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Abdomen-Informal Scientific Presentation

Presenting Final Abstract Presenting Page No. No.

TitleAuthor No.

ISP 02_AB 01 SE 01 AB-03Chronic pancreatitis with extraperitoneal fluid Mohamad Syafeeq

383collection primarily presenting as ascites Faeez Md Noh

ISP 02_AB 02 SE 01 AB-27Pancreatic solid pseudopapillary tumor:

Seung hyun Lee 383Gd-EOB-DTPA-enhanced MRI with DWI

Evaluation of Pancreatic injury: Correlation of ISP 02_AB 03 SE 01 AB-60 radiological pancreatic injury scale and Jeong Hyun No 383

clinical findings

ISP 03_AB 01 SE 01 AB-08Various Fibrotic diseases of the abdomen :

Jung-Hee Yoon 384beyond retroperitoneal fibrosis

ISP 03_AB 02 SE 01 AB-22 CT findings of Appendiceal diseases Mi-Sook Lee 384

ISP 03_AB 03 SE 01 AB-44Imaging findings of variable Fistulas in digestive

Na rae Kim 385system: a pictorial review

Beyond diverticulitis: Severe complications of

ISP 03_AB 04 SE 01 AB-43diverticular diseases from esophagus to colon

Seong hun Oh 385which need urgent interventional and surgical treatment

Hepatic Mass Beyond HCC : Imaging and ISP 04_AB 01 SE 01 AB-25 Histopathological Correlation of Non-epithelial Seung Jin Kim 385

Hepatic Tumors

Analysis for Abnormalities of the portal ISP 04_AB 02 SE 01 AB-18 venous system on biphasic contrast enhanced Jeong Ah Hwang 386

computed tomography

ISP 04_AB 03 SE 01 AB-23 Some weird hypervascular hepatic masses Sehoon Park 386

CT findings of hepatic abscess: predicting the ISP 05_AB 01 SE 01 AB-31 outcome of percutaneous catheter drainage or Sooncheol Baek 387

aspirationk

The Difference of PET/CT uptake betweenISP 05_AB 02 SE 01 AB-40 typical and atypical Hepatocellular Carcinoma Jae Chun Park 387

in dynamic CT finding

ISP 05_AB 03 SE 01 AB-57Point shear wave elastographyfor assessing

Jae Woo Park 387liver fibrosis using in chronic viral hepatitis

Clinical challenges and images of incidental splenic ISP 05_OT 03 SE 01 AB-13 masses: How much do you know regarding splenic Jun Hyung Hong 388

tumors and mimickers?

Comparison of three motion resistant MR imaging ISP 05_OT 04 SE 01 AB-37 sequences for gadoxetic acid(Gd-EOB-DTPA) Doo Ri Kim 388

enhanced MR imaging of the liver

Abdomen-Informal Scientific Presentation09:40-09:55 B2 Hall

Chairperson(s)Jong Young Oh Dong-A University, College of

Medicine, Korea

ISP 02_AB 01 09:40Chronic pancreatitis with extraperitoneal fluidcollection primarily presenting as ascitesMohamad Syafeeq Faeez Md Noh, Anna Misyail Abdul Rashid, Suraini Mohamad Saini,Norafida Bahari, Mohd Hazeman Zakaria, Idris Ibrahim Universiti Putra Malaysia, Malaysia. syafeeq_faeez@yahoo.com

INTRODUCTION: Chronic pancreatitis causes perma-nent changes with functional impairment of the pancreas.Clinical manifestations are chronic abdominal pain andpancreatic dysfunction. The most common complicationis pseudocyst formation. Rarely, it causes pancreaticascites or pleural effusion. We report a case of a manwho initially presented as alcoholic chronic liver disease(CLD) and ascites but later found having chronic pancre-atitis and fluid in the extraperitoneum.CASE PRESENTATION: A 30-year-old male was admit-ted to our medical ward with recurrent abdominal disten-sion. He had multiple admissions for therapeutic anddiagnostic peritoneal tapping, but culture and cytologycame back negative. He was initially treated as alcoholicCLD (Child-Pugh B). Despite having recurrent admissionsand treated as decompensated alcoholic CLD with spon-taneous bacterial peritonitis, his peritoneal fluid cultureswere negative and medical therapy for CLD failed toimprove symptoms. We proceeded with computedtomography abdomen and showed a large collection offluid in the extraperitoneum with mild ascites. Mildhepatomegaly with smooth liver surface. A hypodenselesion seen at the pancreatic body. Consequently, weproceeded with an ultrasound guided pigtail insertion.Extraperitoneal fluid drained was sent for analysis andbiochemistry came back with high amylase level of 9043U/L and total protein of 1.2 g/dL. As fluid amylase level >1000 U/L fulfills the criteria for chronic pancreatitis, hewas managed conservatively. Continuous fluid drainagewas successfully done. Patient improved gradually.CONCLUSION: One of the complications that can occurin alcoholic patients with chronic pancreatitis is pancreaticascites. This may also result from acute pancreatitis orpancreatic trauma. Patients may have abdominal pain,and abdominal distension with constitutional symptoms.Severe pain is rare. In our case, patient presented withrecurrent abdominal distension with background of alco-holic CLD and was noted to have chronic pancreatitiswith extraperitoneal fluid collection. This is rare, but suc-cessfully treated by drainage and conservative manage-ment.

ISP 02_AB 02 09:45Pancreatic solid pseudopapillary tumor: Gd-EOB-DTPA-enhanced MRI with DWI Seung hyun Lee, Suk Kim, Namkyung Lee, Gajin Han Pusan National University Hospital, Korea. leenk77@hanmail.net

PURPOSE: Generally, a pancreatic mass with solid andcystic nature in a young female should raise suspicion forsolid pseudopapillary tumor (SPT). These imaging fea-tures sometimes overlap with neuroendocrine tumor(NET). The purpose of our study was to determine imag-ing features that distinguish SPT from NET on Gd-EOB-DTPA-enhanced MRI with DWI.METHOD AND MATERIALS: From January 2009 toDecember 2014, eight patients with SPT and 19 patientswith NET were retrospectively enrolled, who had under-gone Gd-EOB-DTPA-enhanced MRI with DWI. Sex, loca-tion, morphologic features of the tumor (shape, margin,the presence of hemorrhage, capsule, cystic portion, orcalcification), signal intensities of the tumors on T1-weighted image and T2-weighted image, enhancementpattern, the presence of pancreatic duct dilatation, andthe presence of metastases were qualitatively analyzedby Fisher’s exact test. Age, size and mean ADC values ofthe tumor were quantitatively analyzed by Mann-WhitneyU test.RESULTS: The distinct MRI features of SPT comparedwith NET were as follows: larger size (5.5 cm vs. 2.5 cm,p = 0.005), well-defined (87.5% vs. 42.1%, p = 0.043),capsule (75% vs. 26.3%, p = 0.033), calcification (75%vs. 0%, p < 0.001) and hemorrhage (50% vs. 0%, p =0.004). All SPTs showed no arterial enhancement withprogressively delayed enhancement (p < 0.001). ADCvalues of SPT (0.89 ± 0.28 ×10-3 mm2/sec) were statisti-cally lower than those of NET (1.25 ± 0.25 ×10-3

mm2/sec) (p = 0.022). Other parameters were not helpfulin distinguishing between the two diseases.CONCLUSION: A well-defined pancreatic mass with cap-sule, calcification, hemorrhage, hypovascularity on thearterial phase, and lower ADC values favor diagnosis ofSPT on Gd-EOB-DTPA-enhanced MRI with DWI.

ISP 02_AB 03 09:50Evaluation of pancreatic injury: correlation ofradiological pancreatic injury scale and clinicalfindingsJeong Hyun No, Hee Jeong Kim, Mihyun Park,Keum Nahn Jee Dankook University Hospital, Korea. jkn1303@dreamwiz.com

PURPOSE: To evaluate the correlation of radiologicalscale of pancreatic injury on MDCT and clinical findingsretrospectivelyMATERIALS AND METHODS: 23 patients (M:F = 12:11;mean age, 36.3 year) diagnosed as traumatic pancreaticinjury, were included from January 2010 to February2015. Their radiological findings were assessed about thegrade of pancreatic injury and coexisting other abdominalinjury by AAST and associated injury of other body partsby consensus of two radiologists. Medical records were

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reviewed about type of injury, initial vital sign, elapsedtime after trauma, prognosis including survival and treat-ment methods. Correlation between radiological scale ofpancreatic injury and clinical severity considering variousfindings were evaluated.RESULTS: Pancreatic injury scale from I to V included12, 2, 5, 2, and 5 patients respectively. 21 patient (91.3%)of coexisting other multi-organ injuries include 4 patientsof duodenal injury, 2 of other bowel injury, 8 of hepaticinjury, 10 of renal injury, 5 of splenic injury, 6 of adrenalinjury and 4 of vascular injury of active bleeding fromhepatic or mesenteric vessels, and their injury gradeswere variously distributed. Coexisting other body partsinjury included 3 with thoracic injury and 1 with braininjury. Coexisting organ injury or grade of combinedorgan injury was not correlated with the pancreatic injurygrade. Injury types were various; 15 (65.2%) were driverof traffic accident, 2 of out-car trauma, 5 of blunt traumaand 1 of fall down. 3 patients, among 5 patients withunstable vital sign at the time of admission, died; one hadvascular injury of SMA and SMV with pancreatic injurygrade V and 2 did coexisting multiple intraabdominal andother body part injuries with pancreatic injury grade I.9 patients of equal or higher scale of pancreatic injurygrade III had various types of surgery (splenectomy, distalpancreatectomy, small bowel repair, bleeding control)and procedure of arterial embolization in two and endo-scopic pancreatic intervention in four patients.CONCLUSION: Patients with traumatic pancreatic injuryusually have coexisting other organ injuries, without cor-relation of grade of pancreatic injury and severity of otherorgan injury. Patient with equal or higher than grade IIIpancreatic injury have more critical clinical treatment.Patients with initial unstable vital sign have higher mortali-ty rate regardless of their pancreatic injury grade.

Abdomen-Informal Scientific Presentation11:10-11:30 B2 Hall

Chairperson(s)Kil Sun Park Chungbuk National University Hospital,

Korea

ISP 03_AB 01 11:10Various fibrotic diseases of the abdomen:beyond retroperitoneal fibrosisJung-Hee Yoon, Yedaun Lee, Seung-Ho Kim, Ji-Hwa Ryu, Hong-Dae Kim Inje University Haeundae Paik Hospital, Korea. radyjh@hanmail.net

LEARNING OBJECTIVES: 1. To review the diagnosticapproach and imaging features of various fibrotic dis-eases in the abdomen. 2. To be aware of malignantprocess presenting with a fibrotic appearances. 3. To bedifferentiate of these conditions with malignant diseasesand the need for histopathological correlation for definitivediagnosis.BACKGROUND: Fibrotic diseases of the abdomen arerelatively rare, poorly understood and involve multipleorgan systems. Imaging differentiation of these conditions

is difficult due to considerable overlap in their radiologicfindings. We would like to review idiopathic and iatrogenicfibrotic conditions and present various imaging findings.We will present images of malignant and infective/inflam-matory conditions with similar imaging appearances tofibrotic diseases that should not be mistaken. However,certain conditions such as autoimmune pancreatitis andsclerosing peritonitis may have unique imaging featuresthat can help the radiologist make the diagnosis. IMAGING FINDINGS: Reviews of imaging on US, CTand MR imaging of various chronic fibrotic disease enti-ties. The contents of this exhibit are idiopathic immunemediated fibrosis: retroperitoneal fibrosis, autoimmunepancreatitis, inflammatory pseudotumor, sclerosingmesenteritis, primary sclerosing cholangitis, fibromatoses(desmoid tumor), iatrogenic fibrosis: sclerosing peritonitis,and mimickers. We will present images of the followingmalignancies that must not be dismissed as benignfibrosing conditions: primary peritoneal malignancy(mesothelioma), peritoneal metastases, peritoneal lym-phoma, mesenteric GIST, mesenteric lymphoma, mesen-teric leiomyoma), mucinous tumor related pseudomyxo-ma peritonei. We will present images of the followingbenign conditions with similar imaging appearances tofibrotic conditions: inflammatory bowel disease (Crohn’sdisease), Tuberculosis, radiation enteritis, and sarcoido-sis.CONCLUSION: The radiologist should be able to recog-nize benign fibrotic diseases of the abdomen, but beaware of malignant, inflammatory, infectious processespresenting with a similar appearance and appreciate theneed for histopathological correlation for definitive diagno-sis.

ISP 03_AB 02 11:15CT findings of appendiceal diseasesMi-Sook Lee, Hee-Jun Kim, Gyeong-Gyun Na,Myung-Jin Seol Presbyterian Medical Center, Korea. ms0928l@yahoo.com

PURPOSE: To display the CT findings of many kinds ofdiseases involving appendix.CONTENTS: We reviewed many kinds of CT findings ofappendiceal diseases confirmed by operation as below: 1. Appendiceal cancer with peritoneal seeding2. Appendiceal cancer3. Crohn’s disease on appendix4. Acute perforated appendicitis with abscess of psoas

muscle5. Acute appendicitis with peritoneal abscess6. Cecal cancer with appendicitis7. Appendiceal mucocele8. Appendiceal mucocele with colonic intussusceptionCONCLUSION: Even though acute appendicitis occupiesthe foremost position of appendiceal diseases, some-times we can detect other diseases above mentioned.We hope these findings may helpful to differentiate manykinds of appendiceal diseases.

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ISP 03_AB 03 11:20Imaging findings of variable Fistulas in digestivesystem: a pictorial reviewNa rae Kim, Hyun Young Han Eulji University Hospital, Korea. knrr1212@naver.com

PURPOSE: A fistula is an abnormal connection between2 epithelialized surfaces that usually involves the gut andanother hollow organ. Fistulas may also form betweenthe gut and the skin. Also rarely, fistulas arise between avessel and the gut. Purpose of this study is to show vari-ous cases of fistulas which caused by the result of vari-able disorder in digestive system and recognize its imag-ing features, and also facilitate the accurate diagnosisabout fistula.CONTENTS ORGANIZATION: We reviewed imagingfindings (CT, ultrasonography, MRI, Barium study) ofpatients who diagnosed variable fistulas.1. Review of formation mechanism of fistula: various

causative diseases - Cancer, Inflammatory bowel dis-ease. Diverticulitis, biliary system inflammation (chole-cystitis, cholangitis), pancreatitis, peptic ulcer disease.Vascular disease

2. Radiologic review of features of fistula in each digestiveorgans1) Esophagus: aorto-esophageal fistula, tracheo-

esophageal fistula2) Stomach: gastrogastric fistula, gastrocolic fistula,

gastrocutaneous fistula, cholecysto-gastric fistula3) Duodenum: duodenocolic fistula, cholecysto-duode-

nal fistula4) Small bowel: enteroentric fistula, enterocolic fistula,

enterocutaneous fistula5) Colon: aortocolic fistula, cholecysto-colic fistula,

vesicocolic fistula6) Rectum: rectovaginal fistula, rectovesical fistula

3. Get Characteristic similarity through reviewing thecases

SUMMARY: This exhibition gives a review of variable fis-tula in digestive system. Fistulas can develop in variousparts of the body. Radiologists often miss fistulasbecause it is difficult to look for abnormal connectionbetween two hollow spaces. So after reviewing manycases we should consider the fistula when abnormal tractis found in imaging findings.

ISP 03_AB 04 11:25Beyond diverticulitis: severe complications ofdiverticular diseases from esophagus to colonwhich need urgent interventional and surgicaltreatmentSeong hun Oh, Hyun Young Han Eulji University Hospital, Korea. ohsh4803@naver.com

PURPOSE: Diverticulum is a pouch arising from hollowviscus of the GI tract anywhere. Diverticulum itselfrequires no treatment, but diverticular diseases needtreatments. Although most of diverticular diseases suchas colonic diverticulitis require just medical treatment,there are some severe complications of diverticular dis-eases which require urgent and invasive treatments such

as surgery or radiological intervention. The purpose ofthis pictorial essay is to review the various imaging fea-tures of severe complications of diverticular diseases andto recognize that urgent treatments are needed whenthese radiological findings are seen.CONTENT ORGANIZATION: We reviewed severe com-plications of diverticular disease from esophagus to colonwhich need urgent treatments such as embolization,drainage, surgical resection, and so on.1. Esophageal diverticulitis with mediastinitis2. Duodenal diverticulitis with perforation3. Small bowel diverticulitis

1) Jejunal diverticulitis with bleeding2) Ileal diverticulitis; especially Meckel’s diverticulitis

with luminal obstruction, bleeding4. Colonic diverticulitis

1) Colonic diverticulitis with massive bleeding2) Colonic diverticulitis with abscess3) Colonic diverticulitis with vesicocolic fistula

TEACHING POINTS: We reviewed for a variety of imag-ing features of severe complications in diverticular dis-eases. We must remember that these complications needurgent treatments such as interventional and surgicaltreatment, and to do this, we should familiar with theimaging features of various complications in diverticulardiseases.

Abdomen-Informal Scientific Presentation13:40-13:55 B2 Hall

Chairperson(s)Sang Soo Shin Chonnam National University Hospital,

Korea

ISP 04_AB 01 13:40Hepatic mass beyond HCC: imaging andhistopathological correlation of non-epithelialhepatic tumorsSeung Jin Kim, Jung Hee Yoon, Yedaun Lee, Seung Ho Kim, Hong Dae Kim Inje University Haeundae Paik Hospital, Korea. H102646@paik.ac.kr

LEARNING OBJECTIVES: 1. To review the currenttrends of non-epithelial hepatic tumors. 2. To correlate theradiologic findings with the histopathological findings andimpact on the management of these tumors.BACKGROUND: Recently, the importance of hepatocel-lular carcinoma (HCC) is highlighted. A number of studieshave been made for the HCC and well-defined diagnosticcriteria have been established. However, non-hepatocel-lular origin tumor account for 25% of total liver cancer butdiagnosis of these tumors have many difficulties, becausethere are mimics of HCC and variable imaging findings.Primary hepatic tumors can arise from different compo-nents of the liver, such as hepatocytes, bile duct epitheli-um, neuroendocrine cells, and mesenchymal cells.Primary hepatic mesenchymal tumors which are com-posed of vascular, fibrous, adipose, and other mesenchy-mal tissue differentiation are rare except cavernoushemangioma and are variable faces in radiologic con-

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cern. As knowing of the spectrum of imaging findings ofthese tumors, radiologist will enhance diagnostic accura-cy and adequate treatment. In this exhibit, each non-epithelial origin and miscellaneous tumors will be intro-duced with radiologic findings and correlated withhistopathologic findings.IMAGING FINDINGS: The contents of non-epithelialtumors are benign (cavernous hemangioma, infantilehemangioendothelioma, angiomyolipoma), malignant (pri-mary hepatic lymphoma, angiosarcoma, malignantfibrous histiocytoma, carcinosarcoma), and include neu-roendocrine tumor, miscellaneous (inflammatory pseudo-tumor). These tumors were presented by several imagingmodalities (CT, MRI, US).CONCLUSION: This exhibition presents a review ofimaging characteristics of non-epithelial origin tumor.Several imaging features of non-epithelial origin tumorswhich were matched with histopathological correlationmay be helpful in differentiating from HCC. This exhibitionwill help radiologists and clinicians overcome the diagnos-tic challenges and conduct the appropriate treatment toliver origin tumor.

ISP 04_AB 02 13:45Analysis for abnormalities of the portal venoussystem on biphasic contrast enhanced CT Jeong Ah Hwang, Hyeong Cheol Shin, Il Young Kim Soonchunhyang University Cheonan Hospital, Korea. hcshin@schmc.ac.kr

The portal venous system comprises all of the veinsdraining the abdominal part of the digestive tract, and trib-utaries of the portal vein are the splenic, superior mesen-teric, left and right gastric vein, paraumbilical and cysticveins. The portal vein could be occluded in various clini-cal settings that may cause portal venous system throm-bosis. And rarely aneurysms of the portal venous systemmay be presented. Biphasic contrast enhanced computedtomography (CT) is a useful tool for both functional analy-sis including the perfusion abnormalities and morphologicanalysis of the portal venous system and the liver. And itenables discrimination between bland and neoplastic por-tal vein thrombi.

a bFig. 1. Acute portomesenteric venous thrombosis in a 64-year-old man. (a) Contrast-enhanced CT image shows diverticulitis ofthe ascending colon (arrowheads). (b) Late arterial phaseimage shows a filling defect in the left portal vein with rimenhancement of the vessel wall (black arrows) and atransient hepatic attenuation difference in the left hepatic

lobe.CONTENTS:I. Thrombosis in the portal venous system

Portal vein thrombosis associated with abdominalinflammatory conditionPortal vein thrombosis after traumaPortal vein thrombosis associated with neoplasmChronic portal vein thrombosis and morphologicchange

II. Aneurysm of the Portal Venous System

ISP 04_AB 03 13:50Some weird hypervascular hepatic massesSehoon Park, Juwan Choi, Ji-yeol Shin, Seonghoon Kim Daegu Fatima Hospital, Korea. wanmann@nate.com

BACKGROUND: We frequently encounter hypervascularhepatic masses, but these masses sometimes haveuncommon imaging features. We experienced commonhypervascular hepatic lesions such as hepatocellular car-cinoma (HCC), angiosarcoma, hemangioma and hepaticadenoma that show atypical imaging findings, so we willreport the atypical findings of these hypervascular hepaticmasses.CASE PRESENTATION: 1-1. HCC in the liver without cirrhotic feature, represent-

ing as a large, persistent enhancing solid and cysticmass with internal hemorrhage and fat component.

1-2. HCC with very subtle arterial enhancement and het-erogeneous signal intensity in the T2 and T1 weight-ed image, because of infarction.

1-3. HCC of the patient having history of endoscopicmucosal resection (EMR) for rectal carcinoid tumor,showing enhancement on arterial phase, and no defi-nite washout all through dynamic study.

2. Angiosarcoma which was noted at first as very subtlegeographic hypodense area along right portal vein.After 28 months, it grew up to large, multiple masseswith heterogeneous and centrifugal enhancement.

3. Hemangioma, seen as multiple clustered homogenousenhancing masses in the left lobe of liver.

4. Hepatic adenoma showing persistent high signal inten-sity throughout the whole dynamic study until the hepa-tobiliary phase.

CONCLUSION: We experienced several cases of hyper-vascular hepatic masses showing atypical features andintroduced them. HCC could be shown as solid and cysticmass with internal hemorrhage and fat component on thenoncirrhotic liver, very subtle enhancing and heteroge-neous mass, and relatively persistent enhancing lesionuntil the hepatobiliary phase in the dynamic MRI,angiosarcoma showed very subtle geographic hypodensearea at first, eventually grows up to heterogeneousenhancing masses. There were hemangiomas havingfeature of clustered homogenous enhancing masses.Hepatic adenoma maintained high intense throughout indynamic study. DISCUSSION: Hypervascular masses of liver are oftenencountered. The differential diagnosis can be difficultbecause there are many atypical features of the disease.It will be helpful to understand both typical and atypical

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features of each disease for diagnosis.

Abdomen-Informal Scientific Presentation15:40-15:55 B2 Hall

Chairperson(s)Keum Nahn Jee Dankook University Hospital, Korea

ISP 05_AB 01 15:40CT findings of hepatic abscess: predicting theoutcome of percutaneous catheter drainage oraspirationSooncheol Baek, jisun Lee, Minho Kang, Kyungsik Yi, Bumsang Cho, Kilsun Park, Sang Hoon Cha, Sungjin Kim Chungbuk National University Hospital, Korea. dr.jisunlee@gmail.com

OBJECTIVE: To evaluation the correlation between com-puted tomography (CT) findings and outcome of percuta-neous catheter drainage (PCD) or aspiration in patientswith hepatic abscess.MATERIALS AND METHODS: This retrospective studywas approved by the Institutional Review Board andinformed consent was waived. 93 patients with 97 liverabscesses who had undergone PCD or aspiration in a 5-year period were included. Clinical, laboratory, and micro-biologic characteristics of hepatic abscesses, and out-come of treatment were analyzed. Three radiologistsevaluated the CT findings of hepatic abscess includingsize, number, distribution, configuration, presence of cys-tic component, rim enhancement, thickness of abscesswall, shortest length to liver capsule, and presence ofgas. Patients were divided into “good” (group 1) and“poor” (group 2) outcome groups by amount of initial aspi-ration-to-volume of abscess ratio. CT features and clinicalfindings between the two groups were compared.Statistical analyses were performed using univariate(Student’s t-test and chi-square test) and multivariateanalyses.RESULTS: There were 26 cases in group 1 and 71 ingroup 2. Multiloculation (p = 0.038), lack of cystic compo-nent (p = 0.018), absence of rim enhancement (p =0.022), and thin wall (p = 0.004) were significantly corre-lated with poor outcome of treatment in univariate analy-sis. Multivariate analysis revealed that Multiloculation (p =0.049) and thin wall (p = 0.041) were important predictorfor good outcome of PCD or aspiration.CONCLUSION: Multiloculation and thin wall were may beuseful CT findings to predict poor outcome of PCD oraspiration in patient with hepatic abscess.

ISP 05_AB 02 15:45The difference of PET/CT uptake between typicaland atypical hepatocellular carcinoma indynamic CT findingJae Chun Park, Jung Gu Park, Kyung Seung Oh Kosin University Gospel Hospital, Korea. cibertim@hanmail.net

BACKGROUND/AIMS: It has been known that thedynamic computed tomography (CT) has a role in diagno-sis primary hepatocellular carcinoma (HCC) as well asthe fluorine-18 fluorodeoxyglucose (18F-FDG) positronemission tomography-CT (PET/CT) has a role in detec-tion of metastatic lesions of primary HCC. Yet, it is stilluncertain whether 18FDG-PET/CT has a role in diagnosisof HCC which shows atypical finding in dynamic CT. Thisstudy assessed the difference tendency of 18FDG-PET/CTuptake between typical and atypical HCC in dynamic CTfinding.MATERIALS AND METHODS: From January 2007 toApril 2015, the 230 patients were diagnosed as HCC and17 patients were diagnosed as combined (or mixed)hepatocellular cholangiocarcinoma by pathology. Amongthose patients, we retrospectively investigated thepatients who had an examination of both dynamic CT and18F-FDG PET/CT in initial work up studies. 95 patientswho were diagnosed as HCC were included and 5patients who were diagnosed as combined hepatocellularcarcinoma were also compared with.RESULTS: Among 95 cases of HCC, 62 cases (65.3%)had typical HCC finding and 33 cases (34.7%) had atypi-cal nature in dynamic CT. Among 62 typical HCC cases,43 cases (69.4%) showed no uptake in 18F-FDG PET/CT,whereas among 33 atypical HCC cases, 24 cases(72.7%) showed more than 50% of FDG uptake and 5cases (15.2%) also showed FDG uptake even thoughless than 50% of FDG uptake (p < 0.0001). All of 5 casesof combined hepatocellular cholangiocarcinoma showedmore than 50% of FDG uptake, whether it has typicalHCC findings in dynamic CT or not.CONCLUSION: Atypical HCCs in dynamic CT have obvi-ous uptake tendency in 18F-FDG PET/CT, whereas typicalHCCs usually do not.

ISP 05_AB 03 15:50Point shear wave elastography for assessingliver fibrosis using in chronic viral hepatitisJae Woo Park, Jeong Eun Lee, June Sik Cho,Kyung Sook Shin, Kwang Sik Cheon, In Sang Song,Kyeong Hee Kim Chungnam National University Hospital, Korea. antbantb@naver.com

PURPOSE: To evaluate performance of point shearwave elastography (ElastPQ) for the staging of liver fibro-sis in chronic viral hepatitis patients.MATERIALS AND METHODS: A total of thirty-fivepatients (29 hepatitis B, 6 hepatitis C) who underwentliver stiffness measurements using ElastPQ and transientelastography (TE) as well as biochemical investigationswere included. The diagnostic performance of ElastPQfor staging liver fibrosis was evaluated using the receiveroperating characteristic (ROC) curve analysis. Results of

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the ElastPQ, TE, and serologic fibrosis marker test(APRI) were compared with histopathologic findings asthe reference standard using Spearman’s correlation.RESULTS: Stiffness values obtained by ElastPQ (r =0.356), TE (r = 0.428), and APRI (r = 0.219) results werestatistically significant positive correlation with histologicfibrosis (p < 0.05). Area under the ROC curve for theaccuracy of ElastPQ, TE and APRI were 0.767, 0.850,and 0.589, respectively, for the diagnosis of severe fibro-sis (> F3).CONCLUSION: ElastPQ is a promising noninvasivemethod for evaluation of liver fibrosis in patients withchronic viral hepatitis, which had diagnostic performancecomparable to that of TE.

Abdomen-Informal Scientific Presentation15:40-16:00 B2 Hall

Chairperson(s)Ah Young Jung University of Ulsan College of

Medicine, Asan Medical Center, Korea

ISP 05_OT 03 15:50Clinical challenges and images of incidentalsplenic masses: how much do you knowregarding splenic tumors and mimickers?Jun Hyung Hong1, Jin Woong Kim2, Sang Soo Shin3,Sook Hee Heo2, Yong Yeon Jeong2, Heoung Keun Kang2

1Chonnam National University Hospital, 2ChonnamNational University Hwasun Hospital, 3ChonnamNational University Medical School, Korea.mplife@daum.net

TEACHING POINTS: 1. To overview imaging findings of various splenic tumors

and mimickers2. To illustrate radiologic-pathologic correlation in various

splenic tumors and mimickers3. To discuss differential points to help discriminate

among various splenic tumors and mimickersTABLE OF CONTENTS/OUTLINE: 1. Clinical challenges and images (cases 1~16)

01) Case 1: Metastasis02) Case 2: Pseudocyst03) Case 3: Hamartoma04) Case 4: Hemangioma05) Case 5: Microabscess06) Case 6: Angiosarcoma07) Case 7: Epithelial cyst08) Case 8: Lymphangioma09) Case 9: Splenic abscess10) Case 10: Hemangiomatosis11) Case 11: Splenic infarction12) Case 12: Malignant lymphoma13) Case 13: Invasive aspergillosis14) Case 14: Intraparenchymal hematoma15) Case 15: Malignant fibrous histiocytoma16) Case 16: Sclerosing angiomatoid nodular transfor-

mation2. Review of cases 1~16 with radiologic-pathologic corre-

lation3. Summary of useful radiologic findings to help discrimi-

nate among various splenic tumors and mimickers4. Suggested algorithms for narrowing differential diagno-

sis of various splenic tumors and mimickers

ISP 05_OT 04 15:55Comparison of three motion resistant MRimaging sequences for gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging of the liverDoo Ri Kim, Bong Soo Kim, Seung Hyoung Kim Jeju National University Hospital, Korea. 67kbs@medimail.co.kr

PURPOSE: To compare 3D controlled aliasing in parallelimaging results in higher acceleration (CAIPIRINHA) gra-dient recalled echo (GRE) and free-breathing 3D radialGRE sequences(interleaved angle-bisection [ILAB] andgolden-angle [GA] acquisitions).MATERIALS AND METHODS: Eighty patients under-went gadoxetic acid-enhanced 3T liver MR imaging with3D T1-weighted hepatobiliary GRE with CAIPIRINHA andtwo free-breathing 3D T1-weighted radial GREsequences (ILAB and GA sampling methods): a standardprotocol in cooperative patients (n = 60) and a motionresistant protocol in noncooperative patients (n = 20).Two abdominal radiologists independently and blindlyassessed hepatobiliary phase (HBP) images with motionartifact, streaking artifact, liver edge sharpness, hepaticvessel clarity, lesion conspicuity and over all image quali-ty in retrospective fashion. The results were comparedusing Wilcoxon-signed rank test.RESULTS: In the analysis for imaging of cooperativepatients, the results for 3D CAIPIRINHA sequence hadsignificantly higher rating for liver edge sharpness, hepat-ic vessel clarity, and overall image quality than other twosequences (p<0.05). For imaging of noncooperativepatients, higher scores were recorded for free-breathing3D radial GRE sequence using ILAB, or GA scheme withrespect to all qualitative assessments, except for streakartifact when compared with 3D CAIPIRINHA (p < 0.05)in contrast to patients without breath-hold difficulties. Theresult of two radial GRE sequences did not differ inmotion resistant protocol, significantly.CONCLUSION: The 3D GRE imaging with CAIPIRINHAis useful for patients without breath-hold difficulties. Innoncooperative patients, free-breathing 3D radial GREsequence can reduce motion artifact and improve theimage quality compared with 3D CAIPIRINHA sequence,whatever data acquisition methods (interleaved angle-bisection [ILAB] or golden-angle [GA] acquisitions) areused.

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SE 01 AB-01Iatrogenic bile duct injuries - diagnosis andmanagementDaejung KimBundang CHA Hospital, CHA University, Korea. choikim75@gmail.com

PURPOSE: To review bile duct injury after surgery andtransarterial chemoembolization. To review managementof bile duct injuries.CONTENT: 1. Biliary injuries, related to the biliary tract surgery

1) Classification system for bile duct injuries - Bismuth-Corlette classification, Strasberg classification,Stewart-Way classification

2) Diagnostic techniques3) Complication of bile leakage - biliary fistula, biloma,

bile ascites, bile peritonitis4) Complication of bile stricture5) Management

2. Biliary injuries, related to the biliary tract surgery1) Mechanism and Patterns of bile duct injuries2) Diagnostic techniques3) Complication of bile leakage - biliary fistula, biloma,

bile ascites, bile peritonitis4) Complication of bile stricture5) Management

SE 01 AB-02Gastric carcinoma: imaging assessment andpathologic correlationIl Young Kim1, Jeong Ah Hwang2, Hyeung Cheol Shin2

1Soonchunhyang University Cheonan Hospital,2Soonchunhyang University College of Medicine,Korea. ilykim@schmc.ac.kr

Gastric carcinoma is one of the most frequent malignancyin the worldwide. Initial diagnosis is usually performed bygastrofiberscopy. However, radiologic and imaging studyare essential for the evaluation of the tumor extent andstaging of the tumor. Upper gastrointestinal (UGI) studywas once routinely studied on radiology and there aremany imaging modalities for evaluation of gastric carcino-ma. Those imaging modalities have various imaging find-ings and play in the diagnosis and staging of the stomachcancer. This is because accurate diagnoses are helpfulfor providing the proper treatment and predicting progno-sis. In this review, authors will demonstrate imaging find-ings and pathology of the gastric carcinoma.Radiologic study was UGI for the diagnosis of stomachcancer and it informed many important diagnostic find-ings, however these studies are not frequently used thesedays. CT is replaced the imaging role in the diagnosisand staging of gastric cancer. Ultrasound and magneticresonance imaging and PET-CT have also roles in thediagnosis and staging of gastric cancer. Staging for treat-ment and follow up study were performed by above imag-ing modalities. Furthermore, imaging modalities have

important role in the follow up of the gastric cancer resec-tion. Accurate diagnosis of tumor recur are crucial for theproper management and treatment.Understanding of various imaging findings and pathologicfindings are important for the accurate diagnosis of gas-tric cancer. Various kinds of imaging modalities havebeen shown its characteristic imaging findings in the gas-tric cancer. UGI have been shown filling defect with mass,ulcer and abrupt cutting of converged gastric folds. MDCThave been played in the diagnosis and staging of gastriccancer. MRI is still challenge in the field of gastric cancerstudy. US have some roles as imaging diagnostic tool.Retroperitoneal lymph node metastasis with obstructiveuropathy is infrequently seen. One of rare metastasis ofgastric cancer is epididymis metastasisAuthors illustrate various imaging findings of gastric can-cer and pathologic correlation. A review of related litera-ture is also included in this exhibition. It is helpful in thediagnosis of gastric cancer.

SE 01 AB-04Does sinusoidal obstruction syndrome interferethe response of colorectal liver metastases tooxaliplatin?: evaluation of the effect of hepaticparenchymal heterogeneity of CT on tumorresponseNa Yeon Han, Min Ju Kim, Beom Jin Park, Deuk Jae Sung, Ki Choon Sim, Sung Bum Cho Korea University Anam Hospital, Korea. mammos2000@daum.net

PURPOSE: To evaluate the effect of oxaliplatin-basedchemotherapy (OBC) induced hepatic parenchymal het-erogeneity (HPH) of contrast-enhanced CT scans ontumor response based on the assumption that HPH mayappropriately reflect the chemotherapy-induced sinu-soidal obstruction syndrome (SOS).MATERIALS AND METHODS: 104 patients (M:F =66:38; age range, 20-80 years) with hepatic metastasiswho had underwent OBC (at least 3 sessions) and per-formed serial CT scans were consecutively registered inthis study after excluding patients with diffuse liver dis-ease, bulky hepatic metastasis, insufficient follow up CTscans or who underwent treatment other than chemother-apy. Two blinded abdominal imagers independentlyscored CT scans for the severity of newly developed HPHfollowing OBC with a 5-point scale. Subsequently, a radi-ologist measured longest diameter of target lesions oneach scans and tumor response evaluation was donebased on RECIST guideline (version 1.1). Responsewere recorded with ordinal scales; complete response as1, partial response as 2, stable disease as 3 and progres-sive disease as 4. Pathology and location of primarytumor, session number and regimen of chemotherapyand the presence of other metastasis were also recorded.Multivariate multinomial regression models was then fitwith generalized estimating equations to account for theeffect of HPH severity on the cumulative probability oftumor response.RESULTS: Interobserver agreements for the severity ofHPH between three readers were good or excellent (κ=0.825). The results showed that the presence of othermetastasis (p-value; 0046 and 0.012 for each readers),

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number of chemotherapy sessions (p-value; 0.011 and0.010 for each readers), and the severity of post-oxali-platin HPH (p-value; < 0.0001 for both readers) were thesignificant factors for the prediction of tumor response.Calculated estimated odd ratio showed that the severerthe post-oxaliplatin HPH, the worse tumor response waspredicted.CONCLUSION: Based on the assumption that post-oxali-platin HPH on contrast-enhanced CT appropriately reflectthe SOS, the severer the SOS, the worse tumor responseof hepatic metastasis to oxaliplatin can be predicted.

SE 01 AB-05Imaging predictors discriminating high riskgroup of intrahepatic cholangiocarcinoma andcombined hepatocellular-cholangiocarcinomaon gadoxetic acid-enhanced MRI: aclassification tree analysisHyun Jeong Park1, Kyung Mi Jang2, Tae Wook Kang2, Kyoung Doo Song2, Seong Hyun Kim2, Young Kon Kim2, Dong Ik Cha2

1Chung-Ang University Medical Center, 2SamsungMedical Center, Korea.kmmks.jang@samsung.com

PURPOSE: To identify the predictors discriminating thehigh risk group of intrahepatic mass-forming cholangio-carcinoma (IMCC) and combined hepatocellular-cholan-giocarcinoma (CHC) for primary liver cancers in patientswith chronic liver disease (CLD) on gadoxetic acid-enhanced MRI using classification tree analysis (CTA).MATERIALS AND METHODS: Forty IMCCs, 24 CHCsand 91 hepatocellular carcinomas (HCCs) in patients withCLD were enrolled in this study. Tumor marker and MRimaging variables including morphologic features, signalintensity and enhancement pattern of the tumors wereused to identify the high risk group for IMCC and CHC by

using CTA.RESULTS: On CTA, arterial rim enhancement was theinitial splitting predictor for assessing the probability of atumor to be IMCCs or CHCs. Of 43 tumors which wereclassified as a subgroup on CTA based on presence ofarterial rim enhancement, no intratumoral fat, and non-globular shape, 41 (95.3%) tumors were IMCCs (n = 29)and CHCs (n = 12). All 24 tumors having intratumoral faton MRI were HCCs. The CTA model has sensitivity at84.4%, specificity at 97.8%, and accuracy at 92.3% forprediction of IMCCs and CHCs.CONCLUSION: We established a simple classificationtree model to classify the high risk group of IMCCs andCHCs for primary liver cancers in patients with CLD. Thisclassification tree model can be useful for deciding thetherapeutic method for primary liver cancers in patientswith CLD.

SE 01 AB-06MDCT findings in bowel obstruction: what thesurgeon wants to know from the radiologistHyun Cheol Kim1, Sang Won Kim1, Dal Mo Yang1,Seong Jin Park2

1Kyung Hee University Hospital at Gangdong, 2KyungHee University Medical Center, Korea. khcppp@lycos.co.kr

PURPOSE: 1. To demonstrate the role of CT in patients with small

and large bowel obstruction2. To describe the CT findings of decisions making

regarding surgery in patients with bowel obstructiondue to adhesion

3. To illustrate several causes of a bowel obstruction thatneeds surgery

CONTENTS: 1. Algorithmic approach of CT in small and large bowel

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obstructions2. The CT findings of surgical indication in patients with

bowel obstructions by adhesion- High grade obstruction- Abnormal vascular course around transition zone- Closed-loop obstruction- Strangulated obstruction- Intraperitoneal fluid

3. Causes of a bowel obstruction required surgery otherthan adhesion- Extrinsic (hernia, extrinsic tumors in the mesentery or

retroperitoneum, volvulus)- Intrinsic (small and large bowel cancer, Crohn’s dis-

ease, intussusception)- Intraluminal (gallstone, bezoar)

CONCLUSION: MDCT plays a crucial role in the thera-peutic approach of the patients with bowel obstruction.Radiologists need to be familiar with a broad spectrum ofCT findings of bowel obstruction requiring surgery.

SE 01 AB-07The effect of intralesional fat content on the USvisibility of small hepatocellular carcinomasduring US-guided radiofrequency ablation: aretrospective studyWai Keat Lau1, Ivan Huang2, Uei Pua2

1Yong Loo Lin School of Medicine, 2Tan Tock SengHospital, Singapore. pua_uei@ttsh.com.sg

INTRODUCTION: Radiofrequency ablation has, in recentyears, become the treatment of choice for small hepato-cellular carcinomas (< 3 cm in size), with many of theseprocedures being performed under ultrasound (US) guid-ance. However, there are many factors contributing to alesion’s visibility on US, and this in turn has significanteffects on the success and adequacy of the subsequentablation. Thus, this study aims to assess the effect ofintralesional fat on the sonographic visibility of smallhepatocellular carcinomas (HCC) during radiofrequencyablation. Other factors, such as background fatty liver,presence of cirrhosis, lesional size and distance fromdiaphragm were evaluated as well.MATERIALS AND METHODS: Patients who werereferred for US guided radiofrequency ablation fromJanuary 2010 to April 2015 were included in this study, ifthey had a new case of HCC or a new focus of HCC afterprior treatment. However, patients who underwent simul-taneous treatment (e.g., RFA-TACE), were being treatedfor residual disease, or who underwent CT guided RFAwithout planning US scans were excluded. The presenceof intralesional fat was determined retrospectively via In-and-Out of phase imaging on MRI scan, with an MRIdetermined fat fraction of > 5% being deemed as havingthe presence of intralesional fat. The other factors men-tioned before were also obtained retrospectively.RESULTS: A total of 97 cases (M:F = 81:16; mean age,68.11 [SD ± 11.03]) were included in the study, out of246 potential cases. The overall detection rate was77.3% (75/97). The number of lesions containing fat was26.8% (26/97). On analysis, intralesional fat was found tohave a significantly positive effect (p = 0.004) on visibility.Distance from the diaphragm was also found to signifi-

cantly affect visibility (p = 0.0099) inversely. In this series,the size of the lesion was not significant in predicting thevisibility of the lesion on US (p = 0.128). Similarly, back-ground fatty liver, presence of cirrhosis and the lesion’slocation were not found to be significant in this study.CONCLUSION: The presence of intralesional fat has apositive effect on sonographic visibility during US guidedradiofrequency ablation. Distance of the lesion from thediaphragm was also found to have a significant effect onvisibility.

SE 01 AB-09MRI findings of Lipiodol-uptaken hepatocellularcarcinomas: focus on signal intensityMyungjae Lee, Seung Yon Baek, Joo Yeon Cho, Bo Bae Lee Ewha Womans University Mokdong Hospital, Korea. bbaek@ewha.ac.kr

PURPOSE: To evaluate the MR findings of Lipiodol-uptaken, nodular hepatocellular carcinomas (LHCCs)treated with transarterial chemoembolization (TACE) with-out recurrence, especially focused on signal intensity (SI).MATERIALS AND METHODS: 28 consecutive LHCCswhich showed dense or partial uptake of Lipiodol on pre-contrast CT images after TACE and underwent gadoxeticacid-enhanced dynamic MRI including T2WI, T1WI andDWI with a whole body 3T MRI unit were enrolled fromApril 2009 to June 2014. LHCCs were divided into 2groups according to the amount of Lipiodol uptake onprecontrast CT images as dense uptake (more than 90%)of group A (n = 16) and partial uptake (between 50% and90%) of group B (n = 12). According to the size, LHCCswere divided into 4 groups. Group I was less than 1 cm (n= 4), group II less than 2 cm (n = 8), group III less than 3cm (n = 9) and group IV more than 3 cm (n = 7). We ret-rospectively evaluated MR findings of LHCCs focusing onSI according to the amount of Lipiodol uptake and size.RESULTS: Among group A, 8 LHCCs showed high SI onT2WI, 10 LHCCs showed low SI on T1WI. 6 LHCCshowed decreased SI on higher b value of DWI. 9 LHCCsshowed high SI on GE in phase, and low SI on GE outphase. Among group B, 6 LHCCs revealed high SI onT2WI and low SI in T1WI. 10 LHCCs revealed decreasedSI on higher b value of DWI. 6 LHCCs revealed high SIon GE in phase, 7 LHCCs revealed low SI on GE outphase. All 28 LHCCs were not enhanced on dynamicstudy. According to the size of LHCCs, all LHCCs ofgroup I and 7 LHCCs of group II revealed dense uptakeof Lipiodol, as compared that 4 LHCCs of group III and 1of group IV revealed dense uptake of Lipiodol. As com-pared with the size and SI, 3 LHCCs of group I showediso SI on T2WI. 6 LHCCs of group II, 5 LHCCs of groupIII showed high SI on T2WI. But 3LHCCs of group IVrevealed mixed SI on T2WI.CONCLUSION: More than half of LHCCs showed high SIon T2WI, low SI on T1WI, and decreased SI on higher bvalue of DWI. All LHCCs were not enhanced on dynamicstudy. These can be helpful to interpret the MR findings ofLHCC without recurrence and then radiologist shouldknow MR findings to prevent misinterpretation and makethe proper management.

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SE 01 AB-10Imaging findings of cystic or cyst-like lesions ofthe gallbladder: diagnostic clues or pitfallsSang Won Kim, Hyun Cheol Kim, Dal Mo Yang Kyung Hee University Hospital at Gangdong, Korea. rad2000@hanmail.net

To illustrate various cystic lesions, cystic components orcyst-mimicking lesions in the lumen or wall of the gall-bladder with pathological correlation.01. Rokitansky-Aschoff sinuses in adenomyomatosis

- multiple small cystic appearances on CT- pearl necklace sign on MR- fundal adenomyomatosis on US

02. Xanthoma in xanthogranulomatous cholecystitis03. Abscess or gangrenous change in cholecystitis04. Mucinous cystic neoplasm in gallbladder

- multilocular cystic mass in gallbladder wall05. Mucin-filled cystic component in gallbladder adeno-

carcinoma- cystic lesion in cancer

06. Phrygian cap gallbladder07. Multi-septated gallbladder08. Bicameral gallbladder09. Gallbladder duplication10. Differential diagnosis of gallbladder cystic lesions

SE 01 AB-11Imaging findings of actinomycosis in variousabdominopelvic organsHye Young Choi, Sung Eun Ahn, Sung Kyoung Moon, Dong Ho Lee, Seong Jin Park,Joo Won Lim Kyung Hee University Medical Center, Korea. 83ahnse@hanmail.net

PURPOSE: To review the various cases of actinomyco-sis in abdominopelvic organs and their radiological find-ings, and to search for the radiological clues to make dif-ferential diagnosis from other disease.MATERIALS AND METHODS: To review the pathophys-iology and clinical manifestations of actinomycosis inabdominopelvic organs. To describe the radiological find-ings of actinomycosis in abdominopelvic organs, includ-ing ultrasonography, CT, MR images. To discuss thediagnostic tips of abdominopelvic actinomycosis duringradiological trials.RESULTS: Pathophysiology and clinical manifestationsof actinomycosis in abdominopelvic organs.

Spectrum of abdominopelvic actinomycosisGI tract: small bowel, colon, appendixSolid organ: liverAbdominal wallPelvic cavityRadiological findings of abdominopelvic actinomycosis,

including ultrasonography, CT, MR images.Differential diagnostic tips of actinomycosis

CONCLUSION: It is quite challenging and confusing todifferentiate actinomycosis from malignancy or otherinflammatory lesions with imaging finding alone.Therefore, it is important to know about how they look likeon each abdominopelvic organs and what the clues arefor the differential diagnosis.

SE 01 AB-12US-guided percutaneous liver biopsy: coaxialversus non-coaxial techniquesKa-Wai Shek, Philip Kwok Queen Elizabeth Hospital, Hong Kong, China. skw318@ha.org.hk

INTRODUCTION: Ultrasound (US)-guided percutaneousliver biopsy provides definitive histological diagnosis tohelp management in patients with psoriasis on methotrex-ate, chronic hepatitis B or C, and acute fulminant hepatitiswithout clinically identified cause. In this study, we com-pared complication rate and diagnostic yield of coaxialtechnique with those of non-coaxial technique in ultra-sound-guided percutaneous liver biopsy.MATERIALS AND METHODS: This retrospective studyaims to review the complication rates and pathology yieldin our institution in the period between April 2011 andDecember 2013. The definition of complication was madeaccording to guidelines by the Society of InterventionalRadiology. Pathology yield was classified as diagnostic ornon-diagnostic.RESULTS: There were 58 biopsies performed with non-coaxial technique and 79 biopsies performed with coaxialtechnique. There were no deaths. The rates of majorcomplications were 0% in both groups. For minor compli-cations, one patient (1.2%) in the group with coaxial tech-nique has bleeding not requiring transfusion, which is notstatistically significantly different from the group with non-coaxial technique. There is statistical significant differenceof the non-diagnostic yield between these two groups,6.9% (non-coaxial) versus 0% (coaxial) (p < 0.05).CONCLUSION: US-guided percutaneous liver biopsyusing coaxial technique can provide a higher diagnosticyield without any difference in the complication rate.

SE 01 AB-14Strategies for reducing thermal collateralinjuries in US-guided radiofrequency ablation ofliver tumors: emphasis on artificial ascitestechniqueJin Woong Kim1, Sang Soo Shin2, Jun Hyung Hong3,Sook Hee Heo1, Yong Yeon Jeong1, Heoung Keun Kang1

1Chonnam National University Hwasun Hospital,2Chonnam National University Medical School,3Chonnam National University Hospital, Korea.jw4249@hanmail.net

TEACHING POINTS: 1. To overview the current strategies for reducing thermal

collateral injuries in US-guided radiofrequency (RF)ablation of liver tumors

2. To provide comprehensive review of artificial ascitestechnique

3. To discuss the correlation between artificial ascites anddevelopment of pleural effusion

TABLE OF CONTENTS/OUTLINE: 1. Overview of the current strategies for minimizing ther-

mal collateral injuries1) Artificial ascites technique2) Purposeful patient positioning3) Cooling bile duct with endoscopic nasobiliary tube

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4) Others2. Comprehensive review of artificial ascites technique

1) Steps to make artificial ascites2) Infusion routes of artificial ascites according to the

tumor location in the liver3) Tips to enhance the role of artificial ascites4) Comparison between 5% dextrose solution and

physiologic saline as artificial ascites3. Correlation between artificial ascites and the develop-

ment of pleural effusion1) Mechanism of the development of pleural effusion

after RF ablation with artificial ascites(1) Current understanding of the development of

pleural effusion: a literature review(2) Suggested new concept regarding how pleural

effusion may occur2) The fate of pleural effusion

SE 01 AB-15Are we really closer to the management ofincidental cystic pancreatic lesions?Sook Hee Heo1, Jin Woong Kim1, Sang Soo Shin2,Jun Hyung Hong3, Yong Yeon Jeong1, Heoung Keun Kang1

1Chonnam National University Hwasun Hospital,2Chonnam National University Medical School,3Chonnam National University Hospital, Korea.sheo@jnu.ac.kr

TEACHING POINTS: 1. To overview the current status of consensus guidelines

for the management of incidental cystic pancreaticlesions (CPLs)

2. To discuss imaging appearances of commonlyencountered CPLs

3. To discuss a relationship between incidental CPLs andthe development of pancreatic adenocarcinoma

TABLE OF CONTENTS/OUTLINE: 1. Nature and scope of the problem related with incidental

CPLs2. Various incidental guidelines for the management of

incidental CPLs1) American College of Radiology guideline2) International association of pancreatology3) Sendai criteria4) Flowchart by Sahani et al.5) Others

3. Imaging appearances of commonly encountered CPLs1) Pseudocyst2) Serous cystic neoplasm3) Mucinous cystic neoplasm4) Intraductal papillary mucinous neoplasm5) Solid pseudopapillary neoplasm6) Cystic pancreatic neuroendocrine neoplasm7) Uncharacterized CPLs

4. Relationship between incidental CPLs and the devel-opment of pancreatic adenocarcinoma1) Incidental CPLs as a predictive sign of pancreatic

adenocarcinoma2) Implications of imaging and clinical features3) International Cancer of the Pancreas Screening

(CAPS) Consortium SummitSE 01 AB-17

The role of MRCP without enhancement asscreening imaging modality in patients withsuspected cholecystitis Myung-Won You, Yoon Young Jung Eulji Hospital, Eulji University, Korea.

jyy@eulji.ac.kr

OBJECTIVES: To compare the diagnostic performanceof CT and stone MRCP without enhancement (MRCPWE) and determine the role of stone MRCP WE for eval-uating extrahepatic duct stone in patients with suspectedcholecystitis.METHODS: From January 2013 to February 2015,among the patients who underwent stone MRCP WE withthe impression of symptomatic cholecystitis, after exclud-ing 11 patients without CT and 221 patients withoutERCP, total 78 patients (mean age; 66.06 ± 15.63;range 21-94, M:F = 31:47) were included in this study.Two reviewers independently interpreted CT and MRCPWE images in regard to presence or absence of extra-hepatic duct stone. The diagnostic performance (sensitivi-ty, specificity, PPV, NPV, accuracy) was comparedbetween CT and MRCP WE using McNemar’s test. Andthe inter-observer agreement was evaluated using k-coef-ficient. RESULTS: Fourty three patients underwent cholecystec-tomy. The pathologic results consisted of 38 cases ofacute or chronic cholecystitis, 2 cases of xanthogranulo-matous cholecystitis and 3 cases of others (polyp, choles-terolosis, carcinoid). The diagnostic performance fordetecting extrahepatic duct stone was better of stoneMRCP WE compared with those of CT for both tworeviewers (Reviewer 1, MRCP: sensitivity 73%, specificity85%, accuracy 75%; CT: sensitivity 50%, specificity 85%,accuracy 58%; p < 0.05 and Reviewer 2, MRCP: sensitiv-ity 75%, specificity 67%, accuracy 73%; CT: sensitivity50%, specificity 78%, accuracy 56%; p < 0.05). The inter-observer agreement was good for diagnosing extrahepat-ic stone on both CT (k-value: 0.738) and MRCP (k-value:0.701).CONCLUSION: Stone MRCP WE revealed better diag-nostic performance for detecting extrahepatic duct stonesthan CT with favorable inter-observer agreement.Considering lack of radiation and contrast enhancement,stone MRCP WE would be appropriate for initial screen-ing modality in patients with suspected cholecystitis.KEYWORDS: magnetic resonance cholangiopancreatography, cholecystitis, biliary calculi, computed tomogra-phy

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Table 1. Pathologic results of 43 patients who underwentcholecystectomy

Pathology Cases

Chronic cholecystitis 24Acute cholecystitis 11Acute on chronic cholecystitis 2Xanthogranulomatous cholecystitis 2Subacute cholecystitis 1Others (GB polyp, cholesterolosis, carcinoid) 3

a b cFig. 1. A 33-year-old male patient with acute cholecystitisshowing biliary sludges in the extrahepatic duct depen-dent portion on T2W HASTE image (b, arrow), which wasconfirmed with ERCP with stone extraction. The biliarysludges are nonvisible on pre-enhanced CT exam.

SE 01 AB-18Imaging findings of chemotherapy induced liverabnormalitiesHyun Young Kim, Sung Eun Ahn, Sung Kyoung Moon, Dong Ho Lee, Seong Jin Park,Joo Won Lim Kyung Hee University Medical Center, Korea. 83ahnse@hanmail.net

PURPOSE: It is important to recognize and understandthe different chemotherapeutic agents and how theyaffect the various organs. Most chemotherapy drugsrequire adequate liver function to be metabolized, andsome drugs can induce significant liver injury. We willreview different chemotherapeutic agents and how differ-ent subclasses can affect the liver, and the various casesimaging findings of the hepatotoxicity in patients undergo-ing treatment with chemotherapy.MATERIALS AND METHODS: To review the majorclass of chemotherapeutic agents. To review the hepa-totoxicity of chemotherapeutic agents and radiologicalfindings, including ultrasonography, CT, MR images.RESULTS:1. Spectrum of the major class of chemotherapeutic

agents.2. Radiological findings of hepatotoxicity of chemothera-

peutic agents, including ultrasonography, CT, MRimages.1) Sinusoidal obstructive syndrome

2) Fatty liver3) Acute hepatitis4) Hepatic necrosis5) Portal vein thrombosis

CONCLUSION: It is quite challenging and confusing todifferentiate metastasis from other benign lesions inpatients with chemotherapy. Therefore, it is important toknow about hepatotoxicity pattern of chemotherapeuticagents in management and prognosis assessment inunderlying malignant tumor patients.

SE 01 AB-19Low-dose abdominal CT for evaluatingsuspected appendicitis in adolescents andyoung adults: an evidence-based reviewPenampai Tannaphai1, Ji Ye Sim2, Kyoung Ho Lee2, Dong Hyun Kim3, LOCAT group2

1Ramathibodi Hospital, Thailand, 2Seoul NationalUniversity Bundang Hospital, Korea, 3The ArmedForces Seoul Hospital, Korea.sunnyandluna@naver.com

1. To emphasize the need of using low-dose (LD) com-puted tomography (CT) in this population with normallife expectancies.

2. To review published evidences supporting that LD CTis comparable to standard-dose (SD) CT in the efficacywith respect to diagnostic performance and clinical out-come.

3. To propose LD imaging protocol and to suggest othernecessary ingredients to overcome the low image qual-ity.

4. To discuss future challenges and opportunities in incor-porating LD CT into a multimodal diagnostic algorithm.The contents are consisted of epidemiology, radiationdose level of conventional doses from survey studiesand LDs explored in research studies, carcinogenicrisk associated with CT examination, efficacy compari-son between LD CT and SD CT in term of image quali-ty, diagnostic performance and confidence and clinicaloutcome such as negative appendectomy rate andappendiceal perforation rate, imaging technique includ-ing scanning, image reconstruction, image visualiza-tion, learning curve in interpretation and reporting, cali-brating and monitoring radiation dose and future chal-lenges and opportunities.

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Table 3. Interobserver agreement for detecting biliarystones

K value 95% CI

CT: extrahepatic duct stones 0.738 0.586-0.889MRCP: extrahepatic duct stones 0.701 0.538-0.865

Table 2. Comparison of diagnostic performance of CT and MRCP without enhancement for detecting biliary stones

Reviewer 1 Reviewer 2

CT MRCP p-value CT MRCP p-value

Sensitivity (%) 50 (31/62) 73 (45/62) 50 (30/60) 75 (45/60)Specificity (%) 85 (17/20) 85 (17/20) 78 (14/18) 67 (12/18)PPV (%) 91 (31/34) 94 (45/48) 88 (30/34) 88 (45/51)NPV (%) 35 (17/48) 50 (17/34) 32 (14/44) 44 (12/27)Accuracy (%) 58 (48/82) 75 (62/82) p< 0.05 56 (44/78) 73 (57/78) p< 0.05

SE 01 AB-20Black and white pancreas: pictorial gallery onCT and MRIAnupam Lal, Laxmikant Gupta, Priyanka Naranje,Rakesh Kocher, Niranjan KhandelwalPGIMER, India. lkhunk@gmail.com

PURPOSE: Pancreatic lipomatosis refers to accumula-tion of fat in the pancreatic gland, and is synonymic tolipomatous pseudohypertrophy or pancreatic steatosis.Fat accumulation affects the pancreatic exocrine function,however it is a reversible process. It is an increasingproblem due to the increasing incidence of obesity andmetabolic syndrome. Various systemic causes like cysticfibrosis, hemochromatosis, drugs (steroids), chronic pan-creatitis and syndromic causes such as Cushing syn-drome and Shwachman-Diamond syndrome have beenalso implicated. The condition is easily demonstrableusing common imaging techniques, such as ultrasonogra-phy, computed tomography (CT) and magnetic reso-nance imaging (MRI). With the objective of demonstratingtypical imaging findings of this condition, we present thepictorial gallery of twenty-two patients who were diag-nosed as pancreatic lipomatosis.IMAGING FINDINGS: CT in sixteen patients (includingthose with SPEN, HCC, chronic pancreatitis) demonstrat-ed the entity as even or uneven decreased density of thepancreatic parenchyma to the same level as that of thesurrounding fatty tissue appearing as black pancreas.Contrast-enhanced CT revealed non enhancement of theentire pancreatic parenchyma or some contrast-enhanc-ing net-like shadows were seen. MRI is the best imagingtechnique to demonstrate the entity. In seven patients,hyperintense pancreatic parenchyma was seen on T1weighted images appearing as white pancreas which getssuppressed on fat saturated images. It is important toconfirm that the pancreatic ducts appear normal in CTand MRI images which help distinguishing the entity frompancreatic agenesis.CONCLUSION: With its typical imaging features demon-strable, CT and MRI can reliably be used as imagingmodalities of choice to confidently diagnose or excludepancreatic lipomatosis.

SE 01 AB-21Double duct sign imaging revisited: a pictorialessaySonali Sethi1, Sunil Puri2, Amit Kumar Verma2, Richa Tiwari2, Ruchi Gupta2, Meenakshi Prakash2,Surabhi Gupta2, Richa Yadav2

1Govind Ballabh Pant Institute of Post GraduateMedical Education and Research, 2GIPMER, India. sonali.sethi01@gmail.com

INTRODUCTION: Double duct sign is a commonlyencountered sign in gastrointestinal radiology, and isdefined as the simultaneous dilatation of the intrapancre-atic CBD and the MPD. The most common causes beingpancreatic adenocarcinoma (encasement) and peri-ampullary tumors (contiguous involvement). In peri-ampullary tumors this may be the only sign of disease.PURPOSE: 1. To optimize the CT technique with emphasis on pan-

creatic imaging and 3D reconstruction for the ductdelineation.

2. To study the benign and malignant causes of doubleduct sign and characterization of the lesions based onimage morphology.

3. To differentiate the causes of double duct sign anddescribe them using a reporting format.

MATERIALS AND METHODS: A retrospective study ofcases (65) presenting with double duct sign was madeand the etiology was studied. The cases had beenscanned on a 256 slice dual source CT scanner(Siemens SOMATOM) and the 3D reconstruction wasdone using post processing software (syngo via). In someof the cases the findings were corroborated on MRCP. OBSERVATION AND RESULTS: 1. Optimization of CT technique for pancreatic imaging

and post processing techniques for 3D reconstruction.2. Benign causes of double duct sign: Chronic pancreati-

tis (n = 7, 10.7%), ampullary stenosis (n = 1, 1.5%),tubercular nodes (n = 10, 15.3%), hydatid cyst at theporta (n = 1, 1.5%).

3. Malignant causes: Carcinoma of the head of the pan-creas (n = 18, 27.6%) and carcinoma of the ampulla ofVater (n = 20, 30.7%). Other malignant causes likecholangiocarcinoma of the distal common bile duct (n =2, 3%), neuroendocrine tumor of ampulla of Vater (n =1, 1.5%), neuroendocrine tumor of pancreatic headwith obstructive jaundice (n = 1, 1.5%), lymphoma (n =2, 3%) and metastasis (n = 2, 3%).

4. The characteristic features of each with classical exam-ples and distinguishing features based on imaging.MDCT vs. MRI and ERCP- pros and cons of differentmodalities.

5. Pitfalls in imaging and mimics.CONCLUSION: MDCT plays an important role in theassessment of causes of double duct sign. It is importantto recognize the etiology, with ancillary findings and iden-tify pitfalls and mimics to avoid misdiagnosis

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SE 01 AB-24CT pneumoenterocolonography - a new alternatetechnique for the evaluation of small bowelNaveen Kalra, Priyanka Naranje, Ajay Gulati,Rakesh Kochhar, Niranjan KhandelwalPGIMER, India. priyanka11sh@gmail.com

BACKGROUND: The small intestine is the most chal-lenging segment of the abdomen to examine, due to itslength, caliber, overlap of loops and peristalsis. Amongstthe many radiological armamentariums available for eval-uating small bowel, computed tomographic (CT) entero-clysis and enterography are considered comprehensivetechniques. However, a large volume of polyethylene gly-col solution orally is often not well tolerated by mostpatients causing difficulty in diagnostic interpretation ofinadequately distended loops.PURPOSE: The purpose of this pictorial essay is not onlyto describe the novel technique of CT pneumoentero-colonography but also to illustrate the imaging appear-ances of small bowel abnormalities like tuberculosis withthis method. The technique combines the advantages ofboth the excellent spatial resolution of MDCT and optimalbowel distention achieved by using carbon dioxide (CO2)as the negative enteral contrast.TECHNIQUE AND FINDINGS: Using an administratorset for enteroclysis and colon insufflations (VIMAPTechnologies, Girona, Espagne), a silicone 2-way balloonenteroclysis catheter was positioned in the proximaljejunum under fluoroscopic guidance. Per rectal insertionof the three way Foleys balloon catheter was done in theCT suite and using automated CO2 insufflator (Vimaptechnologies VMX-1010A) distension of small and largebowel was performed simultaneously. Contrast enhancedCT was performed in portal venous phase and delayedphase (120 sec) on a 256 channel multi-detector row CT(iCT 256, BRILLIANCE; Philips Medical Systems, TheNetherlands) in supine position. This method was usefulfor detecting strictures, intestinal wall abnormalities aswell as extraintestinal manifestations. The method has apotential to reconstruct flythrough images and intestinaloverview of small bowel loops. An automated CO2 deliv-ery system reduces patient’s discomfort and results inadequate bowel distension. Peristaltic segments couldalso be differentiated comparing two phases of acquisi-tion.CONCLUSION: CT pneumoenterocolonography withantegrade and retrograde CO2 insufflation technique hasthe potential to permit the evaluation of the entire smallbowel including the terminal ileum and ileocecal junction.

SE 01 AB-26CT findings of tuberculous peritonitis inMongolian populationBulgan Chogjinpalam1, Tungalag Lkhagvajav2,Lkhamjav Mendbayar2, Jambajamts Bilegt2,Amarmend Baldanjamts3, Enkhtamir Purevdorj3,Lkhagvabayar Byadran2

1Grand Med Hospital, 2UB Songdo Hospital, 3NationalCenter for Communicable Diseases, Ulaanbaatar,Mongolia.enkhtamiraaa@yahoo.com

INTRODUCTION: Tuberculosis has been declared aglobal emergency by the World Health Organization andis the most important communicable disease worldwide.In 2013, 4111 new TB cases have registered in Mongolia,which means the TB incidence per population of 10000was 14.6. Compared to the previous year (2012), thenumber of new TB cases has been increased by 167.Among all new TB cases 57.3% were pulmonary and42.7% were extrapulmonary. The abdomen is the mostcommon site of extra-pulmonary tuberculosis, and peri-toneal disease is the most common form in the abdomen.Radiological investigations play a very important role inthe diagnosis of abdominal tuberculosis. Introduction ofCT findings of abdominal TB to Mongolian health servicehelps to improve the making of diagnosis.OBJECTIVE: The aim of this study was to describe thecomputed tomography (CT) findings in patients withdemonstrated peritoneal tuberculosis (TB).MATERIALS AND METHODS: UB Songdo Hospital isthe first and only 64-MDCT operating hospital in Mongoliafrom 2007. This research was a retrospective study of 10patients were scanned with abdominal CT in UB SongdoHospital of Mongolia in the period between January 2011and December 2013 whose diagnosis were clinically orpathologically proved by laparoscopy as tuberculous peri-tonitis. All 10 patients had been cured with TB treatment.The CT images were reviewed on a PACS viewer andevaluated for the abdominal patterns of mesentery,omentum, peritoneum the presence of ascites, lym-phadenopathy and splenomegaly. Study population con-sisted of 2 men and 8 women with mean age of 32.7years (range, 19 to 63 years).RESULTS: The involvement of mesentery, omentum,peritoneum and ascites were present in all patients. Themost common pattern of mesenteric changes was thick-ening of the mesenteric leaves in 8 patients (80%) andthe most common pattern of omental abnormalities wassmudged omentum in 8 patients (80%). The peritonealsmooth uniform thickening pattern was the most commontype (90%). The splenomegaly in 3 patients (30%) andlymphadenopathy in 3 patients (30%) were present.CONCLUSION: CT findings in the patients with tubercu-lous peritonitis include the combination of free ascites,mesenteric thickening, smudged pattern of the omentalinvolvement and smooth uniform thickening of the peri-toneum. The evaluation of CT findings of TB peritonitis inMongolia will help clinicians in planning diagnosis andcontrolling treatment results.

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SE 01 AB-28Percutaneous catheter drainage of intra-abdominal abscesses solely using US-guidance:the feasibility and safetyHyeran Hyun1, Jeong Kyong Lee2, Jia Kwon1

1Ewha Womans University Mokdong Hospital, 2EwhaWomans University School of Medicine, Korea. kyongmd@ewha.ac.kr

PURPOSE: To evaluate the feasibility and safety of per-cutaneous catheter drainage (PCD) of intra-abdominalabscesses solely using ultrasound (US)-guidance.MATERIALS AND METHODS: Clinical and image datareviewed on 47 consecutive patients who underwentPCD of intra-abdominal abscesses solely using US-guid-ance through the whole procedure without fluoroscopicguidance for a 5-year period. Technical success and pro-cedural complications were recorded and retrospectivelyanalyzed.RESULTS: Forty-seven patients underwent PCD withUS-guidance alone due to the need for bed-side proce-dure in intensive care units or fluoroscopic guidanceunavailable. Forty-seven abscesses were identified in 47patients. The location of the abscesses were intrahepatic(n = 5), perihepatic (n = 8), lesser sac (n = 6), gallbladder(n = 2), left subphrenic (n = 3), subhepatic (n = 2), pericol-ic (n = 18), and pelvic (n = 3). PCD was placed in the tar-get area of all patients under real-time US-guidance. Allinstruments including needle, guidewire, dilators,catheters were well-visualized on US. One catheter wasdisplaced from the intrahepatic abscess in hepatic seg-ment VI the following day. Therefore, PCD with US-guid-ance alone was successful in 46 of 47 patients (97.8%).No procedure-related complications occurred.CONCLUSION: PCD of intra-abdominal abscess solelyusing US-guidance is a feasible and safe method withhigh technical success rate and no complication. US-guidance can make PCD procedure be more effective byproviding multiplanar anatomical detail of the target areaand real-time monitoring through the entire path of theinstruments avoiding critical organs such as major ves-sels or bowel without radiation exposure. The techniquecan be done at the bedside and will be effective inpatients who are in intensive care unit and not able tomove into interventional suite.

SE 01 AB-29Early detection of pelvic recurrence after rectalcancer surgeryJoo Hee Kim, Jae-Joon Chung, Jeong-Sik Yu, Eun-Suk Cho Gangnam Severance Hospital, Korea. pavane@yuhs.ac

- Patterns of pelvic recurrence after rectal cancer surgery- Imaging modalities for early detection of pelvic recur-

rence- Tumor resectability of the recurrent rectal cancer on

pelvic MRI- High risk factors of pelvic recurrence on preoperative

MRI and postoperative clinical data- Techniques of high resolution pelvic MR and PET-CT

SE 01 AB-30Percutaneous US-guided core biopsy ofuncommon targets of the abdomen: feasibilityand safetyHyeran Hyun1, Jeong Kyong Lee2, Jia Kwon1

1Ewha Womans University Mokdong Hospital, 2EwhaWomans University School of Medicine, Korea. kyongmd@ewha.ac.kr

1. To describe the expansion of feasibility in the applica-tion of a core biopsy on uncommon targets of abdomenincluding retroperitoneum, lymph node, spleen, omen-tum, etc. under US-guidance.

2. To suggest the tip for the successful biopsy.3. To discuss the feasibility and safety of the core biopsy.

SE 01 AB-32Role of Imaging for cancers of unknown primarysitesJimi Huh, Kyung Won Kim, Hyoung Jung Kim, Jong Seok Lee, Seong Ho Park, Hyun Kwon Ha Asan Medical Center, Korea. medimash@gmail.com

With advances in imaging, pathology and molecular med-icine, the diagnosis and management of cancers ofunknown primary sites (CUPs) have evolved into morepersonalized and site-specific therapies. A multidiscipli-nary integrated approach between oncologists, patholo-gists and radiologists is extremely important. Imagingplays an essential role for the multidisciplinary approach.In this presentation, we will discuss the stepwise diagnos-tic approach for CUPs and the role of imaging in CUPdiagnosis and management. In addition, we discuss theutility of immunohistochemistry, serum tumor markersand molecular profiling for the optimized care of CUPpatients.

SE 01 AB-33MDCT findings in acute pancreatitis: pictorialreview based on 2012 revision of AtlantaclassificationSonali Sethi1, Sunil Puri2, Meenakshi Prakash2, Amit Kumar Verma2, Ruchi Gupta2, Richa Tiwari2,Surabhi Gupta2, Richa Yadav2

1Govind Ballabh Pant Institute of Post GraduateMedical Education and Research, 2GIPMER, India. sonali.sethi01@gmail.com

INTRODUCTION: Acute pancreatitis is conventionallycategorized as mild or severe disease. Several classifica-tion systems have been proposed with AtlantaClassification being the most commonly used. A revisedclassification has been proposed for better clinical under-standing and predicting future course of disease.MATERIALS AND METHODS: MDCT (256 slice dualsource CT scanner) using the pancreatic protocol wasdone in cases of acute pancreatitis. The imaging featureswere studied in the light of standardized definitions. Thepatient were categorized into various categories based onrevised Atlanta classification. CT findings and clinical out-come was correlated.

RESULTS: A spectrum of imaging findings was seenranging from mild to severe changes. The data is beingpresented in formed of pictorial review. The CT severitydirectly co related with the clinical severity and long termout outcome. Patient with low scores recovered com-pletely, increasing CT severity correlated with prolongedstay, morbidity, and mortality in some casesCONCLUSION: Revised Atlanta classification is a potentimaging tools which standardizes the CT description inacute pancreatitis. It improves communication with clinicalmanagement team and enables them to formulate appro-priate management.

SE 01 AB-34US features suggestive of hepatocellularcarcinoma in at-risk patients under surveillanceChansik An, Mi-Suk Park Severance Hospital, Korea. radpms@yuhs.ac

PURPOSE: To determine ultrasonography (US) featuresfavoring hepatocellular carcinoma (HCC) and benignlesions in patients with chronic liver disease undergoingsurveillance US.MATERIALS AND METHODS: Among a total of 8619patients undergoing HCC surveillance from 2008 to 2013at a tertiary hospital, 177 patients were identified in whomhepatic masses were confirmed with CT or MRI per-formed within a month after suspicious nodules had beendetected on surveillance US. Of 188 nodules found inthese 177 patients, 87 and 101 proved to be HCC andbenign lesions, respectively. Two abdominal radiologistsretrospectively and independently reviewed all USimages to determine the number of nodules, morphology,the characteristics of rim, echogenicity, and the presenceof posterior acoustic enhancement. The maximum diame-ter of each tumor was measured by one radiologist. Chi-square test was performed to identify determinants for dif-ferentiating between HCC and benign lesions.Interobserver agreement was analyzed using Kappa’sstatistics.RESULTS: Tumor size (p < 0.001), morphology, rimcharacteristics, and echogenicity were significantly asso-ciated with the high probability of HCC. All of 16 tumors <1 cm and 51 (50.5%) of 67 tumors of 1-2 cm werebenign, whereas 71 (81.6%) of 105 tumors > 2 cm wereHCC (p < 0.001). Nodular lesions with indistinct marginwere more likely to be benign (39 [81.3%] and 34 [70.8%]of 48 lesions for Reviewer 1 and 2, respectively), whilemultinodular confluent or infiltrative lesions were morelikely to be HCC (32 [91.4%] and 29 [82.9%] of 35 forReviewer 1 and 2) (p < 0.001). Hyperechoic rim wasmore frequently seen in benign lesions (12 [92.3%] of 13and 12 [75%] of 16) while thick hypoechoic rim in HCC(31 [83.8%] of 37 and 44 of 51 [86.3%]) (p < 0.001).Homogeneously iso- or hyperechogenicity was more fre-quently seen in benign lesions (68 [72.3%] of 94 and 59[74.7%] of 79) while mosaic pattern in HCC (23 [92%] of25 and 21 of 28 [75%]) (p < 0.001). Interobserver agree-ment was moderate for all these significant determinants(k = 0.413-0.576).CONCLUSION: In patients undergoing surveillance USfor HCC, tumor size < 1 cm, indistinct margin seen in

nodular lesions, and hyperechoic rim are more frequentlyseen in benign lesions, while multinodular confluent mor-phology, mosaic pattern, and thick hypoechoic rim couldbe suggestive of HCC.

SE 01 AB-35How to approach pancreatic cystic lesions-differential diagnosis on imageIsmail Mese1, Isa CAM1, Yonca Anik1, Gul Ozbek2,Burcu Zeren1, Tugce Agirlar1

1Kocaeli University School of Medicine Department ofRadiology, 2Kocaeli University School of MedicineDepartment of Pathology, Turkey.ismail_mese@yahoo.com

BACKGROUND: With advanced imaging technologies,cystic lesions of the pancreas are being recognized withincreasing frequency. The pseudocyst is the most com-mon cystic mass of the pancreas but different pathologicentities can manifest in a similar manner. Understandingtheir radiologic and pathologic features is important fordiagnostic and therapeutic purposes. This exhibit displaysa variety of radiologic and pathologic features in variouspancreatic cystic lesions. Typical and atypical radiologicfeatures in a correlation with pathologic findings are illus-trated with emphasis on the imaging features allowing aspecific diagnosis.PURPOSE: To describe the variety of cystic pancreaticlesions. To identify the most common CT and MR imag-ing features of these masses. To discuss the importanceof differentiating clinical, radiological, and histopathologi-cal findings.MATERIALS AND METHODS: Retrospective study wascarried out to study the various cross sectional imagingfindings using) computed tomography (CT) and magneticresonance imaging (MRI) studies for Pancreas cysticlesions over a period of four year, 53 patients (Jan 2011 -April 2015).RESULTS: In our study A total of 53 patients were identi-fied with pancreatic cystic lesions on imaging. 40 patientswith pseudocysts (prior history of pancreatitis). Theremainder 13 had features consistent with cystic neo-plasm of the pancreas. 4 patients with Serous cystadeno-ma, 4 patients with Mucinous cystic neoplasm, 3 patientswith Intraductal papillary mucinous tumor (IPMT), 1patient with solid pseudopapillary tumor (SPT), 1 patientwith solid tumors with cystic component/degeneration.T1/T2-weighted MR image, MRCP reconstruction andMDCT scans are routinely used. MRI has proved superiorto CT in pseudocysts definition. On the contrary, MDCTseems sufficient while defining mucinous neoplasmshowing enhancing mural nodules. Serous cystic neo-plasms showing T2 hyperintensity and signal void due thecalcifications may be equally studied by means of CT orMRI. In the end, secretin-enhanced MRI proved to besuperior than MDCT while studying IPMNs, originatingboth from main or secondary ducts. CONCLUSION: CT and MR imaging are excellentmodalities for the initial detection as well as the character-ization of cystic pancreatic lesions. Radiology is essentialto help determine the appropriate management of thelesion.

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SE 01 AB-36Imaging features of hepatocellular carcinoma ingadoxetic acid-enhanced MR: correlation withprognostic factorJei Hee Lee, Jai Keun Kim, Min Jung Park, Bohyun Kim Ajou University School of Medicine, Korea. radljh@ajou.ac.kr

PURPOSE: To review the imaging features of hepatocel-lular carcinoma (HCC) in gadoxetic acid-enhanced MRimaging (GAeMR) and correlate with prognosis ofpatients with HCC.BACKGROUND: With improvements in magnetic reso-nance (MR) imaging technology, imaging plays criticalrole in diagnosis of HCC. Until now only the size andnumber criterion have been utilized in prognostic factortumor staging. GAeMR including hepatobiliary phase(HBP) image shows higher sensitivity for HCC detectionand higher diagnostic performance compared with extra-cellular contrast agent-enhanced MR. Several MR imag-ing features are useful for pretreatment estimation ofprognosis of patients with HCC such as presence of cap-sule appearance or intratumoral fat. Role of imaging fea-tures have not been validated yet in larger studies.IMAGING FINDINGS: Among the various imaging fea-tures of HCC with gadoxetic acid-enhanced MR imaging(GAeMR), poor prognostic imaging features are like this:rim-enhancement in the arterial phase, peritumor arterialenhancement, peritumoral hypointensity in HBP, irregulartumor margin in HBP, satellite nodules, gross vascularinvasion, gross bile duct invasion, lower tumor-to-liver sig-nal intensity ratio in HBP, high signal intensity in DWI.Imaging features like capsule appearance and intratu-moral fat in GAeMR suggest favorable prognosis.CONCLUSION: GAeMR may be useful in diagnosis ofHCC and imaging features can be useful parameter topredict prognosis in HCC patients.

SE 01 AB-38Safety and usefulness of contrast-enhanced US-guided biopsy of retroperitoneal lesionsJi Young Woo, Je Young Cho, Hye-Suk Hong, Ik Yang, Yul Lee, Ji-Young Hwang, Han Myun Kim Kangnam Sacred Heart Hospital, Korea. baccas@hallym.or.kr

PURPOSE: To assess the safety and effectiveness ofpercutaneous contrast-enhanced ultrasound (CEUS)guided biopsy of retroperitoneal lesions.MATERIALS AND METHODS: We retrospectively inves-tigated puncture success rates based on findings of diag-nostic imaging, rate of confirmed diagnosis, frequency ofchanges in therapeutic plans and incidence of complica-tions among 13 patients after percutaneous CEUS-guid-ed needle biopsy using an 18G needle between January2012 and October 2013.RESULTS: The pre-biopsy diagnoses for the 13 subjectswho underwent percutaneous needle biopsy included:pancreatic tumor (n = 9), lymphoma (n = 1), lymph nodemetastasis from lung cancer (n = 1), lymph node metasta-sis from thyroid cancer (n = 1), and other malignancy (n =1). The results of diagnostic imaging indicated that all

punctures were successful. The diagnoses were con-firmed in all patients. Histopathological findings confirmedpancreatic adenoca (n = 7), neuroendocrine cancer ofpancreas (n = 1), mucinous cystadenoca of pancreas (n =1), lymphoma (n =1), paraganglioma (n = 1), neurogenictumor (n = 1), and retroperitoneal fibrosis (n = 1).Therapeutic strategies were altered based on the resultsof CEUS-guided needle biopsies in 5 of the 13 patients(38.5%). None of the patients had any complication fol-lowing US-guided needle biopsy.CONCLUSION: CEUS-guided biopsy of retroperitoneallesion is an efficacious and safe technique. It couldincrease clinician’s confidence in the choice and changeof treatment.

SE 01 AB-39CT findings of Internal and external herniafocused on anatomical landmarksHwayoung Song, Min-Jeong Kim, Hong-Il Ha,Kwanseop Lee Hallym University Sacred Heart Hospital, Korea. drkmj@hallym.or.kr

Abdominal wall hernias are common disease in theabdomen and may be complicated by small bowelobstruction, incarceration, strangulation, and perforation.Most abdominal wall hernias are surgically repairedbecause of the risk of developing complications. MDCT(Multi-detector row CT) with its reformatted images pro-vides excellent anatomical delineation of the abdominalwall and peritoneal cavity, thereby allowing accurate diag-nosis of type of hernias, their contents within hernia sac,and complications.This exhibit illustrates the characteristic CT findings of thevarious types of internal and external hernias, withemphasis on anatomical landmarks of various hernias onMDCT. The multiplanar reformatted images of MDCT areespecially helpful for excellent anatomical delineation andoptimal treatment planning.

SE 01 AB-41Prediction of anastomotic leakage afterpancreaticoduodenectomy by preoperativedynamic CT imagingJung-Hyun Kang, Jeong-Sik Yu, Jae-Joon Chung,Joo Hee Kim, Eun-Suk Cho Gangnam Severance Hospital, Korea. yjsrad97@yuhs.ac

PURPOSE: To evaluate the ability of dynamic CT in pre-diction of pancreatic texture and pancreatic anastomoticfailure after pancreaticoduodenectomy.MATERIALS AND METHODS: A review of 79 consecu-tive patients with preoperative dynamic CT between 2006and 2011 was performed. CT attenuation values weremeasured on unenhanced images and images obtainedin the arterial and delayed phases after contrast adminis-tration. The two parameters were calculated as (delayedphase-unenhanced phase/unenhanced phase) and(delayed phase-unenhanced phase/arterial phase-unen-hanced phase). Patients were divided into two groupswith an anastomotic leakage group (grade A/B/C) and

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those with no PAF. Logistic regression models were usedto evaluate parameters for an anastomotic leakage forunivariate analysis.RESULTS: An anastomotic leakage was observed in 32patients with average of (delayed phase-unenhancedphase/unenhanced phase) and (delayed phase-unen-hanced phase/arterial phase-unenhanced phase) of 1.1and 0.7 respectively, while no PAF group showed 2.0 and1.2 respectively. In univariate analysis, (delayed phase-unenhanced phase/unenhanced phase) and (delayedphase-unenhanced phase/arterial phase-unenhancedphase) were significant predictors for the development ofan anastomotic leakage (p = 0.009 and 0.005, respective-ly).CONCLUSION: Dynamic CT enhancement pattern forpancreas can be a powerful tool to predict the risk ofdeveloping an anastomotic failure following pancreatico-duodenectomy.

SE 01 AB-42Effect of liver volume on image quality of hepaticarterial phase in low kVp liver CTYang Shin Park, Chang Hee Lee, Jongmee Lee, Jae Woong Choi, Kyeong Ah Kim, Cheol Min Park Korea University Guro Hospital, Korea. chlee86@hanmail.net

PURPOSE: Object size and object densities are well-known important determinants of X-ray absorption. In liverCT, liver volume may have influence on the gross objectdensity and size at the liver level being imaged.Therefore, we evaluated whether individual liver volumemay have impact on image quality of low kVp liver CTduring the hepatic arterial phase.MATERIALS AND METHODS: Seventy-seven patients(M:F = 72:5; age range, 40-79 years) who underwentclinically indicated liver dynamic CT examination wereenrolled in the study. 80 kVp CT and intermediate tubecurrent was performed in the late hepatic arterial phaseusing a 320-detector row scanner with AIDR 3D recon-struction. Based on the CT volumetric measurement andestimated liver volume calculation, CT liver volume-to-estimated volume ratio (CTLVratio) was calculated. On anaxial scan of hepatic arterial phase at the level of rightportal vein, the ratio of the liver-to-abdominal area (LAratio)was calculated. Then, on the same selected image, themean image noise and contrast-to-noise ratios (CNRA) forthe aorta were assessed. Decreased liver volume wasdetermined when CTLVratio was less than 0.9 or LAratiowas less than 0.22. Correlations between CTLVratio,LAratio and image quality parameters were evaluated.Mean image quality parameters were compared betweendecreased liver volume group and normal liver volumegroup.RESULTS: In all patients, 46 patients had decreasedliver volume and 31 patients had normal liver volume.CTLVratio was significantly correlated with LAratio (r = 708;p = 0.001). CTLVratio and LAratio showed inverse correla-tion with image noise (r = -0.322 and -0.420; all ps <0.05) and positive correlation with CNRA (r = 0.239 and0.281; all ps < 0.05). Patients with decreased liver volumeshowed significantly higher mean image noise (13.61 vs.10.83; p = 0.001) and lower mean CNRA (39.34 vs.

49.10; p = 0.001) than those with normal liver volume.CONCLUSION: Liver volume has influence on imagenoise and CNRA in low-tube-voltage liver CT duringhepatic arterial phase.

SE 01 AB-45Ischemic colitis and mimickersDong Myung Yeo, Geon Park The Catholic University of Korea, Daejeon St. Mary’sHospital, Korea.duehdaud@gmail.com

PURPOSE: To identify clinical features and computedtomographic (CT) findings to differentiate ischemic colitisand mimickersCONTENT ORGANIZATION: 1. Typical findings of ischemic colitis.2. Mimickers

1) Infectious colitis2) Enterohemorrhagic colitis3) Pseudomembranous colitis4) Ulcerative colitis

3. Differential points: Clinical and radiologic features ofischemic colitis for differentiating with other colitis mim-icking ischemic colitis.

CONCLUSION: Various colitis may mimic ischemic colitison clinical features or CT images. Attention to diagnosticclinical or radiologic clues is essential in making an accu-rate radiologic diagnosis or narrowing differential diagno-sis.

SE 01 AB-46Acute RLQ pain in the patients with a history ofappendectomy: appendicitis without appendix?-- evaluation of stump appendicitis with UStechniqueJinyoung Chang, Min-Jeong Kim, Sung Hye Koh,Kyoon Soon Jung, Kwanseop Lee Hallym University Sacred Heart Hospital, Korea. kwanseop@hallym.or.kr

PURPOSE: 1. To understand the rare possibility of stump appendicitis

in the patients with a history of appendectomy.2. To discuss the advantage of US technique to evaluate

stump appendicitis over CT.3. To identify US findings of appendiceal stump with vari-

ous conditions.4. To compare US findings of stump appendicitis with

mimicking disease entities.TABLE OF CONTENTS: 1. General understanding of the appendectomy and

laparoscopic appendectomy2. US Techniques for evaluation of appendiceal stump3. Appendiceal stump in various conditions and stump

appendicitis1) Normal appediceal stump2) Postop. findings of appendiceal stump3) Stump appendicitis / with perforation4) Compare with CT images

4. Pitfalls of stump appendicitis1) Cecal diverticulitis

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2) Cecal inflammation3) Primary epiploic appendicitis4) Terminal ileitis

SE 01 AB-47Difficulty in differentiating small hepaticabscesses from malignant mimickers usingdynamic contrast-enhanced MRIYong pyo Kim, Jeong-Sik Yu, Jae-Joon Chung, Joo Hee Kim, Eun-Suk Cho Gangnam Severance Hospital, Korea. YJSRAD97@yuhs.ac

PURPOSE: To assess feasibility of using MR imagingfindings for differentiation between small hepatic abscess-es from metastases.MATERIALS AND METHODS: Ninety-eight liver massesup to 5.5 cm in diameter, including pathologically or clini-cally proven 50 abscesses from 33 patients and 48metastases from 34 patients were analyzed in the study.Gadoxetic acid-enhanced 1.5T MRI was performed in allpatients. Each group was divided into two subclasses onthe basis of size (class 1; ≤ 2 cm, class 2; > 2 cm). Thefollowing MR findings were evaluated: Perilesional infiltra-tion or edema on T2-weighted images, and peripheralhyperemia or perilesional enhancement on dynamicimages. Additionally, enhancement pattern (double targetappearance, peripheral washout) on gadoxetic acid-enhanced arterial, portal, and 3-minute late phases andperipheral diffusion restriction on diffusion-weightedimages were assessed. These MRI findings were com-pared between two groups in each subclass via Student’st test as well as univariate and multivariate analysis.RESULTS: All MRI features of abscesses in class 2(lesion size ≤ 2 cm) were not significantly different (p >0.05) in comparison with those of metastases. A peripher-al rim of restricted diffusion on ADC map (p = 0.015) andperipheral washout sign on dynamic images (p = 0.002)were independently significant findings for differentiatingthe two groups in class 1 (lesion size > 2 cm).CONCLUSION: Dynamic MR and diffusion-weightedimagings are useful for differentiating hepatic abscessesfrom metastases, but accurate differentiation of smallhepatic abscesses from metastases less than 2 cm indiameter can still be challenging due to infrequentlyobserved and overlapped imaging features of MR.CLINICAL RELEVANCE: These observations show thatdynamic MRI and diffusion-weighted imaging characteris-tics are useful in differentiating hepatic abscesses frommetastases, but suggest the need for establishing sizespecific imaging criteria for the small lesion characteriza-tion.

SE 01 AB-48Illustrative review of US-guided core needlespleen biopsySo Yeon Park, Jae Woong Choi, Yang shin Park,Jongmee Lee, Chang Hee Lee, Kyeong Ah Kim,Cheol Min Park Korea University Guro Hospital, Korea. iasy1124@naver.com

BACKGROUND: Core needle biopsy is rarely performedon the spleen in anticipation of complications such ashemorrhage. However US-guided biopsy of the spleencan be a safe diagnostic option if performed with appro-priate techniques. In this exhibit, we demonstrate diversecases of splenic pathology confirmed by US-guided coreneedle biopsy.LEARNING OBJECTIVES: 1. To learn technical aspects of US-guided spleen biopsy:

How to minimize complications.2. To review various benign and malignant disease enti-

ties of the spleen confirmed by core needle biopsy.3. To understand possible complications following the

spleen biopsy.CONCLUSION: US-guided core needle biopsy can be asafe and reliable diagnostic modality to verify benign andmalignant diseases and prevent unnecessary surgicalintervention.

SE 01 AB-49Radiologic findings of multiple myeloma inabdominal imagingYousun Won, Boemha Yi, Hae-Kyoung Lee, Min Hee Lee, Seo-Youn Choi Soonchunhyang University Bucheon Hospital, Korea. rad1995@schmc.ac.kr

We’d like to review multiple myeloma and present theradiologic features of multiple myeloma in intraperitonealorgans including liver, spleen, stomach, and bowel, aswell as that of retroperitoneal organs such as kidney, pan-creas, genital organs, and retroperitoneal space with mul-tiple radiologic modalities.

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SE 01 AB-50Added value of point shear-wave elastography inthe diagnosis of acute cholecystitisJi Eun Kim, Dae Seob Choi, Kyung Soo Bae, Jae Min Cho, Chi-Young Jeong, Hyun Ok Kim Gyeongsang National University School of Medicine,Korea. choids@gnu.ac.kr

PURPOSE: To evaluate the added value of point shear-wave elastography (pSWE) in diagnostic performance ofconventional B-mode US imaging for diagnosis of acutecholecystitis.MATERIALS AND METHODS: This prospective studywas conducted with Institutional Review Board approval,and written informed consent was obtained. B-mode USand pSWE were performed in 114 patients who were clin-ically suspected of having acute cholecystitis. pSWE wasperformed in the right hepatic parenchyma within 2 cm(0-1 cm, 1-2 cm) lateral to the gallbladder (GB) at the 1-4 cm depth from the liver surface. A median value of 10reliable measurements (success rate ≥ 60% andinterquartile range < 30% of median value) was calculat-ed for each site. Qualitative analysis regarding suggestivefindings of acute cholecystitis was also conducted. Twoobservers independently reviewed conventional B-modeUS images, and subsequently reviewed combined B-mode US and pSWE images after being told of the cut-offshear wave velocity (SWV) value. A four-point scale forlikelihood of acute cholecystitis was used. The diagnosticperformance was compared by using receiver operatingcharacteristic (ROC) curves, accuracy, sensitivity, speci-ficity, positive predictive value (PPV), and negative pre-dictive value (NPV) analysis.RESULTS: The presence of pericholecystic fluidachieved the highest specificity (100%) for diagnosis ofacute cholecystitis, followed by increased Doppler signalof GB wall (94%), striated intramual lucency (72%),tensely distended GB (47%), and internal echogenicdebris (32%). Mean SWVs of acute cholecystitis groupwere significantly higher than those of control group (1.55vs. 1.03, 1.38 vs. 1.04 m/sec, p < 0.0001). The areaunder ROC curve of observers 1 and 2 improved signifi-cantly from 0.770 and 0.757 to 0.955 and 0.954, respec-tively, after additional review of pSWE images (p <0.0001). In addition, diagnostic accuracy, sensitivity,specificity, PPV, and NPV of combined B-mode US andpSWE images were higher than those of B-mode USimages alone.CONCLUSION: Addition of pSWE imaging to B-modeUS imaging improves diagnosis of acute cholecystitiswhen compared with conventional B-mode US imagingalone.CLINICAL RELEVANCE/APPLICATION: Adding pSWEimaging to conventional B-mode US imaging can improveaccuracy in the diagnosis of acute cholecystitis allowingdetection of early acute cholecystitis and exclusion ofnon-inflamed GB that would be overlooked on conven-tional US images.

SE 01 AB-51MDCT feature of small bowel obstruction causedby the Meckel’s diverticulumHyung Won Lee, Young Mi Ku, Su Lim LeeThe Catholic University of Korea, Uijeongbu St. Mary’sHospital, Korea. cherrybalm@hanmail.net

PURPOSE: This study reviews the CT findings of smallbowel obstruction caused by the Meckel’s diverticulum.MATERIALS AND METHODS: A retrospective reviewwas done from 2006 through 2014, 10 patients werepathologically proven as Meckel’s diverticulum. Amongthem, 10 patients were manifested as small bowel ileus.10 patients were finally included study groups. They were9 male patients and one female patient. Their age report-ed from 2 to 44 years. 9 patients did not have previousabdominal operation history, but one patient receivedappendectomy 10 years ago. MDCT was performed in allpatients of study group. Surgical treatment was per-formed in all patients in 8 days from the day of admission.RESULTS: All patients complained about abdominalpain. For the additional pain, three patients had diarrhea,five had vomiting, one has fever up to 39.5℃. For theMDCT feature, All patients were manifested as smallbowel obstruction with high grade (n = 5) and low grade(n = 5). Meckel’s diverticulum was identified in five of the10 patients on the pre-operative MDCT. Of the five diver-ticula identified, there were evidence of diverticulitis (n =3), diverticular torsion and necrosis (n = 1) and invertedMeckel’s diverticulum (n = 1). In the five patients in whomthe diverticulum was not visualized, there were evidenceof converging beak-shaped ileum (n = 2), pneumoperi-toneum (n = 1), jejuno-jejunal intussusception (n = 1), anddiffuse dilated jejunal loops (n = 1).CONCLUSION: Although intestinal obstruction is the sec-ond most common complication of Meckel’s diverticulum,the diagnosis is rarely made preoperatively. The diagno-sis can be made with certainty only if the diverticulum isvisualized at the site of obstruction. However, the diagno-sis is difficult without visualized diverticulum. In this set-ting, the CT features are similar to those of small intesti-nal obstruction secondary to postoperative adhesions.MDCT take a useful role to diagnosis of small bowelobstruction caused by the Meckel’s diverticulum. Andradiologist should be familiar with the possible imagingappearance of complicated Meckel’s diverticulum tomake an early and exact diagnosis.

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SE 01 AB-52Abdominal wall endometrioma: a diagnosticdilemmaBushra Johari, Mazuin Mohd Razalli, Sabrilhakim SidekMedical Imaging Unit, Faculty of Medicine, UniversitiTeknologi MARA, Selangor, Malaysia, Malaysia. bhkimy_7@hotmail.com

Abdominal wall endometrioma in a Caesarean sectionscar is an infrequent type of extrapelvic endometriosis. Aperiodic painful mass located in the scar of a Caesareansection is a typical sign, however its rarity can pose adiagnostic dilemma. We report a patient who was initiallyclinically misdiagnosed as an incisional hernia. Imaging,namely ultrasonography and magnetic resonance imag-ing (MRI) however revealed typical findings of abdominalwall endometrioma. This was later confirmed by thehistopathological findings after excision of the lump. Thisclinical case exemplifies a diagnostic dilemma, emphasiz-ing on the typical imaging findings of abdominal wallendometrioma.

SE 01 AB-53Grading of fatty liver on US and its correlationwith lipid profile and blood glucose levels inindividuals undergoing routine health checkupAmey Narkhede, Aruna Karnawat, Surendar Alwala,Anjani Kumar Yashoda Hospital, Secunderabad, Telangana, India.ameyblue@yahoo.in

INTRODUCTION: Fatty liver is an important hepatic dis-ease which is a threat to public health. Although mild fattyliver is not of much clinical significance but on progressingto moderate and severe fatty liver it can lead to necrosisand fibrosis and further to cirrhosis causing significantmorbidity and mortality. Although liver biopsy remains thegold standard, ultrasonographic (US) imaging of liverhelps us to grade the liver according to the severity of fatdeposition noninvasively.OBJECTIVES: To evaluate and confirm the usefulness ofultrasonography for diagnosing fatty liver and to correlatethe different grades of fatty liver with the lipid profile andblood glucose levels in the individuals undergoing healthcheckup.MATERIALS AND METHODS: A total of 154 cases wereincluded in the study. These patients underwent USG ofabdomen and pelvis as a part of routine health checkup.Characterization of their liver into different grades of fattyliver was done. The lipid profile (triglycerides, total choles-terol, HDL, LDL and VLDL) and blood glucose levels(FBS, PPBS) of these patients were investigated whichwere then correlated with the different grades of fattyliver. The p value was calculated using Kruskal-Wallis testand p value < 0.001 was considered as statistically signifi-cant.RESULTS: Out of the 154 patients, 52 patients (33.8%)had Grade 0,66 patients (42.9%) had Grade I, 24 patients(15.6%) had Grade II and 12 patients (7.8%) had GradeIII fatty liver. On statistical analysis, it was found that withincreasing grades of fatty liver the differences in triglyc-eride levels amongst the grades i.e. Grade 0 (129 ± 56),

Grade I (177 ± 89.77), Grade II (318 ± 185.18) andGrade III (469 ± 192.65) were significant (p < 0.001).Similar findings were noted amongst total cholesterollevel (p < 0.001), HDL (p < 0.001) and VLDL (p < 0.001).However the difference in values of LDL amongst differ-ent grades of fatty liver was not significant (p = 0.104).Significant increase in FBS levels (p < 0.001) was alsoobserved with increasing grades i.e. Grade 0 (100.77 ±27.50), Grade I (124.45 ± 50.77), Grade II (172.39 ±72.71) and Grade III (219 ± 33.92). Similarly significantdifference was noted in PPBS levels (p < 0.001).CONCLUSION: We conclude that increasing grades offatty liver show significant correlation with blood glucoselevels and all the parameters of lipid profile except LDLlevel.

SE 01 AB-54Role of US and color Doppler in living donorliver transplantation: current perspective from atertiary care liver hospitalShalini Thapar, Shridhar Sasturkar, Kalpana Bansal,Binit Sureka, Yashwant Patidar, Senthil Venugopal,Kishore GSB, Viniyendra Pamecha, Shiv Sarin Institute of Liver and Biliary Sciences, India. thaparshalini@gmail.com

PURPOSE: To study the role of B mode and colorDoppler ultrasound (US) in the living donor liver trans-plantation program, in relation to the current advancedimaging options like computed tomography and magneticresonance imaging.MATERIALS AND METHODS: All the recipients anddonors (total = 400) who underwent living donor livertransplant (LDLT) were included in the study group. Forthe donor group, preoperative screening US exams forliver fat, breast and pelvis as well as postoperative followup was evaluated. The recipient work up included spleno-portal axis Doppler pre-operatively, intra-operativeDoppler for graft vascularity and postoperative intensiveUS Doppler monitoring of graft appearance, vascularityindices and perihepatic/abdominal collections.Postoperative, recipient and donor follow up with US forvascular and biliary complications as well as US guidedinterventions was also studied. The role of US in theentire transplant program was studied in relation to goldstandards of tertiary imaging care such as intraoperativefindings, CT, MRI, liver biopsy and endoscopic retrogradecholangiopancreaticography (ERCP).RESULTS: Recipient US 1. Preoperative: Number of patients showing True posi-

tive (TP) findings on B mode and portal axis Doppler =196, Number of patients where US was unable todemonstrate findings seen on CT/ MRI/intraoperativelyi.e. were False negative (FN) = 4, Intra-operative: Truepositive Hepatic artery thrombosis = 2, False negativeHepatic artery thrombosis = 1, True positive portal veinstenosis (PVS) = 1

2. Postoperative: True positive Hepatic artery thrombosis(HAT) = 10, False negative (FN) Hepatic artery throm-bosis = 1, False Positive (HAT) = 3, True positive PVS= 1, True positive portal vein thrombosis = 1, True posi-tive biliary strictures with resultant biliary dilatation = 10,

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Postoperative collections detected on sonography =32, Postoperative deep venous thrombosis: TP = 3, FN= 0

Donor US Preoperative pathologies: Total patients = 200, Normalstudies = 196, FN (Missed findings) = 4, Postoperativecomplications; TP = 30 /200, FN = 2/200CONCLUSION: US and color Doppler are cost effective,radiation free and portable bedside modalities which arecrucial tools to run a successful LDLT program. In the eraof CT and MRI, our study has proven high diagnosticaccuracy of sonography which reaffirms that US is hereto stay in the world of advanced imaging practice.

SE 01 AB-55Spectrum of space occupying lesions (SOLs) ofliver with MDCT as diagnostic modalityRicha Tiwari1, Amit Verma2, Ruchi Gupta2, Sonali Sethi2, Neha Nischal2, Sunil Puri2

1GB Pant Hospital, New Delhi, 2GB Pant Hospital,India. tiwariricha219@gmail.com

AIMS AND OBJECTIVES: To study the spectrum ofspace occupying lesions of liver on MDCT abdomen. Tostudy the characteristic imaging features of individuallesions. To study the relative frequency of benign versusmalignant lesions.MATERIALS AND METHODS: A prospective longitudi-nal observational study of 100 patients was carried out.All patients diagnosed and suspicious of liver SOLs onUSG were included in this study. Triple phase CT usingnon-ionic IV contrast and optimized protocol was doneusing 256 slice MDCT.RESULTS: Our experience with 256 slice CT with triplephase imaging has shown it is a promising, fast, accurateand non-invasive imaging modality that can be utilizedeffectively in the evaluation of liver lesions. Out of 100patients studied, male female ratio was 2.3:1. Benignhepatic lesions (60%) were more common than the malig-nant ones (40%) in the ratio of 3:2. The most commonbenign lesions were hemangioma (22%), followed by livercyst (20%), abscess (8%) and most common malignantlesions were metastasis (18%) followed by hepatocellularcarcinoma (15%). Other common lesions were hydatid,FNH and cholangiocarcinoma. MDCT imaging not onlyprovides information about the nature of liver lesion, but

also the extent of lesion, nodal status, distant metastasisand vascular involvement that help in planning the appro-priate therapeutic approach.CONCLUSION: MDCT provides significant advantagesover conventional CT in evaluation of liver lesions asimproved longitudinal spatial resolution allowing highquality non-axial MPR, 3D reconstructions, CT angiogra-phy as well as rapid accurate multiphase imaging. Triplephase enhancement pattern and acquisition of thin slicesprovide a reliable diagnosis with an improved detectionrate of smaller lesions. Thus MDCT imaging is used asthe diagnostic modality of choice in patients with liverSOLs and MR imaging is used as a problem solving tool.

SE 01 AB-56Early gastric carcinoma with signet ring cellcarcinoma versus non-signet ring cellcarcinoma: differentiation with CT imagingfindingsSung Eun Ahn, Sung Kyoung Moon, Seong Jin Park, Dong Ho Lee, Joo Won Lim Kyung Hee University Medical Center, Korea. aquamsk@naver.com

PURPOSE: To assess the capability of CT to assist in thehistopathological differentiation of early gastric carcinoma(EGC) between signet ring cell (SRC) type and non-signet ring cell (NSRC) type.MATERIALS AND METHODS: We retrospectivelyreviewed CT findings in 88 patients with pathologicallyproven SRC- advanced gastric carcinoma (AGC) (n =22), NSRC-AGC (n = 20), SRC-EGC (n = 23), NSRC-AGC (n = 23). We reviewed CT findings of thickened gas-tric wall length, depth, predominantly thickened layer(inner/outer), enhancement degree (low, moderate, andhigh) comparing to the enhancement degree of the liver,enhancement pattern (target/homogeneous/heteroge-neous) with portal and 3 min-delayed phase.RESULTS: Both SRC-AGC and SRC-EGC showed simi-lar enhancement pattern of target enhancement patternon portal phase and high-degree enhancement ondelayed phase. Target enhancement pattern on portalphase and high-degree enhancement on delayed phasewere most common in both SRC-AGC (54.5%, 68.4%)and SRC-EGC (45.5%, 58.3%). Target enhancement pat-tern on portal phase was more common in SRC-EGC(45.5%) than NSRC-EGC (30%) with statistically signifi-cant difference (p = 0.018). High-degree enhancement ondelayed phase was also more common in SRC-EGC(58.3%) than SNRC-EGC (18.2%) with statistically signifi-cant difference (p = 0.003).CONCLUSION: It is difficult to distinguish SRC-EGC fromNSRC-EGC based on the gastric wall thickening on CTimaging alone. But, target enhancement pattern on portalphase and high-degree enhancement on delayed phasecan be useful in differentiation between SRC-EGC thanNSRC-EGC.

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SE 01 AB-58Diaphragmatic hernia after living donor righthepatectomy: an important late donorcomplicationJi-Won Oh, Seung Eun Jung The Catholic University of Korea, Seoul St. Mary’sHospital, Korea. sejung@catholic.ac.kr

PURPOSE: To evaluate the incidence and the clinicaloutcome of diaphragmatic hernia after living donor righthepatectomy, which is still a not-well described donorcomplication.MATERIALS AND METHODS: Three hundred and thirty-six patients (M:F = 202:134; mean age, 38) who under-went abdomen CT between January 2010 and May 2015after living donor right hepatectomy were enrolled in thisstudy. The CT images of these patients were reviewed toevaluate the presence of diaphragmatic hernia. Inpatients with diaphragmatic hernia, the initial CT reportswere verified to check if there were any comments aboutthe diaphragmatic lesion, and the electronic medicalrecords were also reviewed to assess the clinical out-come.RESULTS: The mean time interval between living donorright hepatectomy and the last abdomen CT was 484days (range, 5-3963 days). Diaphragmatic hernia devel-oped in 9 out of 336 patients (2.7%) at a median timeinterval of 173 days (range; 98-488 days) after hepatec-tomy. On the initial CT images, the mean size of thediaphragmatic defect was 2.8 cm (range, 1.1-7.5 cm).Diaphragmatic defects were not mentioned on the initialCT reports of 8 patients (89%). The diaphragmatic herniawas mentioned only on the initial CT report of the patientwith the largest diaphragmatic defect. In all the 6 patientswho underwent follow-up CT, diaphragmatic herniasincreased in size. And among these, 3 patients presentedwith abdominal pain and underwent diaphragmatic repair.CONCLUSION: Diaphragmatic hernia is an importantlate donor complication after living donor right hepatecto-my, with an incidence of 2.7%. A high proportion (33%) ofthese patients developed symptoms and required surgicalrepair of the diaphragmatic defect. Given that thediaphragmatic defect is often missed on the initial CTreport, radiologists should be careful when interpretingabdomen CT in living donor right hepatectomy patients.

SE 01 AB-59Usefulness of contrast-enhanced US indifferential diagnosis of liver abscess:comparison with CTYoogi Cha, Young-Hwan Lee, Jung Hun Lee, Kwon-Ha Yoon Wonkwang University Hospital, Korea. yjyh@wonkwang.ac.kr

PURPOSE: To evaluate the diagnostic performance ofcontrast-enhanced ultrasound (CEUS) in differential diag-nosis of liver abscess with other focal liver lesions in com-parison to other image modalities. Also, to describe theUS findings of liver abscess after second generation con-trast agent injection.MATERIALS AND METHODS: Between March 2012and March 2015, 40 focal liver lesions suspicious ofabscess in 38 patients (M:F = 19:19; mean age, 67.4years; age range, 42-89 years) were evaluated withCEUS (n = 40), contrast enhanced CT (n = 39), and MRI(n = 13). CEUS was performed by either Sonazoid (n =14) or SonoVue (n = 16). Final diagnosis of focal liverlesions were made on combination of biopsy results (n =10), aspiration of pus (n = 20), typical imaging findings,lab findings and clinical course. The diagnostic perfor-mance of CEUS was compared with that of CT.RESULTS: Final diagnosis of focal liver lesions includedliver abscess (n = 31), cholangiocarcinoma (n = 5), hepa-tocellular carcinoma (n = 1), hepatic metastasis (n = 1),eosinophilic abscess (n = 1), focal fat deposition (n = 1).The diagnosis agreement of CEUS, CT with final diagno-sis are 0.938 and 0.547 in k-value (p < 0.05), respective-ly. The numbers of abscesses with peripheral rimenhancement, heterogeneous enhancement, homoge-nous enhancement in arterial phase were 26 (80.6%), 5(16.1%), 1 (3.2%), respectively. All liver abscesses(100%) had central unenhanced area and showedhypoenhancement in delayed phase. Enhancing internalsepta were found in 20 (64.5%) abscesses. Margin of thelesions showed significant difference in abscess andcholangiocarcinoma (p < 0.05). Abscesses showed morewell-defined margin (n = 22, 70.9%) than ill-defined mar-gin (n = 9, 29%).CONCLUSION: Most of liver abscesses showed periph-eral rim enhancement in arterial phase, central unen-hanced area, enhancing internal septa, and hypoen-hancement in delayed phase. CEUS is effective and com-parable imaging modality to CT in diagnosing liverabscess.

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