[Inflammatory gastrointestinal diseases in children : Radiological diagnosis]. / Entzündliche gastrointestinale Erkrankungen bei Kindern : Radiologische Diagnose.

BACKGROUND/CLINICAL ISSUE: Inflammatory bowel diseases are frequently seen in the clinical routine of a pediatric radiologist. The timely diagnosis of inflammatory bowel diseases in children is particularly important in acute cases. STANDARD RADIOLOGICAL METHODS/METHODOLOGICAL INNOVATIONS: This nonsystematic article intends to give an overview of the radiologic imaging methods for the diagnosis and work-up of pediatric patients with inflammatory bowel diseases. PERFORMANCE: Ultrasound imaging is an important basis tool in pediatric clinical practice. However, sensitivity and specificity depends on the experience of the operator. Cross-sectional imaging modalities in pediatric patients with inflammatory bowel disease are performed only in exceptional cases when clinically justified. Dedicated computed tomography (CT) protocols for children are indispensable to lower radiation dose. ACHIEVEMENTS: Knowledge about particularities in inflammatory bowel diseases in pediatric patients and a rational approach to the use of radiological investigations in order to prevent the harmful effects of ionizing radiation are indispensable in dedicated pediatric imaging departments. PRACTICAL RECOMMENDATIONS: From a radiation-hygiene point of view, the clinical application of ultrasound imaging should be favored in the work-up of pediatric patients with inflammatory bowel diseases. Knowledge about advanced imaging procedures is essential particularly in imaging departments specialized in pediatric radiology.

Endovascular stroke therapy in Austria: a nationwide 1-year experience.

BACKGROUND AND PURPOSE: Based on a tight network of stroke units (SUs) and interventional centres, endovascular treatment of acute major intracranial vessel occlusion has been widely implemented in Austria. Documentation of all patients in the nationwide SU registry has thereby become mandatory. METHODS: Demographic, clinical and interventional characteristics of patients who underwent endovascular treatment for acute ischaemic stroke in 11 Austrian interventional centres between 1 October 2013 and 30 September 2014 were analysed. RESULTS: In total, 301 patients (50.5% women; median age 70.5 years; median National Institutes of Health Stroke Scale score 17) were identified.193 patients (64.1%) additionally received intravenous thrombolysis. The most frequent vessel occlusion sites were the M1 segment of the middle cerebral artery (n = 161, 53.5%), the intracranial internal carotid artery (n = 60, 19.9%) and the basilar artery (n = 40, 13.3%). Stent retrievers were used in 235 patients (78.1%) and adequate reperfusion (modified Thrombolysis in Cerebral Infarction scores 2b and 3, median onset to reperfusion time 254 min) was achieved in 242 patients (81.4%). Symptomatic intracranial haemorrhage occurred in 7%. 43.8% of patients (n = 132) had good functional outcome (modified Rankin Scale score 0-2) and the mortality rate was 20.9% (n = 63) after 3 months. Compared to the anterior circulation, vertebrobasilar stroke patients had higher mortality. Patients with secondary hospital transportation had better outcomes after 3 months than in-house treated patients. CONCLUSION: Our results document nationwide favourable outcome and safety rates of endovascular stroke treatment comparable to recent randomized trials. The ability to provide such data and the need to further optimize such an approach also underscore the contribution of respective registries.

[Flat-panel CT as a new perinterventional imaging modality in aortic stentgraft procedures--work in progress]. / Flachdetektor-CT als ergänzende Untersuchung bei der endoluminalen Behandlung von thorakalen und abdominellen Aortenaneurysmen--Erste klinische Erfahrungen.

PURPOSE: To evaluate the value of flat-panel CT (FP-CT) as a new perinterventional imaging modality in aortic stentgraft procedures. MATERIALS AND METHODS: FP-CT was performed in 21 patients (19 males, mean age 77, range 54 to 90) from June 2005 to February 2007 immediately after endovascular treatment of thoracic and abdominal aortic aneurysms on the angiographic table. Nine thoracic aortic aneurysms were treated with Zenith-endoprosthesis. Nine of twelve abdominal aortic aneurysms were treated with Zenith-endoprosthesis and three with an Excluder-endoprosthesis. Images were acquired with a rotating C-arm and the following parameters: during an acquisition time of 20 seconds and at a rotation of 217 degrees, 538 projections were acquired. Contrast agent was administered in 14 patients. Images were displayed in MIP, MPR and VRT mode. RESULTS: In all patients the stentgraft was shown exactly and the alignment of the prosthesis along the landing zones was well displayed. The aneurismal sack was well shown in all patients. 1 x an endoleak II was detected, 1 x an angiographically verified endoleak I was not detected. In one patient distal extension was considered due to suspected short stentgraft at the distal neck. Flat-panel CT showed sufficient neck coverage and no extension was inserted. Due to artifacts of the prosthesis, the platinum markers and the guide wire as well as due to pulsation of the aorta, the resolution of detail decreased and reduced the visualization of the alignment. CONCLUSION: FP-CT is a promising tool and may provide additional information, but further studies are necessary to define the value of flat-panel CT in thoracic and abdominal aortic stentgraft procedures.

European Multicenter Study for the Evaluation of a Dual-Layer Flow-Diverting Stent for Treatment of Wide-Neck Intracranial Aneurysms: The European Flow-Redirection Intraluminal Device Study.

BACKGROUND AND PURPOSE: Endoluminal reconstruction with flow-diverting stents represents a widely accepted technique for the treatment of complex intracranial aneurysms. This European registry study analyzed the initial experience of 15 neurovascular centers with the Flow-Redirection Intraluminal Device (FRED) system. MATERIALS AND METHODS: Consecutive patients with intracranial aneurysms treated with the FRED between February 2012 and March 2015 were retrospectively reviewed. Complications and adverse events, transient and permanent morbidity, mortality, and occlusion rates were evaluated. RESULTS: During the defined study period, 579 aneurysms in 531 patients (median age, 54 years; range, 13-86 years) were treated with the FRED. Seven percent of patients were treated in the acute phase (≤3 days) of aneurysm rupture. The median aneurysm size was 7.6 mm (range, 1-36.6 mm), and the median neck size 4.5 mm (range, 1-30 mm). Angiographic follow-up of >3 months was available for 516 (89.1%) aneurysms. There was progressive occlusion witnessed with time, with complete occlusion in 18 (20%) aneurysms followed for up to 90 ± 14 days, 141 (82.5%) for 180 ± 20 days, 116 (91.3%) for 1 year ± 24 days, and 122 (95.3%) aneurysms followed for >1 year. Transient and permanent morbidity occurred in 3.2% and 0.8% of procedures, respectively. The overall mortality rate was 1.5%. CONCLUSIONS: This retrospective study in real-world patients demonstrated the safety and efficacy of the FRED for the treatment of intracranial aneurysms. In most cases, treatment with a single FRED resulted in complete angiographic occlusion at 1 year.

Sentinel node SPECT-CT in breast cancer. Can we expect any additional and clinically relevant information?

UNLABELLED: The AIM of this study was to determine the additional value of SPECT/CT in sentinel node scintigraphy in breast cancer. Furthermore, it was our question to determine, whether the low-dose computed tomography component (LD-CT) can be used for axillary lymph node staging of clinically negative patients. PATIENTS, METHODS: 51 patients with invasive breast cancer <3 cm in diameter were included in our prospective investigation. SPECT/CT was performed on a dedicated scanner 30 minutes after subareolar injection of (99m)Tc-Nanocoll. Axillary staging with CT(LD) was performed using standard CT-criteria. SLN were allocated to an axillary level using SPECT alone and SPECT/CT. Additionally, the number of SLN on CT(LD) corresponding to the scintigraphic hot node was notified for each patient and compared to the number of SLN found with the gamma probe. RESULTS: In 45/51 evaluable patients SLN could be localised in level I in 43 patients and in level II in two patients (all positive) using SPECT-CT, whereas a clear allocation could not be obtained by SPECT alone. The number of SLN was discrepant between SPECT and CT(LD) in 13/45 patients. The number of SLN detected with the gamma probe (n = 68) not significantly differed from the number of SLN detected by CT(LD) (n = 65) but was significantly higher than with SPECT (n = 51). CT(LD) yielded a sensitivity of 35.7%, a specificity of 83.9%, a positive predictive value (PPT) of 50%, a negative predictive value (NPV) of 74.3% and a diagnostic accuracy of 68.9% for axillary staging with CT(LD). CONCLUSION: The additional information of SPECT/CT allows a more accurate characterization of the SN concerning size, depth and anatomical location. CT(LD) when performed during (99m)Tc-Nanocoll sentinel-SPECT/CT is not suitable for axillary staging in breast cancer patients with clinical negative axilla due to its low sensitivity and moderate specificity. Therefore, it does not influence the decision for SNB or ALND. The limited resolution of SPECT leads to an underestimation of the number of SLN compared to CT(LD) and the gamma probe.

[Sonography of the scrotum]. / Sonographie des Skrotalinhalts.

Ultrasonography (US) has become the method of choice for imaging in diseases affecting the scrotum. With the development of high resolution transducers using colour Doppler and pulsed Doppler, it is now possible to make accurate diagnoses. Sonography is able to distinguish immediately between intra- and extratesticular lesions. It is also possible to differentiate between cystic and solid tumours. Solid testicular tumours may be detected without difficulty and thus the patient's dignity is practically assured (98 % of solid testicular tumours are malignant). In cases of acute diseases of the scrotum, sonography nearly always permits a differentiation between torsion and inflammation, thus avoiding the risk of unnecessary operations. The review covers the introduction, anatomy, the scanning protocol for scrotal ultrasound and pathological changes. Testicular tumours and torsion are discussed in detail. Variations from the norm and pitfalls are outlined so as to help avoid making misdiagnoses.

Clinical experience with a commercially available negative oral contrast medium in PET/CT.

PURPOSE: To evaluate a commercially available negative oral contrast material for PET/CT. MATERIAL AND METHODS: In a prospective series of 49 patients, Mukofalk, which is a vegetarian-based substance, was used as a negative oral contrast medium in whole body PET/CT studies. Mukofalk was administered during a time period of 1.5 hours before the examination. Quality of small bowl distension and eventual pathological tracer uptake in the intestine were evaluated. RESULTS: Distension of the small bowel was excellent or good in 41 (85 %) and poor in 8 (15 %) patients. Mild tracer uptake in the small bowel was observed in 5 patients (10.2 %) and moderate uptake in another 2 patients (4 %). In none of these patients did the F-18 FDG uptake interfere with image interpretation. CONCLUSION: Mukofalk can be used as a negative oral contrast medium in PET/CT studies.

Posttraumatic extracranial aneurysm of the internal carotid artery: combined endovascular treatment with coils and stents.

We report a case of a posttraumatic extracranial pseudoaneurysm of the internal carotid artery that was treated successfully via embolization with Guglielmi detachable coils and placement of a Wallstent after surgical repair failed.

Intra-hepatic haematoma complicating transjugular intra-hepatic portosystemic shunt for Budd-Chiari syndrome associated with anti-phospholipid antibodies, aplastic anaemia and chronic hepatitis C.

Portal venous decompression with transjugular intra-hepatic portosystemic shunt (TIPS) is a new approach in the treatment of Budd-Chiari syndrome. We report on a 31-year-old female with Budd-Chiari syndrome due to anti-phospholipid antibodies with compression of the inferior vena cava treated with TIPS and stenting of the inferior vena cava. TIPS was complicated by massive intra-hepatic haematoma which was managed conservatively. Treatment options and pathogenic mechanisms of Budd-Chiari syndrome under the rare coincidence of aplastic anaemia and anti-phospholipid syndrome are discussed. TIPS may be considered for venous decompression in Budd-Chiari syndrome, but physicians should be aware of potential TIPS' complications in these patients.

Imaging guided interventional procedures in paediatric uroradiology--a case based overview.

OBJECTIVE: To describe the potential and application of interventional image guided procedures in the paediatric urinary tract. PATIENTS AND METHODS: The different techniques are illustrated using case reports. The examples comprise established indications such as percutaneous nephrostomy for compromised kidneys in obstructive uropathy and infection, sonographic guided renal biopsy including monitoring or treatment of complications after biopsy, and evaluation and balloon dilatation of childhood renal artery stenosis. There are new applications such as treatment of stenosis in cutaneous ureterostomy or sonographically guided catheterism for deployment of therapeutic agents. RESULTS: Generally, the procedures are safe and successful. However, complications may occur, and peri-/post-interventional monitoring is mandatory to insure early detection and adequate management. Sometimes additional treatment such as percutaneous embolisation of a symptomatic post biopsy arterio-venous fistula, or a second biopsy for recurrent disease may become necessary. CONCLUSION: Imaging guided interventional procedures are performed successfully in a variety of diseases of the paediatric urinary tract. They can be considered a valuable additional modality throughout infancy and childhood.

Complications in endoluminal repair of abdominal aortic aneurysms.

In this review the technical and systemic complications occurring during endoluminal repair of abdominal aortic aneurysms are summarized. According to the data in the literature the technical success-rate of the endoluminal procedure should be >90% and the overall complication-rate <10%. It should be differentiated between complications which have an adverse effect on the outcome of the procedure, and technical problems, which complicate the procedure but do not affect the outcome. The majority of the technical problems can be solved endoluminally. The 30-day mortality rate should be in the same range as elective open surgical repair. One major factor influencing the immediate results is the experience of the interventional team.

[Differential sonographic diagnosis of scrotal diseases]. / Sonographische Differentialdiagnose von Erkrankungen des Skrotums.

High-resolution scrotal sonography proves valuable in addition to clinical investigation. On the basis of a retrospective analysis of 282 sonographic examinations this method's contributions to the differential diagnosis of diseases of the scrotum are shown. It is usually possible to distinguish testicular from extratesticular tumours; certain signs of inflammation allow the distinction between orchitis and tumour. Sonography is very important for the study of acute painful lesions of the scrotum, which are not palpable, such as rupture following a trauma, severe inflammation and even tumours.

[Treatment of malignant and benign biliary obstructions with metal stents]. / Behandlung maligner und benigner biliärer Obstruktionen mit Metallstents.

The palliative treatment of malignant biliary tract obstructions using a metal stent is now an established procedure in clinical practice. An endoscopic, transpapillary approach is the first choice for implantation of the stent. If it is not possible to insert the stent in this way, which is often the case with high obstructions, a percutaneous approach is chosen. It appears to be beneficial to use a metal stent with a fine-meshed net such as, for example, the Wall stent. Metal stents have a higher patency rate than plastic stents so that the primary choice of a metal stent is justified. Coated stents have not yet shown any major advantages. In cases of stent occlusion, the coaxial implantation of a plastic stent seems to be the most efficient. In cases of benign biliary tract stenoses, a metal stent should only be implanted after a careful evaluation of all possible surgical modalities and exploitation of balloon dilatation and long-term splinting methods.

[Pelvic artery embolization in gynecological bleeding]. / Beckenarterienembolisationen bei gynäkologischen Blutungen.

The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignancies. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatin sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90 %. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding.

[Differential sonographic diagnosis of space-occupying lesions in the mandibular angle]. / Sonographische Differentialdiagnose von Raumforderungen im Kieferwinkel.

The use of sonography in the evaluation of expansions at the mandibular angle was studied in 143 patients with histologically or laboratory proven diagnoses. The correct localisation of parotid tumours was achieved in all 62 cases. Other expansions were due to enlarged lymphnodes (35 times), 14 branchiogenic cysts and 6 other tumours. The distinction between malignant and benign expansions was successful in 87%, the correlation with histology was correct only in 60%. Sonography offers in the valuation of anatomic relations rather than in telling the histology of a tumour. In certain cases such as branchiogenic cysts, lipomas, haemangiomas and multicentric Whartin tumours sonography gives useful hints towards specific diagnoses. In most cases a final diagnosis of expansions at the mandibular angle must be proven by biopsy or clinical course.

[Clinical experiences with the transjugular intrahepatic portocaval shunt (TIPS)]. / Klinische Erfahrungen mit dem transjugulären intrahepatischen portokavalen Shunt (TIPS).

Twenty-five patients with liver cirrhosis and portal hypertension were admitted for creation of a transjugular intrahepatic portosystemic shunt (TIPS). The procedure was successful in 22 patients (technical success 88%). The mean portal pressure gradient was lowered from 24.5 mmHg before to 11.4 mmHg after TIPS. Two early and three late occlusions were observed (primary patency rate 78%). The rate of secondary interventions was 41%. Five times a hepatic vein stenosis was dilated and stented, two times an occluded shunt was recanalized, two times a new shunt was created parallel to an occluded (secondary patency rate within a maximum of 16 months 95%). In two patients sepsis occurred which was effectively treated with antibiotics, two patients died shortly after TIPS due to hepatorenal syndrome and hepatic failure, respectively. There was no recurrent bleeding. Two patients developed hepatic encephalopathy; both improved after protein restriction. The authors conclude that TIPS is an alternative procedure to shunt surgery, especially for patients who cannot benefit from sclerotherapy.

[The value of different spiral CT phases in the detection of liver metastases]. / Der Wert unterschiedlicher Spiral-CT-Phasen in der Suche nach Lebermetastasen.

PURPOSE: To assess the value of the non-contrast phase (NCP), hepatic-arterial phase (HAP) and portal-venous phases (PVP) for the detection of liver metastases by spiral CT. METHODS: In order to detect liver metastases, 119 patients (58 women, 61 men; mean age: 62 years) underwent triphasic spiral CT (8 mm collimation, 12 mm table increment/rotation, 7 mm reconstruction increment). NCP, HAP (20 s delay) and PVP (70 s delay) scans were acquired (contrast medium injection rate: 4 ml/s). CT analysis comprised independent evaluation of the three scan series for detection and conspicuity of liver metastases (conspicuity score: 0 = not visible, 1 = barely visible, 2 = clearly visible, 3 = distinctly visible). RESULTS: In 83 of the 119 patients, 478 liver metastases were detected (110 hypervascular and 368 hypovascular lesions). 285 (60 %) metastases were detected on NCP scans. Significantly more lesions were seen on HAP (n = 375, 78 %) and on PVP (n = 428, 90 %). No lesion was detected on NCP studies alone. For all detected metastases, mean conspicuity was 1.2 +/- 0.4 on NCP, 1.8 +/- 0.8 on HAP and 2.2 +/- 0.8 PVP. Hypervascular lesions were best seen on HAP with a conspicuity score of 2.0 +/- 0.8 versus 1.3 +/- 0.5 on NCP and 1.5 +/- 0.8 on PVP. Hypovascular lesions reached the highest conspicuity on PVP with 2.4 +/- 0.8 versus 1.2 +/- 0.4 on NCP and 1.7 +/- 0.7 on HAP. CONCLUSION: For detection of liver metastases with spiral CT, contrast series seem to be sufficient. For tumors likely to seed hypervascular metastases, HAP scans should be applied in addition to the PVP.

[Percutaneous recanalization of pelvic artery occlusions--fibrinolysis, PTA, stents]. / Perkutane Rekanalisation von Beckenarterienverschlüssen--Fibrinolyse, PTA, Stents.

In 42 patients with symptomatic chronic iliac artery occlusions with a length of 2-15 cm (mean 4.3 cm), percutaneous recanalization was attempted. The study population was divided into 2 groups: Group I (n = 17) is a retrospective control group, the patients were treated with fibrinolysis (FL) and percutaneous transluminal angioplasty (PTA). In group II (n = 25) the patients were treated according to a prospective protocol including FL, PTA and placement of endovascular self-expandable stents. The recanalization rate for Group I and II together was 83% (35/42). FL was effective in 47%, in 53% the recanalization was performed mechanically only. The patency rate in Group I during a maximum of 69 months was 67%, in Group II, in which residual stenoses were treated with stents, 100% during max. 18 months. Obviously stents help to improve the results after percutaneous recanalization of iliac artery occlusions significantly.

[Endoluminal therapy of infrarenal aortic aneurysms with the Talent system--initial experiences with a new endoprosthesis]. / Endoluminale Therapie infrarenaler Aortenaneurysmen mit dem Talent-System--Erste Erfahrungen mit einer neuen Endoprothese.

PURPOSE: To report the early clinical experience with the Talent stent-graft system in the treatment of infrarenal aortic aneurysms. MATERIALS AND METHODS: The study group comprised 15 males aged from 51-79 years. A bifurcated Talent stent-graft was implanted in 9 patients with type B or C aneurysms, a tube graft in 6 patients with a type A aneurysm. The stent-grafts were introduced via a surgical femoral cut-down, for a bifurcated graft a bilateral surgical access was needed. All procedures were performed as teamwork by radiologists and vascular surgeons under general anaesthesia in the angiography suite. RESULTS: Primary and secondary technical successes were 80 and 86%, respectively. Technical failures were due to access site problems (n = 1; elective open repair), malpositioning of the prosthesis (n = 1; immediate conversion to open surgery), and primary distal leakage (n = 1; elective occlusion by means of distal stent-graft extension). One patient died 15 days after an uneventful stent-graft insertion (30-day mortality 6%). No complications were observed during a mean follow-up period of 7.8 months. The aneurysmal diameter decreased in 6 patients and remained unchanged in the others. CONCLUSIONS: The Talent system revealed satisfactory early results which are comparable to competitive stent-graft systems. An advantage of this stent-graft device is the availability in a wide range of dimensions. A major disadvantage is the large introducer system (french size 22-27).

[Fluoroscopically guided percutaneous fine-needle biopsy of the lung using the ROTEX needle: results in 890 patients with focal lung lesions]. / Durchleuchtungsgezielte perkutane Feinnadelbiopsie der Lunge mit der ROTEX-Nadel. Ergebnisse bei 890 Patienten mit fokalen Lungenläsionen.

Fluoroscopically guided transthoracic fine needle biopsies were performed in 890 patients (380 female, 582 male, mean age: 56 years). In 795 patients (89.4%) the first biopsy was successful. The success rate of biopsy correlated closely with the size of the lesion and increased with larger size. Sensitivity in the diagnosis of malignant lesions was 94.6%, specificity 99.5%. Due to cytological, histological, and clinical confirmation of benign lung lesions in 300 patients (33.7% of all patients), the number of unnecessary diagnostic thoracotomies for benign disease could be reduced significantly. In 9 of 113 cases (8%) histological reclassification of the cytologic results was necessary. Reclassification was not necessary in the differentiation between benign and malignant lesions and between small cell and non-small cell carcinomas. The overall complication rate was 24.7% (220 patients). Only 36 patients (4% of all patients) required chest-tube insertion. There were no fatal complications. Percutaneous fluoroscopically guided transthoracic fine needle biopsy of the lung, performed with the Rotex needle, is a time-effective, safe, and efficient method for diagnosing focal pulmonary lesions.