2024-03-29T00:53:31Z
https://www.icrjournal.ir/?_action=export&rf=summon&issue=12971
Iranian Congress of Radiology
ICRJournal
2019
35
1
Standard Method For Women Pelvic Mri
Behnaz
Moradi
Magnetic resonance imaging of the pelvis is a noninvasive technique for the evaluation, assessment of severity, and follow-up of diseases of the female pelvic organs. MRI provides excellent contrast of soft tissues and provides multiplanar and 3D depiction of pathology and anatomy without exposure to ionizing radiation.
Indication Includes:
1-Evaluation of suspicious known mass/tumors for further evaluation of indeterminate or questionable findings; 2-Evaluation of known cancer for further evaluation of indeterminate or questionable findings or staging; 3-For evaluation of suspected infection or inflammatory disease; 4- Pre-operative evaluation; 5-For post-operative/procedural evaluation; 6- Endometriosis; 7- Pelvic floor imaging…
Standard MRI of the female pelvis includes coronal single-shot fast spin-echo (FSE), axial T2-weighted (T2W) FSE, axial in-phase and opposed-phase T1- weighted (T1W) gradient-recalled echo (GRE), and sagittal T2W FSE fat-suppressed sequences utilizing a dedicated pelvic phased-array coil. Fat-suppressed axial 3-dimensional T1W GRE dynamic imaging following intravenous administration of 20 mL of gadolinium contrast is obtained routinely. Delayed fat-suppressed 2-dimensional (2D) GRE imaging is subsequently obtained in another plane. If artifact from the bowel is perceived as problematic on initial sequences, glucagon may be administered by intramuscular (0.8 mg) or intravenous injection (0.2 mg). For pelvic floor imaging, dynamic 2D GRE imaging may be performed with and without the Valsalva maneuver, to detect pelvic prolapse.
Pelvic MRI
female
uterus
Ovaries
2019
03
01
1
1
Iranian Congress of Radiology
ICRJournal
2019
35
1
Endometrial Abnormalities And Role Of Imaging, Which Modality And When?
Maryam
Rahmani
Women symptoms arising from the endometrial abnormalities are common and depend on age, menstrual cycle, and history of medications such as hormone replacement and tamoxifen.
Although imaging doesn’t replace tissue diagnosis but it could predict benign and malignant conditions based on endometrial thickness, shape and several other characteristics.
The first modality of choice is transvaginal ultrasound (TVUS) and transabdominal ultrasound (TAUS) is sometimes useful. Endometrial biopsy may be used before TVUS in some cases and nowadays it is done more than D&C as first line sampling method. Magnetic resonance imaging (MRI) plays acomplementary role. Additional imaging methods include Saline Infusion hysterosonography (SIS) and new promising method, Gel Infusion hysterosonography (GIS).
2019
03
01
2
2
Iranian Congress of Radiology
ICRJournal
2019
35
1
Imaging Findings Of Endometrial And Cervical Polyps
Ladan
Younesi
Endometrial polyps are sessile masses of variable size that project into the endometrial cavity. They may be asymptomatic or symptomatic, causing abnormal bleeding if they ulcerate or undergo necrosis.
Tamoxifen therapy is a risk factor for the development of endometrial polyps; polyps develop in 8% to 36% of postmenopausal women treated with tamoxifen.
Transvaginal ultrasonography (TVUS) is the primary modality for assessing endometrial abnor-mality. Sonohysterography (saline infusion sonogram) is more accurate than ultrasound (US) alone in making a diagnosis of endometrial polyps. However, these lesions often cannot be separated from the surrounding endometrium because the whole endometrium may appear diffusely thickened. As endometrial thickening is a nonspecific US finding, it should be correlated with the patient’s age, symptoms, and hormonal status.
To make a specific diagnosis in these circumstances, endometrial cytology, biopsy, and curettage have been the mainstays of preoperative diagnosis. As these procedures are commonly performed in a blind manner, it is not always possible to make a definitive and cervix) and posterior compartment(rectum ,anal canal) for anatomical defects, tissue biomechanics and prosthetic implants dislodgement. The study performs in rest, squeeze and straining with benefit of real time access to patient.
3D & 4D US may allow dynamic assessment of anatomy in the axial plane with the advantage of tomographic images for quantification of levator defects. Us also benefits from low cost, easy availability and good access to patient.
Pelvic floor dysfunction
US (2D & 3D)
trans labial (transperineal)
2019
03
01
3
3
Iranian Congress of Radiology
ICRJournal
2019
35
1
Pelvic Floor Us
Arvin
Arian
Pelvic organ dysfunction is widespread problem in the middle age and elderly women’s that significantly decrease the quality of life especially in the later life. Trans perineal (trans perineal), 2D ultrasonography can be used for the assessment of female pelvic floor components in anterior part (Bladder, urethra), middle compartment (Uterus and cervix) and posterior compartment(rectum ,anal canal) for anatomical defects, tissue biomechanics and prosthetic implants dislodgement. The study performs in rest, squeeze and straining with benefit of real time access to patient.
3D & 4D US may allow dynamic assessment of anatomy in the axial plane with the advantage of tomographic images for quantification of levator defects. Us also benefits from low cost, easy availability and good access to patient.
Pelvic floor dysfunction
US (2D & 3D)
trans labial (transperineal)
2019
03
01
4
4
Iranian Congress of Radiology
ICRJournal
2019
35
1
Pelvic Floor Imaging (2D, 3D US AND MRI)
Arvin
Arian
Trans labial US is an easy and available modality with low cost and is recommended as the first line of imaging evaluation. US also lacks the disadvantage of limitation access to patient.
MRI with multiple sequences in static and dynamic series can play a major role in definition of multi compartment nature of most of pelvic floor disorders and potentially can provide a road map for Gynecologist for best surgical planning.
In this presentation we describe the US (2D & 3D) and MRI findings in various defects of muscular support of pelvic floor and endopelvic fascia responsible for dysfunctions in Anterior, mid and posterior compartments.
Pelvic floor disorders consist of a wide spectrum of various pathologies and account for a variety of clinical presentations. Clinical complains include urinary and fecal incontinence, chronic pelvic pain, sexual dysfunction, constipation and genital prolapsed. They make a significant impairment in quality of life and involve up to 30% of middle age women. Basically the first method of investigation is manual exam preferably POP-Q. However, it is not enough as there is a high recurrence rate after pelvic floor surgeries. In this way imaging modalities may help in more precise detection of pelvic floor dysfunction and to determine if the defect is global or confined to a specific compartment.
Pelvic floor dysfunction
US (2D & 3D) and MRI
2019
03
01
5
5
Iranian Congress of Radiology
ICRJournal
2019
35
1
Breast Mri, Role In Screening And Pre-Operative Staging
Amin
Astani
Breast MRI has a proven beneficial role in screening for breast cancer in certain population. If this population is carefully selected, the breast MRI is highly effective, economic, and decreases morbidity and mortality from breast cancer. Currently, based on the available published research, breast MRI is not recommended as a screening tool for general population and masses. Frequently, there is a misconception on the ability and role of breast MRI to the point that the essential and primary role of mammogram is ignored at a great cost and detriment to the patient. Breast MRI and mammography have an additive role and one does not substitute the other. Breast MRI can also have a productive role in pre- operative staging of breast cancer in certain clinical scenarios. Familiarity with the role of breast MRI, its limitations and published guidelines on who can benefit from screening breast MRI is essential for every radiologists and clinicians who can potentially request a breast MRI.
2019
03
01
6
6
Iranian Congress of Radiology
ICRJournal
2019
35
1
Breast Cancer In Men
Amin
Astani
Although significantly less prevalent than female, breast cancer also occurs in men. Male breast cancer is typically more aggressive, diagnosed at larger size and more advanced stage, and has a poorer prognosis than age and stage matched female breast cancers. While female breast cancer survival hasseen significant improvement over time, there is no change in male breast cancer survival. It has been suggested that molecular profile and natural history of male breast cancer is different than female breast cancer. Understanding of male breast cancer pathophysiology and familiarity with clinical presentation and imaging features of male breast cancer are essential in guiding clinicians to earlier diagnosis and potentially better prognosis of male breast cancer.
2019
03
01
7
7
Iranian Congress of Radiology
ICRJournal
2019
35
1
“What Should We Know About Lymph Nodes”
Nahid
Sadighi
Lymph nodes are involved in a wide variety of diseases, particularly in cancer. In the latter, precise nodal staging is essential to guide therapeutic options and to determine prognosis.
In patients with cancer, the demonstration or exclusion of lymph node metastases is an important component of tumor staging besides evaluation of local tumor extent and has crucial implications for the patient’s prognosis and therapeutic strategy, especially when deciding on curative versus palliative treatment.
The lymphatic drainage of the breast is of great importance in the spread of carcinoma and about three quarters of it is to the axillary nodes.
There are three surgical levels of axillary lymph nodes:
level I: below the lower edge of the pectoralis minor muscle.
level II: underneath/posterior the pectoralis minor muscle.
level III: above/medial the pectoralis minor muscle.
In many settings, the ability to detect axillary lymph nodes containing metastases with imaging and image-guided biopsy can allow surgeons to bypass sentinel lymph node dissection and proceed with full axillary lymph node dissection. However, no imaging modality currently has sufficient negative-predictive value to obviate surgical staging of the axilla if no abnormal lymph nodes are detected.
In many settings, the ability to detect axillary lymph nodes containing metastases with imaging and image-guided biopsy can allow surgeons to bypass sentinel lymph node dissection and proceed with full axillary lymph node dissection.
However, no imaging modality currently has sufficient negative-predictive value to obviate surgical staging of the axilla if no abnormal lymph nodes are detected.
Currently, the most accepted and useful modality for imaging axillary lymph nodes is ultrasonography.
Advantages of MRI over sonographic evaluation of the axilla include the ability to compare directly axillary lymph nodes in question with the contralateral axilla and decreased dependence on operator experience.
Finally, the increased availability of functional imaging, especially through the use of FDG-PET, has greatly contributed to the accuracy improvement of nodal metastases identification. The aim of this review will thus be to briefly review the anatomy and physiology of the lymphatic systems and to overview the basic principles of up-to-date lymph node imaging.
2019
03
01
8
8
Iranian Congress of Radiology
ICRJournal
2019
35
1
Mammographic Pathologic Correlation
Arvin
Arian
Nowadays the requests for percutaneous breast biopsy has significantly increased due to improvement of imaging modalities.
The radiologist has to recognize the lesions that need tissue diagnosis then offer the best way to have an efficient biopsy and then proceeding to biopsy. After that he or she should determine the concordance of radiology and pathology according to BI-RADS Lexicons. Whether the lesion needs to have short term follow up or surgical excision. It is a main responsibility of radiologist to make decision in this way.
2019
03
01
9
9
Iranian Congress of Radiology
ICRJournal
2019
35
1
Lobular Neoplasia In Breast Screen Setting Multicentre Study (St Vincent And Monash) Retrospective, Descriptive Study 23 Years (1993-2016)
Parisa
Aminzadeh
.
Stephanie Khoo
Background on Lobular neoplasms Spectrum of lesions encompassing atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS).
LN is often multifocal and bilateral.
LCIS SUBTYPES
Classic
Variant types (pleomorphic and LCIS with comedo necrosis)
SIGNIFICANCE
Marker of increased risk for invasive carcinoma.
LCIS: 8-9-fold risk of developing subsequent carcinoma
ALH:4-5-fold risk
Clinical guidance for the management of lobular
carcinoma in situ(Cancer Australia)
MDM Decision
Concordant Classic LCIS on core needle biopsy. No other higher risk abnormalities that would impact management surveillance remains an appropriate option.
Discordant LCIS on core needle biopsy: Subsequent biopsy to obtain a larger tissue sample
Other LCIS subtypes (pleomorphic or with comedo necrosis) or proliferative lesions present that require investigation, excision should be undertaken.
Problem
limited consensus recommendation for the management of lobular neoplasia in particular Classic LCIS.
Research question:
Incidence
Radiological appearance
Management
Final outcome
of screen-detected lobular neoplasia (LN)?
to help guide future management and evidence- based recommendations.
Method
Inclusion criteria: Patients with ALH and LCIS as the highest risk lesion on core biopsy were included
Search parameters using ALH and/or LCIS diagnosis on core biopsy and high-risk status LCIS patients
Exclusion criteria: Those with additional ADH, DCIS, invasive carcinoma and radial scar on core biopsy
Analysis of
Age, family history, Breast Screen round, lesion type
Imaging
Architectural distortion, mass, calcification
Size
Unilateral, Bilateral
Imaging concordance? (calcification or asymmetric density in this group)
Histopathology on excision or follow up period
Results
At both centers during 1993 -2016:
504 686 women were screened
1 913 245 screening mammograms were performed
72 patients met inclusion criteria
60 LCIS and 12 ALH on core biopsy; 16 with
LCIS – variant type
Median screening round 3.5 (range 1 - 11)
Incidence of LCIS 11.8 per 100 000 Breast Screen women
Table A at the end of abstract
2019
03
01
10
10
Iranian Congress of Radiology
ICRJournal
2019
35
1
Approach To Children Thyroid Nodules
Hashem
Sharifian
Thyroid nodules are among the most common disorders in human being. The difference in prevalence and rate of malignancy between thyroid nodules in children and adults, make it necessary to discuss this entity separately in children.
According to ATA guidelines, I discuss the age group that in them these differences are important, rate of malignancy, points for follow-up or intervention and classic approach to children’s thyroid nodule will be reviewed in the lecture.
2019
03
01
11
11
Iranian Congress of Radiology
ICRJournal
2019
35
1
Skull Base Lesion
Timothy
Beale
The lecture will cover a method of classifying skull base lesions and briefly demonstrate the clinically relevant anatomy.
A series of cases will highlight how to differentiate skull base lesions depending on site (anterior, central and posterior skull base) and subsites (jugular foramen and petrous apex).
The common pitfalls in imaging this complex region and how to avoid them will be discussed.
2019
03
01
12
12
Iranian Congress of Radiology
ICRJournal
2019
35
1
Interactive Cases: Review Of Sinonasal Disease And Tumors
Timothy
Beale
A variety of clinical cases will be presented highlighting a range of sinonasal pathology. Important review areas and the “pearls and pitfalls” for each clinical scenario will be discussed. The important features to mention in your report and how to come to an appropriate differential diagnosis will be covered.
2019
03
01
13
13
Iranian Congress of Radiology
ICRJournal
2019
35
1
Approach To Cervical Lymph Nodes
Mohammad Ali
Kazemi
Cervical lymph nodes are mentioned by their levels from one to seven. There are also some important lymph nodes out of these levels.
We are going to discuss about warning signs of lymph nodes findings as size, borders, appearance, vascularity and so on.
At the end we want to see what is the next step for each lymph node to be done?
2019
03
01
14
14
Iranian Congress of Radiology
ICRJournal
2019
35
1
Facial Nerve Anatomy And Pathology
Mahmood F.
Mafee
Learning Objectives:
Upon completion of this presentation participants
will be able to:
Understand the CT and MR imaging anatomy of facial nerve within the temporal bone and its extracranial course within the parotid gland.
Identify the role of CT and MR imaging in the clinical management of patients with facial nerve varied pathologies.
Choose the most appropriate imaging modality and protocol in the facial nerve palsy clinical scenarios.
Review a gallery of neuroimaging cases of patients with peripheral facial nerve palsy.
2019
03
01
15
15
Iranian Congress of Radiology
ICRJournal
2019
35
1
Interactive Fascinating Head & Neck Cases
Mahmood F.
Mafee
Learning Objectives:
Upon completion of this board review/presentation
participants will be able to:
Understand the concepts underlying CT and MR imaging in a systematic approach in providing an intellectual list of differential diagnosis in imaging interpretation of varied head and neck pathologies.
Explain and define the role of head and neck imaging with regard to clinical management of patients with varied head and neck lesions.
List an imaging overview with regard to differential diagnosis of head and neck pathology.
2019
03
01
16
16
Iranian Congress of Radiology
ICRJournal
2019
35
1
Optic Nerve And Globe Pathology
Mahmood F.
Mafee
Learning Objectives:
Upon completion of this presentation participants
will be able to:
Identify the role of CT and MR imagining in the clinical management of patients with optic nerve and intraocular pathology.
Review the differential diagnosis of optic nerve and ocular lesions.
Demonstrate the utility of diffusion – weighted imaging in the diagnosis of ischemic optic nerve/infarct and ocular pathology including retinoblastoma, medulloepithelioma and uveal melanoma.
2019
03
01
17
17
Iranian Congress of Radiology
ICRJournal
2019
35
1
Carotid Sheath Lesions
M.
Mohammadzadeh
Carotid space extends from carotid canal and jugular foramen at skull space down to aortic arch.
It contains internal carotid artery, internal jugular vein, cranial nerves 9-12 & sympathetic plexus. Common lesions of carotid space include mainly paraganglioma, nerve sheath tumors, lymph nodes and vascular lesions such as carotid artery aneurysm and dissection as well as jugular vein thrombosis. Different interactive cases of carotid space lesions as well as clues for differentiating them from parapharyngeal space lesions will be presented with details during the session.
2019
03
01
18
18
Iranian Congress of Radiology
ICRJournal
2019
35
1
Post Op Thyroid Ultrasonography
Leila
Aghaghazvini
Thyroid cancer most times has good prognosis and surgery is the mainstay treatment and is followed by hormone therapy.
Post op ultrasonography and isotope scan follow up duration depend on the severity and type of malignancy.
Different pattern including post thyroidectomy normal tissue, thyroid remnant, granulation tissue or recurrence can be evaluated by ultrasonography. On the other hand ultrasound can determine the different pattern of malignant or suspicious metastatic lymphadenopathy versus reactive types.
We describe the ultrasound finding in post thyroidectomy period.
2019
03
01
19
19
Iranian Congress of Radiology
ICRJournal
2019
35
1
Imaging In Cystic Neck Masses
Associate Professor of Radiology Head of the Radiology Education Program Mashhad University of Medical Sciences MR Neuro Radiology Fellowship University of Califronia, San Diego Cystic masses of neck are a frequent finding on imaging and include a wide range of congenital and acquired lesions. Although clinical history and examination may suggest the diagnosis, imaging has a critical role in confirmation of the clinical diagnosis and assess the anatomical extent of the lesion before treatment.
High-resolution ultrasound (US) is an ideal initial imaging investigation for neck masses as it shows the cystic nature in most cases and localizes the mass in relationship to the surrounding structures. Development of three-dimensional technology, color, and power Doppler applications has led to great improvement in its diagnostic utility.
This presentation would review the imaging findings of different cystic neck lesions and would Focus on the important imaging characteristics that will help to narrow the differential and in many situations, would give the definite diagnosis.
2019
03
01
20
20
Iranian Congress of Radiology
ICRJournal
2019
35
1
Inflammatory Disorders Of The Nervous System
Reza
Bakhshandehpour
Alireza
Aziz Ahari
Mohammad
Molavi
The inflammatory and infectious diseases of the nervous system are a large group of disorders caused by abnormal autoimmune response of body against specific targets in the CNS or tissue damages triggered by different types of pathogens in the brain and spine. They can present with a wide spectrum of clinical symptoms, locations, and appearance.
The purpose of this presentation is to review their imaging characteristics in a case review manner. Although there might be some typical imaging findings, most of these disorders have nonspecific and even atypical appearances and could be in differential of wide range of neurological diseases, including primary and secondary tumors. So, awareness of radiologist will have a critical role for better patients’ medical and surgical management and prevention of unwanted surgical interventions. We discuss these disorders in the adults and pediatric groups separately.
2019
03
01
21
21
Iranian Congress of Radiology
ICRJournal
2019
35
1
Cns Tumors
Ali
Hekmatnia
Mahshid
Bahrami
Hodasadat
Sharif
Helen
Nayeri
Often, the radiologist is the first physician to diagnose a probable brain tumor, and description and differential diagnosis provided have profound implication for subsequent clinical decision making, so a radiologic accurate diagnosis can be very helpful in patient management.
In 2016, the WHO released an update to its brain tumor classification system (not only based on microscopic information but also including molecular/genetic information) that included numerous significant changes. Several previously recognized brain tumor diagnoses such as oligoastrocytoma, PNET, and gliomatosis cerebri, were redefined or eliminated altogether.
Conversely multiple new entities were recognized, including diffuse leptomeningeal glioneural tumor and multinodular and vacuolating tumor of the cerebrum.
The glioma category has been significantly reorganized, with several infiltrating gliomas in children and adults now defined by genetic features for the first time.
The increased emphasis on genetic factors in brain tumor diagnosis has important implication for radiology.
According to the 2016 WHO classification of CNS
tumors, these lesions can broadly divide as following:
Diffuse astrocytic and oligodendroglial tumors
Other astrocytic tumors (pilocytic astrocytoma, subependymal giant cell astrocytoma &…)
Ependymal tumors
Other gliomas (choroid glioma of 3rd ventricle, angiocentric glioma, astroblastoma)
Choroid plexus tumors
Neuronal and mixed neuronal-glial tumors
Tumors of the pineal region
• Embryonal tumors
Tumors of cranial and paraspinal nerves
Despite the currently ongoing efforts, the medical treatment options for patients with brain tumors are limited and significant efforts are underway to find more effective and novel therapies for patients with brain tumors. The (RANO) working group is an international collaboration of neuro-oncologists, medical oncologists, radiation oncologists, neurosurgeons, neuroradiologists, and regulatory groups commissioned to develop objective and tumor-specific response criteria for various tumor subtypes.
The development of reliable response assessment criteria is necessary to avoid false conclusions regarding the efficacy of the investigated drugs (responders and non-responders).
In the first part of the session we will have a brief discussion about 2016 updates to the WHO brain tumor classification and The Response Assessment in Neuro-Oncology (RANO). In other parts we will discuss interactive case presentations about different types of CNS tumors according to new WHO classification.
2019
03
01
22
22
Iranian Congress of Radiology
ICRJournal
2019
35
1
Imaging Findings In Precocious Puberty
Leila
Bayani
Precocious puberty is defined as the development of secondary sexual characteristics before the age of 8 years in girls and less than 9 years in boys.
Precocious puberty is caused by a heterogeneous group of disorders, which ranges from idiopathic to malignant tumors.
It is divided into central (gonadotrophin-dependent) precocious puberty and peripheral (gonadotrophin- independent) precocious puberty.
In order to understand the two types of precocious puberty, basic knowledge of normal puberty pertaining to the hypothalamus-pituitary-gonadal (HPG) axis is necessary.
There are several causes of premature sexual development which can be divided into:
a) premature activation of the hypothalamic pituitary-gonadal (HPG) axis (central PP).
b) abnormal patterns of gonadotrophin secretion (premature thelarche, thelarche variant).
c) excess adrenal androgens (adrenarche, congenital adrenal hyperplasia (CAH), adrenal tumours).
d) gonadotrophin independent PP (secretion of sex steroids is independent of the HPG axis).
MRI of the brain, ultrasound of the pelvis/testes or CT of the abdomen are main modality which performed in these group of patient.
According to literature, brain MRI can show spectrum from normal to brain tumor, hydrocephalus ,inflammatory changes and etc.
Abdominal CT scan can be normal or show adrenal hyperplasia or adrenocortical carcinoma.
Although the most valuable parameter for differentiating girls with CPP is the measurement of luteinizing hormone (either the baseline value or after stimulation with gonadotropin-releasing hormone (GnRH) or GnRH analogs), it has been reported in a recent consensus statement that pelvic ultrasound imaging is considered helpful as an adjunct to GnRH stimulation in differentiating CPP from premature thelarche.This consensus statement reported cut-off valuesfor uterine length ranging from 3.4 to 4.0 cm, and between 1.0 and 3.0 cm
For ovarian volume which are going to be discussed in more detail in this lecture.
2019
03
01
23
23
Iranian Congress of Radiology
ICRJournal
2019
35
1
Imaging For Response Assessment In Lymphoma Patients
Atoosa
Adibi
CT-Based Response Assessment is main part of our regional practice for lymphoma because in most parts of our country PET/CT is unavailable (as in certain parts of the world). Guidelines are provided for assessing outcome can be categorized as follows: complete response, partial response, stable disease, or progressive disease.
For response evaluation, tumor burden is calculated at baseline by choosing up to six of the largest measurable target lesions (e.g., the largest nodes, nodal mass, or extra nodal deposits in solid organs) representing different body regions and overall disease burden and then performing follow-up evaluations.
Lymph nodes larger than 1.5 cm and extranodal lesions larger than 1.0 cm along their longest diameter are considered to be target lesions, although target nodal lesions are preferable.
The overall objective assessment is performed by measuring the target lesion area as the product of the perpendicular diameters (i.e., the diameter of the long axis multiplied by the diameter of the short axis) and then calculating the sum of the product of the perpendicular diameters of all considered target lesions.
No measurable disease includes lesions too small to be considered measurable, bony skeleton lesions, ascites, pleural and pericardial effusion, spread of lymphangitis, and leptomeningeal disease.
a partial response (PR) was defined as a 50% or greater reduction in the area based on bidimensional measurements.
Likewise, progression in lymphoma is defined as a 50% or greater in the area from nadir.
CR is defined as a complete resolution of all target lesions by CT scans with complete normalization of FDGPET uptake in all areas (Deauville score of 1–3), and bone marrow biopsy negativity (if it was positive or unknown at baseline).
If pretreatment PET scan was negative, lymph nodes that measured 15mm in the long axis should regress to <10 mm. CR is also defined as achievement of a partial remission by CT scan criteria (reduction in sum of longest diameters by CT imaging by >30%) with normalization (Deauville score 1–3) of FDG-PET activity in FDG-avid lymphoma.
There are some differences between RECIST, RECIL, and Lugano assessment which should be considered.
2019
03
01
24
24
Iranian Congress of Radiology
ICRJournal
2019
35
1
Interventional Procedures For Invasive Placenta
Amin
Astani
There is a growing incidence of invasive placenta as a result of increasing deliveries by cesarean section. Invasive placenta can cause massive life-threatening hemorrhage and is now the most common indication for emergent postpartum hysterectomy. Postpartum hemorrhage can be severe in these patients and medical management may be insufficient. Antepartum diagnosis of invasive placenta enables a planned delivery approach that may lead to significantly less blood loss than that resulting from emergent management. The interventional radiologist plays a major role in prevention of major hemorrhage due to invasive placenta. A number of interventional procedures are available for these placentae including balloon inflation technique, planned uterine artery embolization, hybrid techniques and emergency postpartum UAE.
2019
03
01
25
25
Iranian Congress of Radiology
ICRJournal
2019
35
1
Pelvic Congestion Syndrome And Uterine Avf
Amin
Astani
Pelvic congestion syndrome is varicosities of the veins inside the female pelvis causing chronic dull and aching pain and is analogous to varicocele in men. This syndrome is not rare and is estimated to account for 15% of outpatient gynecologic visits and 30% of diagnostic laparoscopic exams. Yet, it is consistently underdiagnosed and under treated. Many clinicians are not familiar with this syndrome or are uncomfortable in rendering the diagnosis. Therefore, many women with this treatable condition are left with decades of draining pelvic pain. There are effective treatment options and interventional radiology procedures for pelvic congestion syndrome. Familiarity with this syndrome, comfort in making the diagnosis, and awareness of the treatment options are essential for any clinician for interacts with chronic pelvic pain.
2019
03
01
26
26
Iranian Congress of Radiology
ICRJournal
2019
35
1
Placenta Accreta (Challenges And Pitfalls).
Amin
Astani
Leila
Bayani
There are three commonly recognized types abnormal adhered placenta defined by the depth of penetration of the placental villi into the myometrium.
The placenta accreta spectrum disorders include both abnormally adherent (accreta) and invasive placenta (increta and percreta).
Placenta accreta spectrum disorders prevent normal separation of the placenta at delivery, resulting in a high risk of severe post-partum hemorrhage.
Abnormally invasive placenta (increta and percreta) is a life-threatening condition, and a major cause of caesarean-hysterectomy and maternal morbidity and mortality.
The prevalence in the general population of pregnant women is around 1.7 per 10,000 pregnancies.
The incidence of PAS is 4.1% in women with one prior cesarean delivery and 13.3% in women with two or more previous caesarean deliveries.
Prenatal diagnosis of PAS is vital as it facilitates appropriate referral to a team experienced in the complexities such deliveries present and has been shown to reduce maternal morbidity.
In the FIGO consensus guidelines, there is a clinical grading system to categorize placental adherence at delivery,but the main criteria for diagnosis are sonographic signs.
Prenatal ultrasound diagnosis is based on a number of different signs. Standardized descriptions of these signs were proposed by the European Working Group on Abnormally Invasive Placenta (EW-AIP) which is going to explain with detail in the lecture.
There are two sub groups , 2D Grey-scale and Color Doppler imaging.
Magnetic Resonance Imaging is widely used to assist with the prenatal diagnosis of PAS, although the accuracy of MRI isn’t much more better than high resolution accurate sonography ;however, MRI is especially useful where evaluation of uteroplacental interface is difficult, for example when there is a posterior placenta.
Management depends both on the type of PAS and the standard practices of the specialist centre. Delivery is generally by planned caesarean section at around 34-36 weeks’ gestation, in order to avoid emergency delivery.
The two most common management strategies are caesarean-hysterectomy and leaving the placenta in situ (conservative management)
2019
03
01
27
27
Iranian Congress of Radiology
ICRJournal
2019
35
1
Functional Assessment Of Fetal Heart
Behnaz
Moradi
Evaluation of fetal cardiac function is one of the most important components of fetal echocardiography. Cardiac function might provide importantinformation on fetal hemodynamic adaptation or deterioration. A variety of functional tests can be used, but there is no single clinical standard. To maintainnormal cardiac function, both systolic and diastolic processes must be preserved and time events must occur in a synchronized manner. Ventricular inflow characteristics; the duration of the left ventricular IR time; and the systemic and pulmonary venous Doppler flow patterns are used for evaluation of diastolic function. An abnormal shortening fraction or decreased cardiac output are usually indicative of myocardial compromise and systolic dysfunction. Myocardial Performance Index (MPI) is a widely used ratio to describe the systolic and diastolic function of the heart in echocardiography.
Fetal cardiac dysfunction may be due to an intrinsic myocardial disease or to a secondary adaptive mechanism. Detailed functional assessment should be performed if cardiac function appears impaired.
Cardiac function. Echocardiography. Fetus
2019
03
01
28
28
Iranian Congress of Radiology
ICRJournal
2019
35
1
First Trimester Thick Nuchal Translucency: Causes And Management
Mohammad
Zare Mehrjardi
Currently, a fetus with thick nuchal translucency (NT) on ultrasound screening is referred for genetic counselling and invasive diagnostic testing, because an increased NT thickness is strongly associated with aneuploidies particularly trisomy 21. However, presence of thick NT with normal karyotyping is not uncommon and causes a major challenge both for the clinician and the parents. There is a wide spectrum of conditions that may lead to a thick NT with normal karyotype such as genetic syndromes and congenital heart defects. Also, it can be associated with an increased risk of intrauterine fetal demise. In this lecture, current knowledge related to this topic and a stepwise approach in case of thick NT detection on sonography would be presented.
2019
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Fetal Venous System Evaluation
Reza
Gerami
The most important Fetal veins are, Umbelical vein, ductus venusus.
The main blood flow of Umbelical vein_relative sixty-five percent _is toward to portal vein and 35% direct to dactus venusus that contains well oxygenated blood.This DV blood is direct to IVC with liver bypass then
enter to RA،fossa ovals and LA and LV and AORTA and shifted to head and neck and upper limbs. Concept of ductus venusus circulation and its Doppler pattern is very important to understand of fetal heart physiology.
Venus anomalies of fetus have some sign in ante natal sono/echo such as:
Persistent left svc
Dilated coronary sinus
Thoracic Venus collector
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Fetal Hypoxic- Ischemic Injuries
Behnaz
Moradi
Hypoxicischemic injury (HII), which is also known as hypoxic-ischemic encephalopathy, refers to the subset of neonatal encephalopathy that results from a hypoxic or ischemic event.
Fetal hypoxic stress that may eventually be sufficient to cause fetal brain damage as a result of prolonged partial hypoxic ischemia. In some cases, it is difficult to classify the lesion since we see the end effect: cavitation.
It is not so easy to differentiate between effect of genetic or environment. Following the diagnosis of a clastic/ cavitary congenital lesion, detailed investigation of a possible pregnancy related event like: Prothrombotic factors, genetic mutation in the mother and child is recommended.Frequently these lesions are not diagnosed in utero
due to late occurrence. Ultrasonography is the first modality but MRI is more accurate. Intraventricular hemorrhage (IVH) is the most common of all. Other types of fetal brain damage include: porencephaly, multicystic encephalopathy, periventricular leukomalacia schizencephaly…
hypoxic- ischemic injuries. MRI. Fetus
2019
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Mild Fetal Ventriculomegaly: Diagnosis,Evaluation, And Management
Ladan
Younesi
Ventriculomegaly is defined as dilation of the fetal cerebral ventricles and is a relatively common finding on prenatal ultrasound. The purpose of this lecture is to review the diagnosis, evaluation, and management of mild fetal ventriculomegaly.When enlargement of the lateral ventricles (≥10 mm) is identified, a thorough evaluation should be performed, including detailed sonographic evaluation of fetal anatomy, amniocentesis for karyotype and chromosomal microarray analysis, and a workup for fetal infection.
In some cases, fetal magnetic resonance imaging may identify other central nervous system abnormalities and should be considered when this technology as well as expert interpretation is available.
Follow-up ultrasound examination should be performed to assess for progression of the ventricular dilation. In the setting of isolated ventriculomegaly of 10-12 mm, the likelihood of survival with normal neurodevelopment is >90%. With moderate ventriculomegaly (13-15 mm), the likelihood of normal neurodevelopment is 75-93%. The following are Society for Maternal- Fetal Medicine recommendations: We suggest that ventriculomegaly be characterized as mild (10-12 mm), moderate (13-15 mm), or severe (>15 mm) for the purposes of patient counseling, given that the chance of an adverse outcome and potential for other abnormalities are higher when the ventriclesmeasure 13-15 mm vs 10-12 mm (GRADE 2B); we recommend that diagnostic testing (amniocentesis) with chromosomal microarray analysis should be offered when ventriculomegaly is detected (GRADE 1B); we recommend testing for cytomegalovirus and toxoplasmosis when ventriculomegaly is detected, regardless of known exposure or symptoms (GRADE 1B); we suggest that magnetic resonance imaging be considered in cases of mild or moderate fetal ventriculomegaly when this modality and expert radiologic interpretation are available; magnetic resonance imaging is likely to be of less value if the patient has had a detailed ultrasound performed by an individual with specific experience and expertise in sonographic imaging of the fetal brain (GRADE 2B); we recommend that timing and mode of delivery be based on standard obstetric indications (GRADE 1C); we recommend that with isolated mild ventriculomegaly of 10-12 mm, after a complete evaluation, women be counseled that the outcome is favorable, and the infant is likely to be normal (GRADE 1B); we recommend that with isolated moderate ventriculomegaly of 13-15 mm, after a complete evaluation, women be counseled that the outcome is likely to be favorable but that there is an increased risk of neurodevelopmental disabilities (GRADE 1B).
Dilated cerebral ventricles
Fetal brain
Fetal magnetic resonance imaging
Hydrocephalus
Ventriculomegaly
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Retained Products Of Conception
Masoumeh
Raoufi
Retained products of conception (RPOC) are a common and treatable complication after delivery or termination of pregnancy.
The pathologic diagnosis of RPOC is made based on the presence of chorionic villi, which indicates persistent placental or trophoblastic tissue. In the setting of postpartum hemorrhage, however, distinguishing RPOC from bleeding related to normalpostpartum lochia or uterine atony is important. Ultrasonography is first line study in these patients. A thickened endometrium or a discrete mass in the uterine cavity is a helpful finding that suggests RPOC however detection of vascularity in a thickened endometrium or an endometrial mass at color or power Doppler US increases the positive predictive value for the diagnosis of RPOC. Diagnostic pitfalls may include highly vascular RPOC, which can be mistaken for a uterine arteriovenous malformation; true arteriovenous malformations of the uterus; invasive moles; blood clot; and subinvolution of the placental implantation site. In this lecture we explain role of different imaging modalities especially ultrasound in diagnosis, ruling out differential diagnosis and also diagnostic pitfalls.
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Placental Hypoechoic Zones
Atoosa
Adibi
Placental function is essential for fetal growth and wellbeing.
Although uncommon, abnormalities of the placenta are important to recognize owing to the potential for maternal and fetal morbidity and mortality.
Sonography is the imaging modality of choice for placental evaluation.
On the other hand, by increasing placental age, this structure becomes nonhomogeneous by itself.
There are some pathological conditions which cause placental heterogeneity and produce some hypoechoic zones in placenta. Placental Lakes, Sub chorionic Fibrin Deposition, and placental Infarcts are examples of hypoechoic zones in placenta becoming obvious with placental maturity.
The role of radiologist is to define pathological conditions from physiologic ones.
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Avascular Necrosis Or Osteonecrosis
Leila
Aghaghazvini
Describes an ischemic death of the some areas of bones and is associated with different factors and can affect any bone.
Infarction begins when the circulation is interrupted to any part of bone and in any stages can be seen with variety of radiologic presentation.
MRI and nuclear medicine are the best modalities and MRI can be considered as the first modality for diagnosis.
We describe different staging radiologic pattern of AVN with focus on MRI presentation.
2019
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How To Report Knee Mri And Review Of Different Cases
Leila
Aghaghazvini
Knee has a complex anatomy and different pathologies such as tumors, arthritis, trauma and etc, can involve the knee.
Trauma with different mechanism is the most common problem and can lead to probable ligamentous, menisci or. tendon injuries
In this workshop and lecture we plan to introduce normal anatomy in knee and present some cases of knee MRI indicative different pathologies.
2019
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Ultrasound Guided Wire Localization Of Anal Tract In Imperforate Anus Patients
Seyed Ali
Alamdaran
.
Rashed
Masoud
Mahdavi
Samira
Jafari
Marjan
Joodi
Objectives:
The exact anus reconstruction is critical in patients with imperforated anus. It is related to the correct diagnosis of sphincter complex. The aim of this study was accurate investigation of the perineal region for ultrasound detection of the location and pathway of sphincter muscle complex and the efficacy of the ultrasound-guided wire localization of the anal tract and sphincter muscle complex in the patients with imperforate anus.
Methods:
This study was conducted on 34 patients with imperforate anus referring to the Doctor Sheikh and Akbar Pediatric Hospitals, Mashhad, Iran, between2016 and 2018. The trans-perineal ultrasonography was performed under general anesthesia to identify the location and direction of the anal tract, which was checked by a muscle stimulator. Then, the localization needle was inserted in the center of two multi-layer structure in surface
and depth of perineal area until it reached the rectal pouch. Eventually, by using the wire as a guide, the rectum was brought to the middle of the sphincter complex through the minimally invasive pull- through procedure.
Results:
The deep concentric hypoechoic structure (probably levator ani muscle) could be seen in all patients with the thickness of 1.8 – 5.8 mm and occasionally asymmetric. The superficial multi-layerview structure (the anal pit probably contains of subcutaneous and superficial external muscle complex and parasagittal fibers) is visualized in all patients. These two had a curved and occasionally parasagittal pathway. The shortest distance between the rectal pouch and skin was 8 to 20 mm, but the distance between the rectal pouch and skin via the muscle sphincter path was longer (11 to 23 mm). Muscle stimulator findings showed that the wire was located in the middle of the sphincter muscle complex in all patients. Mean localization time was 38 min.
Conclusions:
in imperforate anus patients, two anatomic- sonographic structure as multi-layer view in surface and depth of perineal area were seen that adapted with anal pit (subcutaneous and superficial external muscle sphincter) and the levator ani muscle. These two important sonographic findings can act as an indicator for the location of this procedure. The ultra sound-guided wire localization of the anal tract facilitated the implementation of a less invasive and anatomically corrected rectal pull-through operation in patients with imperforate anus.
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Myocarditis
Sanaz
Asadian
In a cohort of healthy subjects undergoing smallpox vaccination, new-onset chest pain, dyspnoea, or palpitations occurred in 10.6% of the cases, as compared to 2.6% in subjects undergoing another vaccination. Importantly, an active survey of these subjects, including high-sensitive troponin testing, revealed that myocarditis was 60 times more frequent than clinically suspected.
Aside from clinically mild cases, myocarditis can present with symptoms and findings of acute heart failure or MI. In patients with MI and non-obstructed coronary arteries (MINOCA), myocarditis occurred in 33% of cases and was the single most frequent underlying cause for MINOCA.
Myocarditis can result in myocardial scars, which themselves may introduce a risk for cardiovascular events. In a recent study, myocardial scarring consistent with myocarditis was found in 25% of survivors of sudden cardiac death, and the presence and extent of such scars predicted outcome . However, in the setting of subepicardial LV scar, a differential diagnosis of other conditions, including hereditary forms of cardiomyopathy, needs to be considered. Neither the clinical presentation nor findings obtained by standard techniques, such as ECG or echocardiography, are specific for non-ischaemic myocardial inflammation, and thus CMR plays an important role in patients with suspected myocarditis. In turn, myocarditis is one of the most frequent indications for CMR scans.
Since the introduction of non-invasive in vivo tissue characterization by CMR, the awareness and understanding of clinicians of the impact of myocardial
involvement in systemic diseases have increased significantly. CMR is indicated in patients with symptoms and findings suggestive of myocardial injury of unknown aetiology. In patients with heart failure, it may act as a gatekeeper for the need of endomyocardial biopsy (EMB). Diagnostic targets of CMR in patients with suspected myocardial inflammation are myocardial oedema, inflammation-induced hyperaemia, and myocardial scarring in a non-ischaemic regional distribution pattern, and a standard protocol, known as the Lake Louise criteria, has been proposed.
Imaging in Myocarditis
Given the invasive nature of EMBs, non-invasive methods to assess for myocarditis play an essential role in the diagnosis of suspected myocarditis, although EMB remains the gold standard to achieve the aetiopathogenetic diagnosis. As stated in the recommendations of the ESC, CMR may be considered in clinically stable patients. However, CMR cannot differentiate between virus persistence and autoimmune inflammation and thus cannot replace EMB for certain therapeutic decision- making. In cases with acute heart failure or other life-threatening presentations, EMB should not be delayed by any other diagnostic procedure . Echocardiography remains an essential, and often the first-line, imaging modality to assess suspected cases; however, it suffers from a lack of sensitivity to identify myocarditis in cases without overt LV dysfunction , with a low specificity in distinguishing acute from chronic, as well as non-ischaemic from ischaemic forms of, cardiac disease. In the past, nuclear medicine imaging with 67-gallium and 111-indium has been described as a useful technique to identify acute myocarditis, but it is rarely used in contemporary clinical practice. FDG-PET has been compared to CMR with good diagnostic agreement but suffers from radiation exposure, limited availability, and relative poor spatial resolution. CMR, with its superior capabilities in myocardial tissue characterization, compared to other cardiac imaging modalities, in addition to excellent functional and morphological visualization, plays an eminent role in the non-invasive diagnosis of myocarditis. Suspected myocarditis is a top indication (>30% when including cardiomyopathies) for CMR . Tissue abnormalities related to inflammation, such as oedema, hyperaemia
and capillary leak, and myocyte necrosis, can be detected by CMR using T2-weighted imaging, EGE, and LGE, respectively. In addition, CMR can detect associated pericardial effusions and ventricular dysfunction as supportive information, and follow LV mass regression over time with the resolution of oedema. The Lake Louise Consensus Criteria (2009) recommends using a combination of any two out of the three tissue characterization techniques to increase the confidence in detecting acute myocarditis. Novel techniques, such as T1-mapping, ECV mapping, and T2-mapping, are emerging as promising methods to evaluate myocarditis.
The Lake Louise Criteria
Include T2-weighted, EGE, and LGE imaging. Cine imaging using SSFP sequences should also be performed for functional analysis and identification of any associated pericardial effusion. Most of the sequences used are well established in MR systems and standardized in recent recommendations, from image acquisition to final reporting.
T2-weighted Imaging
T2-weighted imaging is typically acquired using black blood spin echo techniques with flow and fat suppression. Body coils or surface coils with signal intensity correction algorithms should be used to minimize hardware-derived signal inhomogeneity. Maximizing LV coverage will increase the diagnostic yield, and at least three short-axis slices should be obtained, with careful adjustments for heart rate variability which might hamper correct interpretation of signal intensities. Findings suspicious of focal oedema should be confirmed in at least one orthogonal plane.
Pre- and Post-contrast EGE Imaging
Pre- and post-contrast EGE imaging is obtained using T1-weighted, free-breathing black blood fast spin echo sequences in short-axis or axial views (the latter with more robust image quality). As for dark blood T2-weighted images, body coils are preferable. Spatial saturation bands over the atria and using four averages will improve the SNR. Post-contrast images should be acquired within the first minute after gadolinium injection (0.1 mmol/kg) at the same slice positions and using the same parameter prescriptions
as for the pre-contrast images.
Currently, these two components of the Lake Louise Criteria are not employed by all centres for a number of reasons, including the local ability to implement the methods, availability of expertise, and inconsistent image quality of T2-weighted and EGE images.
LGE Imaging
LGE imaging should be obtained using an inversion recovery GRE sequence, about 10 minutes after gadolinium administration (0.1 mmol/kg). As for all LGE imaging, optimization of the inversion time for myocardial nulling is essential. To increase the sensitivity for detecting disease, acquisition of a full short-axis stack, as well as long-axis views, should be performed. Findings of focal injury should be confirmed in at least one orthogonal plane.
Reporting of the results for assessment of myocarditis should include the description of the presence or absence of the assessed criteria.
Future Developments
The diagnosis of myocarditis using CMR requires multiple CMR techniques that provide overlapping, as well as complementary, information to increase diagnostic confidence.
The true gold standard of myocarditis for the validation of CMR imaging techniques is whole- heart histopathology for direct comparison to imaging findings, although this type of data is difficult to obtain for in vivo human subjects. EMB is problematic as a gold standard for validation of CMR diagnostic performance due to its sampling error and inability to rule out small areas of focal myocarditis, although it may have a role in selected clinical settings for therapeutic decision-making. The availability of imaging (echo, CMR, electrovoltage mapping)- guided EMB can increase its diagnostic sensitivity. Novel mapping methods are now available to add to the repertoire of tissue characterization techniques that are sensitive to various pathophysiologic changes that occur in myocarditis. In the future, it may be feasible to prescribe simplified and gadolinium-free CMR protocols, which can shorten scan times and obviate the need for contrast agent administration. As further evidence and experience accumulate, revised CMR imaging protocols are expected to increase the confidence and efficiency in the non-invasive diagnosis of myocarditis.
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Clinical Indication In Coronary Ct Angiography
Maryam
Farghadani
Meri
Sirous
Background:
Imaging of the coronary arteries requires high temporal and spatial resolution. Invasive, catheter-based coronary angiography is the clinical standard tool for assessment of the coronary arteries, but it has several shortcomings: First of all, it is an invasive procedure and, as such, is associated with a certain morbidity and mortality, which in most cases is a consequence of the required arterial access. 1 Secondly, some limitations are due to its projectional nature, finally, cardiac catheterization requires elaborate equipment that is not available at every hospital or outpatient setting, dedicated and well-trained staff is necessary, and associated costs are high. Computed tomographic (CT) technology has progressed rapidly over the past several years. Both spatial and temporal resolution have steadily been improved, and the introduction of 64-slice and higher-slice CT has made coronary CT angiography (CTA) a relatively robust and stable tool for coronary artery visualization
Objectives:
In this presentation, clinical applications, the advantages and disadvantages of CTAwill be weighed against those of invasive coronary angiography.
Conclusion:
Coronary CTA has numerous clinical applications. Its most prominent role is in the assessment of patients with possible coronary artery stenosis, but a relatively low likelihood of disease, with the aim to rule out coronary stenosis and avoid the need for an invasive coronary angiogram. This includes patients with various clinical scenarios, such as atypical symptoms, unclear electrocardiographic changes or stress test results, patients with new onset of heart failure, and patients before non coronary cardiac surgery. Assessment of coronary anomalies is another strong indication, but much less frequent. Other applications of CT are to provide peri-interventional information, to detect in- stent restenosis, or to provide risk stratification.
Coronary CT angiography
clinical indication
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Pancreatic Adenocarcinoma: Part 1. Preop Staging, Assessment For Respectability Part 2. Treatment Response
Amir H.
Davarpanah
Pancreatic ductal adenocarcinoma (PDA) is the second most common gastrointestinal malignancy and the fourth leading cause of all cancer-related deaths in the US. It is a highly aggressive tumor that continues to carry a high mortality rate continues to carry a poor prognosis. This can be attributed to the lack of early detection and the aggressive disease biology and early systemic spread of disease. Surgical resection remains the only curative option; however, at the time of diagnosis only minority of the patients are deemed resectable. With limited improvements in the treatment of advanced PDA, the main hope for improved patient survival and potential cure lies in early detection of the disease when complete surgical resection is feasible. Any patients with PDA evaluated by a pancreatic surgeon may require a high-risk surgical procedure that offers the only chance of cure. Accurate staging of PDA (identifying anatomic relationship of the tumor and critical vessels as well as extrapancreatic disease) carries substantial implications for appropriate recommendation of the most suitable treatment option, thus maximizing the survival benefit for patients in whom complete resection can be achieved and minimizing the morbidity from unnecessary laparotomy or major surgery in patients with high risk of residual disease following resection. In this two-part talk, we will discuss pretreatment imaging evaluation of patients with PDA and respectability criteria. We will also discuss role of radiologist for tumor restaging after neoadjuvant therapy.
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