Top posters focus on implants, coronaries, and liver transplants

Posters about the imaging of orthopedic implants, coronary artery anomalies, and pediatric liver transplantation complications were among the top six prize-winning education exhibits revealed at the RSNA meeting on Wednesday afternoon.

Four of the six winners of the prestigious magna cum laude awards came from the U.S. The other two came from Korea and Spain.

Radiologists who can assess and recognize the growing number of orthopedic implants and their radiographic appearances are in demand. They can offer important observations to referring physicians, according to magna cum laude winner Dr. Samuel S. Charles of the radiology department at the University of Wisconsin, Madison.

"The purpose of our poster is to describe a variety of newer devices being implanted during extremity and spine surgery,: Charles said. "It is our hope that this discussion will aid radiologists to become more conversant in these implants. In turn, radiologists will be able to critically evaluate these devices and to discuss them with surgeons."

Among the devices covered in Charles' poster are low-contact dynamic compression plates, locked extremity plates, combi plates, locking condylar plates, less invasive stablization system plates, trochanteric femoral nails, locking cervical plates, laminoplasty, bone-graft substitutes, bioabsorbable hardware, and disc arthroplasty.

Congenital abnormalities of the coronary arteries are an uncommon but important cause of chest pain and sudden cardiac death, according to another magna cum laude winner, Dr. So Yeon Kim, a radiologist at the, Asan Medical Center, University of Ulsan, in Seoul.

The incidence has been reported to be between 0.3% and 1% of the population, although this may be an underestimate because many asymptomatic individuals may be unrecognized. For several decades, premorbid diagnosis of coronary artery anomalies was made by catheter angiography, but this technique has limitations due to its projectional nature and invasiveness.

"ECG-gated multidetector CT provides a noninvasive means of demonstrating coronary artery anomalies. Radiologists need to be familiar with the basic anatomy of the coronary artery tree and patterns of coronary artery anomalies," Kim said. "Knowledge of CT findings of these anomalies, along with understanding of their clinical significance, is essential for an accurate diagnosis and proper patient management."

In her award-winning exhibit, Dr. Teresa Berrocal, a pediatric radiologist from University Hospital La Paz in Madrid, focused on orthotopic liver transplantation, the current treatment of choice for patients with severe acute or chronic liver failure for which no other therapy is available.

"In children, the number of cadaveric donor livers is not sufficient, so living related donor partial liver transplantation has become an important therapeutic option for children with terminal liver diseases," she said. "The surgical techniques and immunosuppressive therapy for this procedure have improved considerably, but there are still significant complications, particularly those of vascular origin, which can lead to graft failure and require transplantation unless prompt treatment is instituted."

Early diagnosis of organ-related complications is essential for achieving the best short- and long-term results. Knowledge of the types of transplantation procedures used in children and the postoperative imaging appearance of the anatomy of the transplanted liver graft is essential for the radiologist, Berrocal said.

The main complications in patients after living related donor transplantation include vascular stenosis and thrombosis, biliary stenosis or bilomas, fatty liver, extrahepatic fluid collection, post-transplantation lymphoproliferative disorder, and rejection.

The three other magna cum laude prizewinners were Dr. Marcus Van from the University of California, Los Angeles (evidence-based review of indications of fetal and obstetrical MRI), Dr. Srinivasa Prasad from UTHSCSA in San Antonio (common and uncommon histologic subtypes of renal cell carcinoma), and Dr. Robert Kuske from Arizona Oncology Services and Cancer Research Foundation in Scottsdale (use of the stereotactic breast core biopsy table to perform image-guided breast brachytherapy in the prone position for select carcinomas of the breast).