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647

Meeting

American Roentgen May 1992

Ray Society,

92nd Annual

News

Meeting,

The 92nd annual meeting of the American Roentgen Ray Society was held May 10-1 5, 1 992, at the Marriott Orlando World Center in Orlando, FL. Approximately 200 scientific presentations, 60 instructional courses, and a large and varied selection of scientific and technical exhibits were available to the more than 2000 attendees. The topic of this year’s

subjects underwent lung needle biopsy without specific postprocedural precautions. No statistically significant differences in complication rates were noted between the two groups of patients. G. Wittich and coworkers (L. Hamid, J. Lukacs, D. Lucas, C. Kusnick; Stanford, CA) reviewed the technique, results,

categorical

and complications of percutaneous needle biopsy in patients who were recovering from heart or heart/lung transplantation.

course

was

neunoradiology,

and there

were

two

Friday morning symposia: one, held jointly with the Society for Pediatric Radiology, was titled Stat and Urgent Problems in Pediatrics; the other was titled New Issues Forum. A very successful spouse/companion program on osteoporosis was provided also. This

review

of the

1992

ARRS

meeting

is intended

to

provide the reader with a short summary of many of the papers presented in the scientific program. Unfortunately, space limitations in the Journal do not allow coverage of all presentations or an analysis of them. Chest

Radiology

J. W. Hanna and colleagues J_ Anderson, S. L. Solomon, presented a paper comparing biopsy pneumothorax and the in a study

group

maintained

postbiopsy

placed

vs control

in a dependent

coughing,

(P. L. Molina, H. S. Glazer, D. S. S. Sagel; St. Louis, MO) the rate of occurrence of postneed for chest tube placement subjects.

precautions position

and movement

were

Study

group

patients

(e.g., the biopsy site was

for at least

restricted)

1 hr and talking,

whereas

control

Percutaneous malignant

biopsy lesions,

proved

to be effective

particularly

in differentiating

cyclosporine-induced

lym-

phoma, from infectious complications. Pneumothorax occuffed in seven (24%) of the 29 patients studied. Simultaneous bilateral pneumothorax may occur in these patients because of a common pleural space; it may be treated with a solitary chest tube, which was required in four of these patients.

Two presentations concerned pulmonary complications in AIDS patients. In one, C. Chow and coauthors (P. A. Templeton and C. S. White; Baltimore, MD) followed the natural radiologic history of pulmonary cysts in AIDS patients who had pneumocystis carinii pneumonia (PCP). They found that 34% of 90 patients with PCP had pulmonary cysts, which were

typically

multiple

with

an

upper

lobe

predominance.

Pneumothorax developed in 32% of the patients with cysts. In most patients, follow-up chest radiographs showed the cysts had resolved or improved. In the other study, N. Segumn and coworkers (M. E. Osborne, L. Samson, R. Morisset, P. Ghadirian; Montreal, Canada) correlated the presence of

Editor’s note.-”Meeting News” articles report the highlights of important national radiology meetings. The articles will not undergo the peer review usually required of AJR publications, nor will they offer a critique of the information provided. The sole purpose of the series is to provide Joumal readers with succinct, substantive, and accurate reviews of topics of current interest, written in a readable fashion and published promptly after the meeting. Presenters did not have the opportunity to review this summary before publication. I thank Dennis M. Balfe, Emil J. Balthazar, Richard L. Baron, Claire Bender, William J. Casarella, D. David Dershaw, Arthur C. Fleischer, Jay P. Heiken, Barbara S. Hertzberg, Michael Huckman, Jeremy J. Kaye, Melvyn Korobkin, Mark D. Murphey, Andrew K. Poznanski, Robert M. Quencer, Lee F. Rogers, Ama Van Breda, Kay H. Vydareny, and Stephanie Wilson for contributing to this summary. AJR 157:647-656,

September

1992 0361-803X/92/1593-0647

© American Roentgen Ray Society

MEETING

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648

NEWS

AJR:159, September

1992

pleural effusion with underlying pulmonary disease in 97 patients with AIDS. In their population, a minimal or unilateral pleural effusion showed high sensitivity for mycobactenium avium intracellulare infection. PCP was the underlying cause in 20% of their patients, Kaposi’s sarcoma in 10%, and tuberculosis in 8%. Intrathoracic Kaposi’s sarcoma without moderate or bilateral pleural effusion was unusual. In 38% of the patients, the cause of the pleural effusion was undetermined.

leaks, was often identifiable but could be mimicked by double lumen implants and capsule formation. The University of Michigan group defined the sonographic characteristics of silicone leakage as an echodense shadowing pattern and/or a hypoechoic mass. More precise sonognaphic diagnosis of breast lesions was encouraged by studies from Korea and Pennsylvania. H-Y

Cardiac

evaluated 36 breast lesions with color Doppler sonography and found a low flow pattern in 83% of benign tumors and a

imaging inversion

Choi MR Imaging

Potentially the most useful study in this section was the one presented by W. A. Carpenter, A. G. Stiles, and S. K. Sheppard (Atlanta, GA). These researchers described the use of a computer to color enhance MR images after gadopentetate dimeglummne enhancement while maintaining anatomic detail. The authors used a Macintosh computer connected directly to the output of a 1 .5-T MR scanner via an Ethernet network. Images were imported into a graphics program via commercially available software (Adobe PhotoShop). Using

this relatively simple method, the authors were able to demonstrate in multicolor format the areas of the scan that were selectively enhanced by contrast material while retaining all the anatomic detail in the precontrast scan. This application appeared to be most useful in the analysis of postoperative spines, bone tumors, and inflammation in the musculoskeletal system. Another paper that appears to be of clinical significance is that presented by E. Winberger and colleagues (K. S. White, 0. W. Shaw, M. K. Winning; Seattle, WA). These authors used fat-saturation techniques to enhance the conspicuity of vessels with a fat interface. The use of fat-saturation sequences markedly diminished the chemical-shift artifact and positively affected vessel conspicuity. Gradient-recalled parameters with TA of 50, TE of 1 6-1 7, and a 60#{176} flip angle with RF fat saturation were optimal for enhancing imaging of small blood vessels adjacent to fat tissue. In a preliminary study, K. C. Seelos and coworkers (A. von Smekal, J. Gieseke, J. van Vaals, M. Reiser; Bonn, Germany) were able to characterize normal myocardium as well as six intra- or paracardiac tumors by measuring gadopentetate dimeglummne

perfusion

with

a turbo

fast-scan

technique

at

The authors demonstrated adequate time and spatial resolution in cardiac MR perfusion imaging, and they believe this particular MR pulse sequence holds promise for the evaluation of ischemic coronary artery disease. 0.5

T.

Breast

Radiology

of silicone implants recovery sequence.

and coauthors

high flow

pattern

was best performed with an Silicone leakage, including silent

(K. Park,

in 77%

S. Lee, T. Kim;

of malignant

Seoul,

tumors.

Korea)

M. J. Staiger

and coauthors (K. M. Harris, Z. S. llkhanipour, M. A. Ganott, P. H. Hintz, A. B. Baratz, M. L. Skolnick; Pittsburgh, PA) found that in 25 fluid-containing masses, a thick, irregular wall was common in malignant tumors whereas other cystic or complex sonographic patterns were associated with benign lesions. The importance of routine mammography in younger women was emphasized in papers concerned with screening. L. Liberman and coauthors (D. D. Dershaw, B. M. Deutch, B. Smolek-Lippmn; New York, NY), in a study of mammographic screening in women 35-39 years old, found the rate of breast cancer equaled that of women in their 40s and suggested more aggressive screening of these younger women. T. L. Roberts and coworkers (B. S. Monsees, T. Wasserman, E. Miller, J. M. Destouet; St. Louis, MO) found an increased rate of breast cancer in women after mantle radiation for Hodgkin’s disease, and encouraged screening of these women starting 1 0 years after their treatment, whatever their age. Radiologists

were

encouraged

to

refine

their

diagnostic

capabilities by A. M. Knutzen and J. J. Gisvold (Rochester, MN). These researchers noted that by appreciating clearly benign patterns as benign, fewer women will be biopsied unnecessarily. The positive predictive value for a biopsy necommendation in their series was raised to 39% by eliminating these biopsies. However, a note of caution was raised by A. S. Lev-Toaff and S. A. Feig (Philadelphia, PA), who reported on the mammographic findings of 27 women seen at their institution

who

had cancer

despite

a pattern

of stable

calcifi-

cations over an 8- to 63-month interval. Although most of these were due to intraductal tumors, 10% were infiltrating tumors. The overall message of the session seemed to be that while breast imagers pursue new techniques to deal with clinical

problems,

attempts

ness of mammography, which standard of breast imaging. Gastrointestinal

continue to improve the usefulremains the unchallenged gold

Radiology

The scientific papers presented in the breast session coyered a variety of breast imaging techniques and clinical situations. M. K. Jones (other authors: D. A. Clunie, J. Szumowski, B. Webben, G. Woltening, A. S. Thurmond; Portland, OR) and K. A. Rosculet (other authors: D. M. Ikeda, M. E.

the pancreas were presented and discussed during the gastnointestinal scientific session. The presentations focused on the contribution, accuracy, and pitfalls of different imaging techniques available today, including barium studies, CT, MR

Forrest,

imaging,

M. A. Helvie,

Ml) presented studies in silicone prostheses.

R. O’Neal,

D. 0. Jeffries;

Ann

Arbor,

on imaging women to diagnose leaks The Oregon group found that MR

A variety

of diseases

the gastrointestinal

tract and

and sonognaphy.

The prevalence noma

affecting

vs gastric

of transpylonic lymphoma

was

extension evaluated

of gastric by

carci-

K. C. Cho

AJR:159,

September

(Newark,

MEETING

1992

NJ) and coauthors

M. Fusco,

S. Cho;

Bronx,

(S. R. Baker,

D. D. Altenman,

NY). The nadiologic

findings

J.

in 102

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patients with gastric carcinoma and 25 patients with gastric lymphoma were correlated with the endoscopic, surgical, and pathologic findings. Transpylonic extension into the duodenal bulb occurred 28% of those

in 1 7% of the patients with carcinoma and in with lymphoma. In this series, the transpylonic of gastric carcinoma is more frequent (1 7%) than

NEWS

649

Durham, NC) reported on a retrospective study to determine the sensitivity and specificity of CT for the detection and localization

of aldosterone-secreting

Dawson,

tumor

extending

into the duodenal bulb is more likely to be an adenocancinoma than a lymphoma. K. W. Sievens and coauthors (H. J. Feldman, M. Molls, E. Lohr; Essen, Germany) presented their findings from a study in which dynamic MR imaging was used to determine the blood perfusion of pelvic neoplasms in an attempt to identify and select patients who will respond to radiation therapy. After injecting a bolus of gadopentetate dimeglumine, these researchers examined changes in signal intensity over a period of more than 3 mm. Preliminary results suggest that dynamic MR imaging is able to classify high- and low-perfusion tumor as well as inhomogeneities of blood supply within the tumor itself. It is hoped that, in combination with good anatomic resolution, this MR application will play a major role in treatment

planning

and

in determining

the

responses

of

different types of tumor. The message of the paper presented by M. F. Levin and coauthors (A. D. Vellet, P. L. Munk, D. B. Bach; London, Ontario, Canada) was that evaluation of peripancreatic fluid collections should be performed with color Doppler sonography in addition to conventional sonognaphy. Among the five patients diagnosed by conventional sonography as having penipancreatic fluid collections, colon Doppler sonognaphy detected the presence of pseudoaneurysm in two patients. This significant complication can be missed if color Doppler sonography

is not

used

in the

evaluation

of penipancreatic

fluid

collections

seen in patients with acute pancreatitis. Rominger and coauthors (P. J. Kenney, D. B. Koslin, J. J. Listinsky; Birmingham, AL) correlated the accuracy of M. B.

MR

imaging

with

that

of CT in the detection

of pancreatic

masses in 20 patients. MR imaging was performed with oral (Kaopectate) and IV (gadopentetate dimeglumine) contrast agents using multiple sequences. Contrast-enhanced CT was performed, and results were correlated with the available surgical results, biopsy findings, and follow-up studies. The investigators concluded that MR imaging is at least as accurate as CT in detecting, characterizing, and staging pancreatic masses. At present, MR imaging is most helpful for problem solving and for patients in whom iodinated contrast material is contraindicated.

CT: Abdomen N. R. Dunnick

(other

authors:

J. C. Gunnells,

Jr., R. A. Leden, M. A. Roubidoux,

E. Paulson,

G. S. Leight,

L. Kuryio;

sections. syndrome

of

material

Of 27 patients who were stud-

15

radiologic

A gastric

CT scans

IV contrast

were found at surgery to have an aldosterone-secretCT identified the adenoma in 13 patients (senThe two adenomas missed by CT were 0.9 cm and 1 .1 cm in diameter, respectively. None of the CT examinations produced false-positive results (specificity, 100%). ied,

ing adenoma. sitivity, 87%).

diagnosis.

without

by using 5- or 1 0-mm continuous with biochemically proved Conn’s

extension previously stated in the literature (5%). Given the much higher prevalence of stomach carcinoma than lymphoma, and contrary to previous statements in the literature, the demonstration of transpylonic extension of tumor cannot be used in the differential

adenomas.

the adrenal glands were obtained

A study

Hahn,

conducted

by M. J. Lee

D. McLouglin,

P. R. Mueller;

of image-guided

T. Kinney, Boston,

and

coworkers

S. Gazelle,

MA) evaluated

fine needle

aspiration

were normal (