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Different times call for different measures. The COVID-19 pandemic has forced us to search for alternative methods to provide an annual meeting which is equally interesting and has quality. For the Belgian Society of Radiology (BSR) 2020 Annual Meeting, the sections on Abdominal Imaging, Thoracic Imaging and the Young Radiologist Section (YRS) joined forces to organize a meeting which is quite different from the ones we have organised in the past. We have chosen to create a compact - approximately 5 hour - and entirely virtual meeting with the possibility of live interaction with the speakers during the question and answer sessions. The meeting kicks off with a message from the BSR president about radiology in 2020, followed by three abdominal talks. The second session combines an abdominal talk with COVID-related talks. We have chosen to include not only thoracic findings in COVID-19, but to take it further and discuss neurological patterns, long-term clinical findings and the progress in artificial intelligence in COVID-19. Lastly, the annual meeting closes off with a short movie about the (re)discovery of Röntgens X-ray, presented to us by the Belgian Museum for Radiology, Military Hospital, Brussels. ispartof: J Belg Soc Radiol vol:104 issue:1 pages:63- ispartof: location:England status: Published online

ObjectivesCT coronary angiography (CTCA) has become a valuable diagnostic test in the workup of patients with possible coronary artery disease (CAD). Because of inherent limitations in spatial resolution, epicardial vessels with a small diameter, in general less than 1.5–2 mm, have so far been excluded in studies assessing clinical utility of CTCA. This study sought to assess the clinical impact of CTCA taking into account pathology in small coronary arteries.MethodsWe conducted a retrospective cohort study of all patients with possible CAD who underwent dual-source CTCA and subsequent invasive coronary angiography (ICA) between January 2010 and July 2017. Patients with an Agatston calcium score ≥1000 were reported separately. Diagnostic accuracy of CTCA on a patient, vessel and segment level was calculated. The physician’s therapeutic decision was defined as conservative, medical antianginal treatment or revascularisation. Using ICA as the reference, we calculated the precision of CTCA to replicate these therapeutic recommendations.ResultsIn total, 1209 patients underwent both CTCA and ICA. Overall diagnostic performance of CTCA showed a sensitivity of 90% (95% CI 86% to 93%) and specificity of 40% (95% CI 36% to 45%). With regard to clinical decision making, CTCA showed good performance: 91% of patients who were treated medically or by revascularisation were correctly identified. Prevalence of disease in small vessel segments was low: 16% showed significant CAD on ICA. Prevalence of significant disease was 70% in patients with an Agatston score ≥1000: the majority underwent revascularisation.ConclusionsFrom a true patient perspective, without exclusion of smaller coronary artery segments, CTCA allows safe patient management.

Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has assumed growing importance in the treatment of patients with severe aortic stenosis (AS), because it offers a much less invasive alternative for those in high risk for surgery. Good early results and advances in percutaneous valve technology have led to a substantial increase in procedural success rate and number of patients undergoing this less invasive treatment. Pre-procedural screening of several anatomic factors to assess the feasibility of this technique is important. Multidetector row computed tomography (MDCT) is the technique of choice in assessing these factors. This technical note aims to describe and illustrate the key elements that need to be evaluated before the procedure.

AIMS To assess plaque characteristics by multi-detector computed tomography angiography in patients with known coronary artery disease and to compare these findings with those obtained with intravascular ultrasound-derived radiofrequency analysis of plaque composition. METHODS AND RESULTS By computed tomography, lesions were classified on the basis of Hounsfield Units as non-calcified, calcified, or mixed. By intravascular ultrasound-derived radiofrequency analysis, plaques were classified according to the relative composition of components with specific backscatter characteristics (necrotic core, fibrous, fibro-fatty, calcium). Thin cap fibroatheroma (defined as necrotic core component >10% without evidence of fibrotic cap, calcium >5%, remodelling index >1.05) was considered as vulnerable plaque. Seventy-eight plaques were analysed. By computed tomography, 22 plaques were classified as non-calcified and 56 as mixed. A higher incidence of mixed plaques was observed among lesions causing unstable angina and non-ST elevation myocardial infarction compared to stable angina (76% vs 38%, p=0.04). Plaque composition by radiofrequency analysis was significantly different between mixed and non-calcified plaques by computed tomography. The calcium content was 6.0+/-3.2% vs 2.5+/-1.8% (p=0.001), necrotic core was 14.0+/-6.9% vs 7.5+/-5.6% (p=0.03) and fibrous tissue was 59.0+/-7.5% vs 67.0+/-5.9% (p=0.03), for mixed vs non-calcified plaques, respectively. Positive, negative predictive value and diagnostic accuracy for detection of vulnerable plaque by computed tomography was 77, 54 and 59%. CONCLUSIONS Mixed plaque by computed tomography correlates with plaque composition as determined by intravascular ultrasound-derived radiofrequency analysis. However, the present diagnostic accuracy of computed tomography is not high enough to support its use for non invasive detection of vulnerable coronary plaque.

In this presentation, less common causes of acute abdomen are reviewed. Emphasis is on three topics. First, the anatomy of the superior mesenteric vein and mesentery is reviewed, together with the anatomical basis and clinical/radiological presentation of midgut volvulus. Emphasis is on diagnostic clues (whirl sign, abnormal position of cecum, small bowel, and third part of duodenum) and pitfalls (positional variation of small bowel loops with pseudo-twisting of mesenteric vessels). Second, atypical presentations of acute appendicitis and appendagitis, as well as their mimics, are discussed. Finally, an overview is given of uncommon but important causes of free intraperitoneal fluid in patients with acute abdominal pain.

A 29-year-old bodybuilder presented with a bilateral palpable and painful soft tissue mass in the deltoid region. CT scan showed a bilateral intramuscular mass within the deltoid muscle with intralesional fat (not shown). For further differentiation and exclusion of a fat-containing sarcomatous lesion, MRI of both shoulders was performed. Axial T1-weighted images (WI) of the right shoulder showed a heterogeneous mass lesion containing multiple fatty components (Fig. A, arrows). Axial T1-WI of the left shoulder depicted a mass with a T1-hyperintense fatty component and marked fat-fluid level (Fig. B, arrow). The lesion also demonstrated a fat-fluid level on a sagittal fat suppressed T2-WI (Fig. C, arrow).

Axial and sagittal proton density and T2-weighted MR images (TR 2,500-3,000 ms, TE 15-22 and 85-90 ms) were performed in 50 patients with multiple sclerosis (MS) on a 1.5 T superconductive system. The number of plaques on the axial and sagittal images in the periventricular white matter, the corpus callosum, the brain stem, the cerebellum, and the basal ganglia were counted separately by two independent observers. A total of 858 lesions (mean 17.40 +/- 21.57) were seen on the axial series and 1,196 (mean 24.32 +/- 26.22) on the sagittal scans. More lesions were visualized on sagittal images in the periventricular region (mean 18.79 +/- 21.69 versus 13.34 +/- 16.45; p less than 0.001) and the corpus callosum (mean 3.00 +/- 2.72 versus 0.57 +/- 1.19; p less than 0.001). In the brain stem more lesions were visualized on the axial images (mean 1.55 +/- 2.55 versus 0.87 +/- 1.20; p less than 0.05). In the cerebellum and basal ganglia, scans in the two planes were equivalent (p greater than 0.5). In three patients lesions were seen on the sagittal series, while the axial scans were normal. Sagittal T2-weighted images appear to demonstrate significantly more MS plaques than transverse images, especially in the periventricular region and the corpus callosum. This is explained by partial volume averaging, by the orientation of some cerebral structures (e.g., corpus callosum) with regard to the section plane, and by the longer diameter of the lesions in the axial plane.

Primary cardiac lymphoma is rare. It can present with a wide variability of clinical symptoms frequently leading to a delay in diagnosis. We report a case of a primary cardiac lymphoma in a 85 year old woman. The MRI showed a large mass in the right atrio-ventricular groove and infiltration of the interventricular septum and left ventricular wall with subtle contrast enhancement, isointense aspect on T1 weighted and hyperintense aspect on T2 weighted sequences. Mostly the radiological signs are non specific. Calcification, hemorrhage, a diffuse infiltrative pattern with infiltration of the valves and coronary arteries and a left atrial localization can suggest the diagnosis.

Intrapetrosal dissections is a special kind of intracranial dissection since it is located intracranially but extradurally. Only three reports of spontaneous intrapetrosal dissection have been published so far, the posttraumatic intrapetrosal dissections caused by penetrating or blunt trauma not included. Based on the clinical and radiological presentation a treatment with anticoagulantia (a coumarine derivative) was successfully installed. A short review of the major studies concerning intracranial dissection is presented. Firm guidelines for the treatment cannot be provided based on these data but the etiology of the dissection, whether it was posttraumatic or spontaneous, seems to be important. The diagnostic problem of pulsatile tinnitus is briefly discussed.

MRI of the knee joint is one of the most common and important clinical applications in most MRI units today. Thorough knowledge of the detailed anatomy is a prerequisite for the understanding of knee pathology. This article reviews the MR anatomy of menisci, the cruciate ligaments, the medial and lateral supporting structures, the extensor mechanism, synovial plicae around the joint and some pitfalls in the interpretation.

Since the development of dedicated surface coils and the more widespread use of state-of-the-art arthrographic techniques, MR imaging of the shoulder has come to maturity. In this article the imaging techniques of conventional MR imaging and MR arthrography of the shoulder are reviewed. The complex anatomy, the many anatomic variations and diagnostic variants and pitfalls and discrimination of pathologic entities from normal findings are discussed. Familiarity with the normal anatomy is a prerequisite to achieve a high diagnostic accuracy in the detection of a variety of pathologic conditions of the shoulder joint.

Cervical spinal arteriovenous malformations and fistulas are rare but important entities because they are potentially curable. MRI and angiography are the most useful imaging modalities for the diagnosis. On contrast-enhanced CT imaging, they can mimic a tumor. A case report of cervical spinal arteriovenous malformation, initially believed to be a tumor, is presented.

We describe a case of mucocele of the appendix, observed incidentally in a 42-year-old man. The plain film, ultrasound and CT features are reviewed. Adequate diagnosis and resection are important because of the risk of rupture and development of pseudomyxoma peritonei.

Takotsubo cardiomyopathy is an important differential diagnosis in patients with an acute coronary syndrome. This syndrome is typically characterized by a reversible contractile dysfunction of the left ventricular myocardium without any obstructive etiological coronary disease. This is not a rare entity in acute settings and a better knowledge of the syndrome could result in a heightened alertness and a higher detection. We present a case of takotsubo showing the importance of cardiac MRI in the differential diagnosis and reviewed the present literature concerning this syndrome and the usefulness of MRI in the detection.

Selective and superselective renal embolization is a generally accepted technique for treating traumatic or iatrogenic renal arteriovenous fistulas or arteriocalyceal fistulas. Only a minority are pure arteriocalyceal fistulas. During embolization, an arteriovenous fistula may become a frankly bleeding arteriocalyceal fistula, causing massive haematuria and necessitating further embolization.

The purpose of our study is to model cost-effectiveness of MDCTA for the diagnosis of NSTE-ACS with initially negative enzymes, in the emergency department. In Belgium, the use of multi-detector computed tomography (MDCTA) is probably cost-effective in the diagnosis of NSTE-ACS in the acute setting A decision tree model was developed and a mathematical study was performed that included two hypothetical strategies: MDCTA and admission with classic clinical follow-up and treatment. Cost-effectiveness for the Belgian situation was simulated with sensitivity analysis using known values for diagnostic performance and known costs for the different strategies or components of strategies.

Outpatient angiography of the abdominal aorta and the peripheral arteries of the under limbs was performed in 100 patients with complaints of peripheral vascular disease. In all patients small 5F catheters, a low-osmolar contrast medium and intraarterial digital subtraction angiography could reduce the local and general invasiveness of the angiographic procedure. Two complications occurred. In one patient thrombosis at the puncture site was noted. In another patient, an onset of angina pectoris was a minor and transitory complication. In 42 out of the 100 patients, treatment was conservative so that hospitalization could be avoided. With newer technical equipment angiography can be performed safely on an outpatient basis with important costsaving for the community. The late occurrence of some complications though, requires good information of the patient.