Magnetic resonance cholangiopancreatography (MRCP) using the HASTE sequence: Technical advances and clinical applications

C o n c l u s i o n : GI and hepatobiliary complications are c o m m o n during the post-cardiac transplant recovery period. Radiologic studies assist the clinician in determining a diagnosis and treatment regimen for the majority of these patients. T a k e H o m e Points: 1. Most complications that occur are minor requiring only conservative management. 2. Radiologists are an instrumental part of the transplant team. 3. Radiologic studies assist the clinician in diagnosis and treatment in a majority of patients with GI/ hepatobiliary problems.

P-37 M a g n e t i c R e s o n a n c e C h o l an g i o p an cr eat o g r ap hy (MRCP| Using the H A S T E Sequence: Technical A d v a n c e s and Clinical Applications Ann S. Fulcher, MD, Medical College of Virginia, Richmond, VA, Mary Ann Turner, MD, Gerald W. Capps, MD, Alvin M. Zfass, MD P u r p o s e : To demonstrate the technical advances in MRCP afforded by half-Fourier single shot turbo spin echo (HASTE) s e q u e n c e and to illustrate the clinical applications of this technique. M a t e r i a l s & M e t h o d s : O n e htmdred-forty patients referred for evaluation of obstructive jaundice were studied with HASTE MRCP. The HASTE MRCPs were correlated with direct cholangiopancreatography. Results: HASTE MRCP allowed for rapid (18 seconds) imaging of the biliary tract and pancreatic duct during a single breathhold. W h e n compared with direct cholangiopancreatography, MRCP yielded resuits of equal or superior diagnostic accuracy. In s o m e instances MRCP allowed for more complete visualization of the blliary tract and pancreatic duct than did direct cholangiopancreatography. HASTE MRCP was s h o w n to be particularly useful in demonstration of anatomy in problematic cases s u c h as biliary-enteric anastomoses strictures following liver transplantation, AIDS cbolangiopathy, and chronic pancreatitis as well as choledocholithiasis and malignant obstructions. C o n c l u s i o n : HASTE MRCP allows for rapid visualization of the biliary tract and pancreatic duct and provides a highly-accurate, noninvasive alternative to direct cholangiopancreatography. T a k e H o m e Points: HASTE MRCP allows for rapid, noninvasive evaluation of t h e biliary tract and pancreatic duct. HASTE MRCP is particularly useful in evaluating patients with biliary enteric anastomoses, c o m p l e x strictures, choledocholithiasis, and malignant obstruction.

P-38 Heparin-lnduced T h r o m b o c y t o p e n i a and Throm. bosis Syndr ome Kenneth D. Murphy, MD, SUNY Health Science Center, Syracuse, NY, ChristopherJ. Vaughn, MD, Gerard McCrohan, MD P u r p o s e : The p u r p o s e of this exhibit is to present the etiology, pathophysiology, clinical presentation, laboratory features, imaging findings and therapeutic options for heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). M e t h o d s : Thrombocytopenia is a k n o w n complication of heparin, with 3 types described. The most serious type is HITrS in w h i c h the thrombocytopenia is complicated by arterial and venous thrombosis with marked patient morbidity and mortality. Complications include stroke, pulmonary embolism, myocardial infarction, deep venous thrombosis, extremity ischemia and death. The exhibit will emphasize treatment options, including discontinuation of heparin and administration of alternative anticoagulants. C o n c l u s i o n : As the domain of the vascular radiologist expands, the likelihood of confronting a case of HITFS increases. Recognition of this syndrome and awareness of different treatment options will help facilitate optimal intervention. T a k e H o m e Points: Heparin-induced thrombocytopeuia and thrombosis syndrome is associated with high incidence of severe, life-threatening complications. Recognition of this syndrome and awareness of therapeutic options will help minimize the morbidity and mortality.

P-39 Practical Pelvic MRh Evaluation of Uterine Fibroids Gary J. Whitman, MD, MO Anderson Cancer Center, Houston, TX, Pamela L. Caslowitz, MD, Isabel C. Yoder, MD, William W. MayoSmith, MD P u r p o s e : The p u r p o s e of this scientific exhibit is to review practical applications of MRI in evaluating uterine fibroids. M a t e r i a l s a n d M e t h o d s : T w e n t y female patients (ages 15 to 72 years) u n d e r w e n t 24 pelvic MR examinations to evaluate uterine fibroids. Results: MRI allows for accurate delineation of the number, size, and location of fibroids. MRI is a useful tool in distinguishing submucosal fibroids from endometrial masses and in differentiating snbserosal fibroids from extra-uterine pelvic masses. C o n c l u s i o n : The anatomic information provided by MRI can play a significant role in treatment planning. Submucosal fibroids m a y be approached hysteroscopically, transmural fibroids usually require laparotomy, and subserosal fihroids m a y be approached laparoscopically. T a k e H o m e Points: MRI accurately s h o w s the number, size, and location of uterine fibroids. MRI can play a significant role in treatment planning in patients with fibroids. F i n a n c i a l D i s c l o s u r e : G. J. W. is a stockholder in General Electric.

P-40 Single Voxel H I - M R S (SV/MRS) Detection of Primary Intracranial Neoplasms in Lesions Previously Diagnosed as Cerebral Infarction by CT/M RI Joseph P. Cousins, PhD, Pina C. Seymour, MD, Albany Medical College, Albany, NY, James Dollar, MD, Joseph Emrich, MD, Susan Weaver, MD, William A. Wagle, MD, et al P u r p o s e : The purpose of this study is the evaluation of SV/MRS to detect primary intracranial neoplasms. We report 4 incidents w h e r e MRS demonstrates neoplasms in patients previously diagnosed with cerebral infarction. M a t e r i a l s a n d M e t h o d s : SV/MRS was performed on 4 patients referred by the neurology and oncology departments for evaluation of intracranial lesions previously diagnosed as cerebral infarction by CT/ MRI. Following routine M R / w i t h gadolinium contrast, lesion and contralateral control voxels were sampled, using PROBE. P (G.E. Medical Systems) (PRESS) (TE/TR 272/2000). Spectra were processed and digitally integrated on a SPARC workstation. Results: The data summarizes the MRS and pathology results from the four patients. MRS predicted tumors in all cases and correctly classified the high grade tumors (GBM) prior to pathology. C o n c l u s i o n : SV/MRS patterns can assist clinicians in detecting and differentiating primary intracranial neoplasms from infarction. T a k e H o m e Points: SV/MRS can be a useful tool for clinicians in differentiating primary intracranial neoplasms from infarctions.

P-41 Percutaneous Iliac Venous Stenting For lilac Vein Stenoses Sanjay Misra, MD, Hahnemann University Hospital, Philadelphia, PA, Jean K. Yi, MD, George Kimbiris, MD, Paul A. Khoury, MD, Simin Dadparvar, MD, Fong Y. Tsai, MD P u r p o s e : To evaluate the efficacy of percutaneous endovascular stents for the treatment of iliac vein stenoses. M a t e r i a l s a n d M e t h o d s : Consideration of an lilac vein stenoses should be made particularly in a patient with a history of multiple catheter placements. Over the past 4 years, 6 patients, 4 male and 2 female, ages 27 to 89 years (mean age = 58.5 years) presented iliac vein stenoses and u n d e r w e n t 7 iliac vein stents. Follow u p ranged from 1.5 to 15 m o n t h s (mean=8.5 months). All patients had contrast venography. They subsequently received thrombolytic therapy and percutane-

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