstykh, Alla P-130, P-150 Tonnelet, Romain O3A-1.5, P-103

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Tonoyan, Aram O4A-2.9 Torrents, M O1A-3.4 Tóth, Vivien P-47 Toulas, Panagiotis P-186, P-51 Toyoguchi, Yuuki P-139, P-161 Traverso, Annalisa P-82 Trechot, Fanny P-103 Trifonova, Olga P-180 Trufanov, Artem P-31 Trufanov, Gennadii P-184 Tsiotas, Nikolaos P-10 Tsironi, Evangelia P-110 Tsirouki, Theodora P-110 Tsougos, Ioannis P-32 Tutton, Sean O2B-2.6 U Uarnieri, G Refresher Lecutre 3b.2 Uchino, Akira P-170 Ugai, Tomotaka P-18 Urtasun, Miguel P-28 V Vakatov, DV P-64 Valálik, István P-47 Valanne, Leena P-100 Valavanis, Anton Lecture 2b.2 (AC) Valdes Hernandez, Maria O4A-1.9 Valleriani, Annamaria P-84 van den Hauwe, Luc Lecture 2a.2 (AC), O4B-2.2 Van der Flier, Wiesie Lecture 2a.2 (ESNR) van der Graaf, Marinette P-85 Van der Zijden, T. Lecture 2a.2 (AC) Vandevelde, Michel P-23 Van de Ville, Dimitri P-42, P-43 Vangberg, Torgil O4A-1.1 Van Goethem, Johan Lecture 2a.2 (AC) van Hartevelt, Tim O3A-1.9 Van Hecke, W. Lecture 2a.2 (AC) Van Laere, Koen Lecture 2a.4 (ESNR) van Lindert, Erik O4B-2.2 Vannucci, Stefano P-66 Vasic, Brankica P-26 Vega, Pedro P-76 Venstermans, C. Lecture 2a.2 (AC) Ventura, M O1A-3.4 Verganellakis, Dimitrios P-186

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Vert, Carla O2B-2.4 Viaño, Juan P-162 Vicente Olabarria, Iñigo P-124 Vidal-Jordana, Anka O3B-1.3 Vignal, Catherine P-109 Villa, Graziella O2A-2.3 Villanua, Jorge A P-28 Villarroel, Pedro P-97 von Kummer, Rudiger Plenary Lecture 5 (ESNR), O1B-2.2, P-179 Voormolen, M. Lecture 2a.2 (AC) Vossough, Arastoo P-102 Vrána, Jirí O2A-1.5, P-35 Vukasinovic, Ivan P-75 W Wagner, Michaela P-134 Waldman, Adam Lecture 1a.2 (AC), O3B-1.5 Walker, David O3A-1.3 Waneck, Fredrik P-134 Wang, Hseuh-Han O4B-2.4 Wanke, Isabel O3A-2.2, O4B-1.5 Ward, Emily P-77 Wardlaw, Joanna State of the art lecture 2a (ESNR), O1A-1.5, O3A-2.8, O4A-1.9, P-16, P-171 Warlow, CP O3B-2.9 Warren, Daniel O4A-2.8 Watarai, Fumika P-139 Watel, Clément P-109 Waterval, JJ O1B-2.1 Wattjes, Michael Lecture 1a.2 (ESNR), O3B-2.8 Watt, Michael O4A-1.8 Weese, Juergen P-55 Wenzel, Fabian P-55 Wesseling, Pieter O4B-2.2 Westerland, Olwen P-61 Whalley, Lawrence O1A-3.1, O1A-3.3 White, Philip Refresher Lecture 1b.1 (ESNR), O1B-1.1, O2B-1.1, P-67 Whittle, Ian Lecture 2a.1 (AC) Wijayatilake, Dhuleep P-70 Wikran, Gry O4A-1.1 Wilhelm, Thomas P-24, P-53 Wilkinson, Iain O2A-2.2, O4A-2.6 Will, Robert Refresher Lecture 3a.3 (ESNR)

Williams, David O2B-1.6, O3A-2.1, O4B-1.9, P-169 Williams, Fionnan O1B-1.3 Wilne, Sophie O3A-1.3 Wintermark, Max Plenary Lecture 4 (ESNR) Wong, George Kwok Chu O3A-2.4, P-78 Wong, Tai-Tong O4B-2.4 Woodbridge, Lorna P-116, P-41, P-62 Wright, Neville O4B-2.3 Wu, Chen-Hao O4A-2.3, P-50 Wu, Hsiu-Mei O3B-2.4, O4B-1.8, O4B-2.4 Y Yakovlev, Sergey P-141 Yano, Takanori O1A-2.6, P-112 Yeom, Jeong A O1A-2.4, P-120, P-166, P-29 Yoon, Byung-Woo P-166 Young, William Leuture 1b.1 (AC) Youroukos, Sotirios P-89 Yousry, Tarek Lecture 1a.4 (ESNR), O3B-1.1, P-36 Yoxall, Heather P-132 Yu, Inkyu P-172 Yun, Tae Jin P-166 Yu, Simon P-78 Z Zacharzewska, Anna O3B-1.7 Zagorchev, Lyubomir P-55 Zakharova, Natalia P-63 Zanotti, Maria Chiara P-82 Zarnow, Deborah P-102 Zarowski, A State of the art lecture 3a (ESNR) Zavalishin, Igor P-180 Zavareh, Alireza P-45 Zaytsev, Oleg P-63 Zdaniecka, Elżbieta P-133 Zerbo, Fabio O4A-2.7 Zerbo, Marco P-82 Zhuchkova, Elena P-164 Ziemssen, Tjalf P-179 Zilinskiene, Laura P-142 Zimmerman, Robert P-102 Zimny, Anna O1A-3.2, O1A-3.5, O3B-1.7 Zrinzo, Ludvic P-36