In conclusion, multi-phasic hydro-MDCT is excellent for pancreatic cancer detection. 3D reformations are helpful for demonstration of vascular involvement during staging. For differentiation between cancer and tumour-simulating disease (focal pancreatitis, steatosis), MRI is complementary to MDCT. Cystic tumours of the pancreas are less frequent than solid lesions, and quite often they are occasionally recognised, as many of these lesions are small and asymptomatic, but they may be associated with pancreatitis or have malignant potential. An accurate differentiation between different cystic tumours is important because they require a different treatment according to their histological type and differentiation, but due to the frequent lack of specific clinical and laboratoristic signs, the overlap of imaging findings between different cystic tumours and between non neoplastic and neoplastic cistic lesions of the pancreas, the management of these patients is complex, and knowledge of symptoms of the patients, natural history and predictors of malignancy for pancreatic cysts are important. When dealing with pancreatic cysts, the aim of the imaging is to differentiate cystic tumour from tumour-like lesions and to characterise cystic tumour, distinguishing benign tumour, which usually does not require surgical excision, from border-line or malignant ones, which must be resected whenever possible. On the basis of imaging criteria alone, it can be very difficult to differentiate non tumoural cystic lesions from neoplastic ones; in order to achieve a correct diagnosis it is important to correlate the imaging findings with the clinical history of the patient, the presence or absence of symptoms and their type. US, CT and MRI are excellent tools which permit to accurately evaluate these lesions, making thus possible their correct management. Diagnosis of trauma-related injuries is a key task in modern radiology. Early, thorough and accurate detection of potentially life-threatening injuries is crucial for fast and targeted initiation of treatment. Conventional radiography (CR) and ultrasound (US) are well established and still represent the basic diagnostic tools for trauma imaging. However, a number of studies have shown a lower detection rate of injuries for radiography and ultrasound compared with computed tomography (CT). Multi-detector CT (MDCT) with its shorter scan time and increased accuracy has become the gold standard for most indications in trauma imaging. As MDCT has a higher radiation dose, its use should be restricted and carefully indicated especially when dealing with a younger patient population. Careful optimisation of imaging parameters has to be performed to minimise exposure and maximise diagnostic safety. Modern MDCT examinations produce a large number of images, which have to be limited to a reasonable number for interpretation. This review article focuses on optimisation of examination protocols and on how to handle the flood of images for viewing and archiving. Arterial haemorrhage in polytrauma remains the leading cause of death. The aim of this presentation is to evaluate interventional radiology as a life-saving procedure. Contrast-enhanced CT has been reported to be an accurate technique for identifying ongoing arterial haemorrhage in polytraumatised patients. TAE may be a rapid, safe and effective technique for treatment of haemorrhage. To increase the efficacy of the method and to reduce complications, the trend is to combine several materials for embolisation. Several embolisation devices are available: a fibrin sponge is used for temporary embolisation (PVA) and microspheres are commonly used for permanent embolisation, whereas detachable balloons, glue, coils and plugs are used for definitive embolisation. Stent grafting permits the exclusion of bleeding and obtaining the patency of the vessel. Different types and sizes of stent grafts are available. The success rate, expressed in terms of haemorrhage control and reduction in transfusion requirement, for pelvic haemorrhage, liver, kidney and spleen is high. Stent grafting has different rates of success related to the injury site. TAE should be performed as early as possible, because effective embolisation must be achieved before severe systemic coagulopathy and multiple organ failure develop. CT allows locating and characterising the haemorrhages, which will reduce the diagnosis time and, above all, improve the embolisation procedures. These features make it very useful in this setting, where the clinical course and prognosis are related to the achievement of haemodynamic stability. The patient presenting with an abdominal mass represents a common clinical problem. Clearly, the differential diagnosis is large and obviously will depend on the age and sex of the patient as well as location of the mass. Of course history and clinical examination are mandatory, but formal diagnosis will usually rest on radiological interpretation. Contrast examinations have now been replaced by cross-sectional imaging and endoscopy and it behoves the clinical radiologist to be aware of the advantages and limitations of these methods in order to reach a diagnosis. Particular difficulty may be encountered when the mass is so large that it is difficult to determine the organ of origin. The purpose of this interactive case discussion is to explore the relative merits of ultrasound, CT, MR and Endoscopy in establishing a diagnosis in two different cases. The cases concerned are 1. a 21-year-old man who presents with a right iliac fossa mass, but is otherwise asymptomatic. 2. A 54-year-old woman who presents with anaemia and a large upper abdominal mass. Active audience participation will be encouraged by means of key pads in order to respond to issues raised during the debate. Clinical presentation: patients with spontaneous (SAH) most often present with severe, so-called thunderclap headache. However, the clinical picture can vary from mild headache to abrupt death. Rupture of an intracranial arterial aneurysm (AA) is the most common source; other non-aneurysmatic causes may be perimesencepahic haemorrhage or SAH secondary to cerebral vasculitis. Arteriovenous malformations (AVM) and dural arteriovenous fistulae (DAVF) may also present with SAH. Diagnosis of SAH is typically by non contrast CT, less often by lumbar puncture or MRI. Intracranial AA that has ruptured carries a 50% chance of re-rupture the first year, with 20% mortality. The risk for re-bleeding from an AVM or DAVF is 5-10%. Imaging strategies to detect aneurysms: The aim of the neuroradiological investigation is to identify AA or other causes for the SAH. CT and CT angiography are effective in finding AA and excluding some pathologies, such as cerebral vasculitis. The sensitivity of MRI or MRA is less well documented. An arterial dissection, a microAVM or a DAVF may not be visible on CTA or MRI/MRA. Thus further investigation with conventional catheter angiography is warranted in all cases where there are doubts about the source of the bleeding and for further anatomical assessment. Different forms of aneurysms: Berry aneurysms comprise the majority of the AA, the rest being partially thrombosed AA or dissecting AA. Screening: Non-invasive screening is with MRI/MRA or CT/CTA and may be warranted in patients with two relatives having suffered from aneurysmal SAH or a family history of AA. Finding of a palpable mass in the abdomen always raises the possibility of an important clinical problem. A potentially life-threatening process, especially malignancy is the major concern. The list of differential diagnosis of "abdominal mass" is a very long one. In the process of differential diagnosis the most common approach is to evaluate the patient according to the gender, age, patient history and coexisting clinical and laboratory findings. The accompanying symptoms and signs and the location of the abdominal mass are the key indicators in the clinician's way of thinking in the process of differential diagnosis. For instance, a palpable mass with acute abdomen or intestinal obstruction will be assessed differently than a mass found incidentally. Imaging is commonly required to confirm or ascertain the diagnosis. Cross-sectional imaging is required to accurately evaluate a palpable abdominal mass in most situations. Ultrasound and computed tomography have each been used successfully in evaluating patients with palpable abdominal mass. Although each modality is appropriate in most situations, the advantages and disadvantages of each modality in certain situations will be addressed and the appropriateness criteria will be reviewed in this lecture. Knowledge of a detailed clinical history is as important to the radiologist as to the clinician. Its impact on the diagnostic accuracy in the interpretation of the images will also be addressed. A palpable abdominal mass has a long list of benign and malignant differential diagnoses. These diagnoses may be as different as a hydatid cyst of the liver, a volvolus, an aneurysm, or a giant renal cell carcinoma. The diagnostic approach is based on two major steps: first, the affected organ must be identified. Second, the differential diagnosis must be established based on imaging characteristics. The choice of ultrasound, CT or MRI should be based on location and size of the mass. Despite the fact that ultrasound is frequently used as a first step, the overview and anatomic orientation in large masses may be hampered, making ultrasound a better technique for image-guided biopsy than for primary diagnosis. In the vast majority of cases, multidetector CT is the first technique of choice. A thin-section protocol should be used to allow for high-quality multiplanar imaging. A pre-contrast scan is usually not required but can be helpful in suspected haemorrhage. For most upper and middle abdominal masses, biphasic imaging in the arterial and portal phase is recommended in order to establish the relation of the mass to the vasculature and to assess vascularity. In the small pelvis, MR is the superior imaging technique. Otherwise, MRI is mainly used for problem-solving. This course will discuss how to use the various imaging tools efficiently to narrow the differential diagnosis, decide about the need for biopsy and establish a suitable therapy. Normal genital anatomy varies with the age and the hormonal status of the paediatric patient. Knowledge of embryology is essential to understand congenital anomalies of the male and female developing genital systems. Common congenital anomalies include cryptorchidism in males and Müllerian duct anomalies and/or obstructing vaginal anomalies in females. Abnormalities of sexual differentiation result from non-accord of chromosomal, gonadal and genital sex. Dysplastic gonads carry a high risk of gonadal malignancy. Acquired disorders include a variety of acute and non-acute conditions such as testicular or ovary torsion, inflammatory and infectious scrotal or pelvic disorders, ovarian cysts and genital neoplasms, ectopic pregnancy and genital (scrotal) trauma. Ultrasound, including Doppler tools, is the primary modality for imaging both male and female genitalia. A proper and dedicated ultrasound technique examination is essential to obtain maximum diagnostic information. Further genital system imaging, when needed, is preferably accomplished with magnetic resonance such as in cases of complex urogenital (female) malformations and oncologic conditions. Except for tumour spread assessment, computed tomography has a limited role in paediatric genital disorders and should be avoided due to the associated high radiation burden. Plain films are obtained to assess bone age in pubertal disorders, and genitography is usually restricted to the evaluation of rare complex genital malformation. Genitourinary tumours in paediatrics usually present as a painless abdominal mass, the patient's age being an important clue in the differential diagnosis. Neonatal renal tumours are rare and mesoblastic nephroma is the most common tumour at this age. In children older than one year, the most common intra-abdominal masses in children are Wilms tumour and neuroblastoma. Wilms tumour represents approximately 95% of paediatric renal tumours (peak incidence of 2-3 years); mainly sporadic, it may occur in a small number of genetically predisposed children; it may be unilateral or bilateral. Abdominal color Doppler-US and chest radiograph are first-line tests; abdominal contrast-enhanced CT or MRI further delineates tumour extension and excludes bilateral disease; the role of CT versus chest radiograph to detect pulmonary lesion is still controversial. US surveillance is recommended in predisposed children. Non-Wilms tumours may represent a significant proportion of renal tumours in children (especially in children aged 12 years); preoperative imaging, however, is of limited value in the differential diagnosis. The differential diagnosis for a painless scrotal mass in a child includes primary testicular tumours, rabdomyosarcoma, and leukaemia. Scrotal ultrasound remains the imaging modality of choice. The presentation of adnexal masses in childhood differs from that in adult women: children may present with poorly localised symptoms, precocious puberty or with an acute abdomen due to torsion or haemorrhage within an adnexal mass. Both imaging studies and the assessment of the patient's hormonal and pubertal status should be considered in the differential diagnosis. Intracranial aneurysms are in most cases the cause of a subarachnoid haemorrhage (SAH). Ideally, ruptured aneurysms should be excluded from the circulation as soon as possible to prevent rebleeding and allow aggressive treatment of SAH complications such as vasospasm. Endovascular treatment of intracranial aneurysms has evolved in the twentieth century from parent vessel occlusion to selective occlusion of the aneurysm sac with detachable microcoils ("coiling"). The first coiling was performed twenty years ago in 1992. The endovascular approach to the coiling of aneurysms has become an alternative to surgical clipping both due to the low procedural morbidity and mortality, and to the possibility to treat aneurysms with complex vascular anatomy and at locations not accessible to clipping. Compared with clipping the disadvantage of coiling is the incomplete occlusion of aneurysms (neck remnants). Therefore, coiled aneurysms need to be regularly followed by angiography or magnetic resonance imaging. Recently, supportive techniques to coiling have been optimised to help occlude the aneurysm and preserve the parent artery. Compliant balloons can be used to temporarily support the introduction of coils in the aneurysm sac. In wide-necked or dissecting aneurysms intracranial self-expanding stents can be placed. Anticoagulants need to be taken after stent placement complicating the post procedural care of recently ruptured aneurysms. The most recent development is the use of flow-diverting stents that alter the haemodynamics inside the aneurysm sac. Based on various patient and aneurysm characteristics the treatment options need to be discussed with a neurovascular surgeon, neurologist and interventional neuroradiologist. At the subacute phase after surgical or endovascular aneurysm treatment, aneurysm rebleeding or intracranial vasospasm must be clinically suspected when the neurological status suddenly worsens including increased headaches, neurological deficit or loss of consciousness. Doppler sonography and brain CT scan must be performed in emergency to confirm the diagnosis and to discuss an additional treatment in selective cases. In the mid-and long-term follow-up, non-invasive imaging is needed to detect aneurysm recurrence, neck remnant regrowing or de novo aneurysm. After endovascular treatment, the rate of aneurysm recurrence may be estimated between 10 and 30% according to the aneurismal size with a risk of rebleeding from 1 to 2% per year. Most of recurrences are detected during the first 6 months after embolisation leading to an additional treatment in about half of cases. MR angiography is the technique of choice including time-of-flight technique and/or Gd-enhanced MR angiography at 6 months after the initial event and then every year during the following 5 years and finally every 3 years in the long-term follow-up. After surgical treatment, the rate of aneurysm recurrence and the risk of rebleeding are much lower when the aneurismal neck has been clipped in good technical conditions. CT angiography using 64-detector rows or more is definitely the best technique to detect post-surgical aneurysm recurrence. CT is usually performed at 3 years after the initial event and then every 5 years.