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We report the case of a 62-year-old Caucasian male patient who presented with epigastric pain to our outpatient clinic. On abdominal ultrasound we detected a 26âmm oval hypoechoic lesion in segment 2 of the left liver lobe. Performing contrast-enhanced ultrasound this lesion showed an arterial hypervascularization with centripetal filling and a spoke wheel pattern. Due to a hyperenhancement during the portal and late phase this lesion led to the diagnosis of a benign liver tumor, probably a hepatocellular adenoma (HCA). As focal nodular hyperplasia (FNH) was still another possible diagnosis, we decided to perform an MRI, which could not differentiate between HCA and hepatocellular carcinoma (HCC). Therefore, we performed liver biopsy of this lesion. Histology and immunohistochemistry led to the final diagnosis of intrahepatic splenosis. Reassessment of patient history revealed an abdominal trauma with splenic rupture 5 years ago. Intrahepatic splenosis should be considered as an important differential diagnosis in patients with unknown liver tumor and a history of splenic trauma.
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Imageamento por Ressonância Magnética , Esplenose/patologia , Abdome/diagnóstico por imagem , Adenoma de Células Hepáticas , Carcinoma Hepatocelular , Meios de Contraste , Diagnóstico Diferencial , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ultrassonografia/métodosRESUMO
Molecular diagnostics are increasingly important to guide treatment decisions in oncologic patients. For instance, the presence of high-grade microsatellite-instability (MSI-high) is considered to be one of the major positive predictors of therapy response to immune-checkpoint inhibitors in patients with solid tumors. Based on impressive results from several immune-oncology trials, the American Food and Drug Administration (FDA) granted approval to immunotherapy in any previously treated, MSI-high solid cancer in 2017. Here, we report the clinical case of a young patient with MSI-high colorectal cancer. The case illustrates, that insurance companies in Germany are still reluctant to cover the cost of immunotherapy in this specific patient subgroup, which, in our opinion, results in an ethically problematic therapeutic dilemma.
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Neoplasias Colorretais/imunologia , Imunoterapia/métodos , Neoplasias do Colo/terapia , Neoplasias Colorretais/genética , Neoplasias Colorretais/terapia , Alemanha , Humanos , Instabilidade de Microssatélites , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this study was to optimize computed tomography pulmonary angiography (CTPA) protocols with regard to improve vascular attenuation without increasing contrast media (CM) volumes. Therefore, we compared the standard CTPA protocol to an individualized contrast media injection protocols adjusted for the patient's body mass index (BMI). MATERIALS AND METHODS: Two groups of 295 patients with suspected pulmonary embolism (PE) have been receiving CTPA. Group 1 received a standard protocol without taking patient's BMI into account. Group 2 received a CTPA scan, where dose and flow rate of CM injections were adjusted for the patient's BMI. Images were retrospectively analyzed by drawing regions of interests in defined positions in the superior vena cava, descending aorta, the pulmonary main trunk as well as the left and right lower lobe arteries. Intravascular attenuation, contrast volumes, and flow rates were compared using unpaired t-tests. Furthermore, a qualitative image analysis was performed by two experienced readers blinded for the protocol used for image acquisition to evaluate the image quality and arterial attenuation. RESULTS: Patient's BMI was similar in both the groups (27.5 ± 1.5 kg/m2 vs. 28.4 ± 2.1 kg/m2; P = 0.67). Contrast volumes were lower (54.2 ± 4.8 ml vs. 55 ml; P < 0.05), and flow rates (4.1 ± 0.3 ml/s vs. 3.5 ml/s; P < 0.05) were significantly higher in the individualized protocol. The qualitative image analysis yielded an agreement on diagnostic interpretability in the individualized and standard group of 49% and 51% (95% Wilson confidence interval for mean), respectively. CONCLUSION: An individualized CTPA protocol based on the patient's BMI reduced the contrast media volume and led to an increased pulmonary artery enhancement improving image quality, particularly in the evaluation of the peripheral pulmonary arteries. Thus, contrast media volumes in CTPA should be adjusted for the patient's BMI.
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BACKGROUND: Radiofrequency (RFA) and microwave ablation (MWA) are established minimally invasive techniques for treatment of hepatic tumors. PURPOSE: To compare technical success and accuracy of hepatic thermoablation using computed tomography (CT) and magnetic resonance imaging (MRI) acquired 24 h after ablation with regard to evaluation of the post-interventional ablation zone and local tumor recurrence (LTR), and to assess whether additional MRI within 24 h is beneficial. MATERIAL AND METHODS: Thirty-two patients (23 men, 9 women; mean age, 60 years) with 48 lesions were included in this retrospective study. CT was performed immediately and MRI was performed 24 h after ablation. Diameter and volume calculations of the ablation zone were compared (T-Test). Technical success and ablation margin distinction, shape, and configuration were evaluated (κ-statistic). Local effectiveness was calculated based on follow-up imaging. Technical success and ablation margin features were correlated with LTR (log-rank test, Fisher's exact test). RESULTS: Ablation zone volumes were significantly higher with MRI compared to CT (P < 0.05; mean volume, 55.19 and 45.97 mL). Agreement between CT and MRI for technical success was good (κ = 0.801) and for margin conspicuity fair (κ = 0.289). LTR was 26.1% (mean follow-up, 11.7 months). LTR showed no correlation with technical success or margin conspicuity. CONCLUSION: CT and MRI are suited for early evaluation of technical success after thermoablation. Within 24 h a significant increase of the ablation volume is observed, which has to be taken into account when interpreting immediate postprocedural imaging and treating lesions near critical structures. Additional MRI 24 h after ablation seems of limited value regarding prognosis of LTR, especially with regards to evaluation of ablation margin shape and conspicuity.
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Eletrocoagulação/métodos , Hipertermia Induzida/métodos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Neoplasia Residual , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Cirurgia Assistida por Computador , Resultado do TratamentoRESUMO
BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is an established technique for the evaluation of intra- and extrahepatic bile ducts in patients with known or suspected hepatobiliary disease. However, the ideal acquisition and reconstruction plane for optimal bile duct evaluation with 3D technique has not been evaluated. The purpose of our study was to compare different acquisition and reconstruction planes of 3D-MRCP for bile duct assessment. METHODS: 34 patients (17f/17 m, mean age 41y) referred for MRCP were included in this prospective IRB-approved study. Respiratory-triggered 3D-T2w-MRCP sequences were acquired in coronal and axial plane. Coronal and axial MIP were reconstructed based on each dataset (resulting in two coronal and two axial MIP, respectively). Three readers in two sessions independently assessed the MIP, regarding visualization of bile ducts and image quality. Results were compared (Wilcoxon test). Intra- and interobserver variability were calculated (kappa-statistic). RESULTS: In case of coronal data acquisition, visualization of bile duct segments was significantly better on coronal reconstructed MIP images as compared to axial reconstructed MIP (p < 0.05). Regarding visualization, coronal MIP of the coronal acquisition were equal to coronal MIP of the axial acquisition (p > 0.05). Image quality of coronal and axial datasets did not differ significantly. Intra- and interobserver agreement regarding bile duct visualization were moderate to excellent (κ-range 0.55-1.00 and 0.42-0.85, respectively). CONCLUSIONS: The results of our study suggest that for visualization and evaluation of intra- and extrahepatic bile duct segments reconstructed images in coronal orientation are preferable. The orientation of the primary dataset (coronal or axial) is negligible.
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Ductos Biliares Extra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética/métodos , Imageamento Tridimensional/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Adulto JovemRESUMO
BACKGROUND: Computed tomography pulmonary angiography (CTPA) is used most often in routine clinical practice for the assessment of a suspected pulmonary embolism. The diagnostic accuracy relies on sufficient contrast enhancement. PURPOSE: To evaluate whether image acquisition during shallow breathing can improve the image quality in patients with insufficient contrast enhancement during breath-hold examinations. MATERIAL AND METHODS: A total of 2786 CT pulmonary angiographies, acquired on a 64-row CT during deep-inspiration breath-hold, were reviewed. Twenty-four examinations were considered non-diagnostic due to poor contrast enhancement in the pulmonary arteries (PA), although they showed preserved vascular enhancement of the superior vena cava (SVC) and the ascending aorta (AO). Eleven flawed CTPA examinations, including severe breathing artifacts and incorrect triggering were excluded. In 13 of the remaining patients, the examination was repeated during shallow breathing. Vascular contrast enhancement was compared between both scans by measuring the relative enhancement within the SVC, the main PA, and the AO. Image quality was scored by two, clinically experienced radiologists. The values are given as median and [25th;75th] quartile. RESULTS: There was a significant difference in the CT values for the PA between the repeated scans (P = 0.0002, Wilcoxon test), and with the CTPA in deep-inspiration showing a median enhancement of 97 HU (59-173), compared with 303 HU (239-385) in the CTPA acquired during free breathing. The differences for both the AO (P = 0.54) and the SVC (P = 0.78) were not significant. Scoring for the attenuation quality rose significantly (P = 0.0002) and no severe motion artifacts were detected on either scans. CONCLUSION: If there is insufficient pulmonary artery enhancement during CTPA, attenuation of the pulmonary arteries can be improved by acquisition during shallow breathing and is without significant loss of the overall diagnostic image quality.
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Tomografia Computadorizada Multidetectores/métodos , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Respiração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Criança , Pré-Escolar , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Iopamidol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: Along with ultrasound, computed tomography (CT) is one of the imaging modalities of choice in patients with suspected diverticular disease (DD). Recently, a newer Classification of Diverticular Disease (CDD) has been proposed. However, its reliability in daily radiological practice has never been proven. Therefore, our aim was to evaluate the intra- and interobserver agreement of the CDD in abdominal CT scans. METHODS: In this retrospective study, 481 CT scans of patients with suspected DD were included. Two readers (one board-certified radiologist with 6 years of experience, one 3ârd year radiology resident) individually evaluated all CTs in two reading sessions using the CDD. A composite endpoint of a prior consensus reading, follow-up, and intraoperative findings served as the reference. Intra- and interobserver agreement were calculated using Cohen-k statistic. RESULTS: DD was present in 317 cases (66â%), mostly classified as CDD stage 0, 1b, and 2a (28â%, 30â%, und 14â%). Intraobserver agreement was almost perfect for both readers (kappa 0.93 and 0.88). Interobserver agreement was high and improved from substantial (kappa 0.77) in the first reading session to almost perfect (kappa 0.84) in the second reading session. The interobserver agreement was best for CDD types 0 (diverticulosis) and 2c (free perforated diverticulitis) (mean kappa 0.83 and 0.86) and poorest for CDD types 1a (diverticulitis without phlegmon) and 2b (covered diverticulitis with macroabscess) (mean kappa 0.17 and 0.38). Intra- and interobserver agreement of acute uncomplicated (CDD type 1) and acute complicated diverticulitis (CDD type 2) were substantial to almost perfect (mean kappa 0.63-0.86). Agreement with the reference was almost perfect for both observers (mean kappa 0.86 and 0.82). Administration of rectal contrast did not significantly improve the diagnosis. CONCLUSION: The CDD is a classification based on relatively clear imaging characteristics, which can be readily applied by radiologists with different expertise. In our study, the CDD had a high intra- and interobserver agreement, enabling a reliable therapy-related categorization of DD. KEY POINTS: · The Classification of Diverticular Disease (CDD) is an easy-to-use classification for diverticular disease based on relatively clear image features.. · The CDD can be applied equally by radiologists with different levels of experience in the clinical routine.. · The high intra- and interobserver agreement indicates high reliability in the therapy-relevant classification of diverticulitis on CT..
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Acute renal allograft dysfunction in the first weeks after transplantation primarily requires examination for acute rejection, drug-associated injury, pre-renal failure due to exsiccosis/dehydration, and post-renal problems such as urinary tract obstruction. In rare instances, main renal artery or vein thrombosis may be found, e.g. due to acute rejection of the vessels. Herein, we describe the clinical course of a patient with a recent renal transplantation who presented with an acute enigmatic renal allograft failure which, after intensive diagnostic efforts, emerged as paradoxical embolism with extensive allograft ischemia in consequence of a venous thrombosis and a patent foramen ovale - a so far unreported case.
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Embolia Paradoxal/diagnóstico , Forame Oval Patente/diagnóstico , Transplante de Rim , Disfunção Primária do Enxerto/etiologia , Embolia Paradoxal/complicações , Forame Oval Patente/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Living donor liver transplantation (LDLT) is a valuable and legitimate treatment for patients with end-stage liver disease. Computed tomography (CT) has proven to be an important tool in the process of donor evaluation. The purpose of this study was to evaluate the significance of CT in the donor selection process. METHODS: Between May 1999 and October 2010 170 candidate donors underwent biphasic CT. We retrospectively reviewed the results of the CT and liver volumetry, and assessed reasons for rejection. RESULTS: 89 candidates underwent partial liver resection (52.4%). Based on the results of liver CT and volumetry 22 candidates were excluded as donors (31% of the cases). Reasons included fatty liver (n = 9), vascular anatomical variants (n = 4), incidental finding of hemangioma and focal nodular hyperplasia (n = 1) and small (n = 5) or large for size (n = 5) graft volume. CONCLUSION: CT based imaging of the liver in combination with dedicated software plays a key role in the process of evaluation of candidates for LDLT. It may account for up to 1/3 of the contraindications for LDLT.
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Seleção do Doador/estatística & dados numéricos , Hepatopatias/diagnóstico por imagem , Hepatopatias/epidemiologia , Transplante de Fígado/diagnóstico por imagem , Transplante de Fígado/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Seleção do Doador/métodos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
PURPOSE: To analyze the impact of the COVID-19 pandemic in 2020 on the radiological imaging volume in Germany. MATERIALS UND METHODS: In this retrospective multicenter study, we analyzed CT and MRI examinations of 7 radiology institutes across Germany from January to December 2020. The imaging volume was compared to 2019 (Wilcoxon-Mann-Whitney test). Modality, patient service locations, and examined body parts were assessed in consideration of time periods of the pandemic. In addition, correlation with the incidence of SARS-CoV-2 cases and associated death was performed (Spearman-test). RESULTS: In total, in 2020, imaging volume declined by 4â% (nâ=â8314) compared with 2019 (pâ<â0.05). The hard lockdown during the first pandemic wave (calendar week 12-16, March 22 - April 19) revealed the highest decrease with 29â% (nâ=â894, pâ<â0.01), with the greatest decrease in CT (36â% vs. MRI 26â%), outpatients (38â%, pâ<â0.01), and imaging of the spine and extremities (51-72â%, <â0.05 - pâ<â0.01). Examinations referred from the emergency department (-13â%, pâ<â0.05) and CT of the chest (-16â%, pâ<â0.05) were least affected. With the end of the first wave, gradual normalization of the imaging volume was observed and persisted until the end of the observation period. A reduction of imaging volume negatively correlated with the incidence of SARS-CoV-2-positive cases and associated deaths (râ=â0.28 and 0.49, pâ<â0.05 and pâ<â0.001). CONCLUSION: The COVID-19 pandemic was associated with a significant temporary decline in imaging volume. After the first lockdown period, a quick recovery was observed with radiologic imaging examinations steadily approaching prior-year figures. KEY POINTS: · This study assesses the impact of dynamic pandemic activity on radiological imaging in a multicenter analysis in Germany.. · The COVID-19 pandemic was associated with a temporary decline in CT and MRI scans.. · Relaxation of restrictions was associated with fast normalization of imaging volumes to prior-year levels, which persisted until the end of the year.. · Significant catch-up effects were not observed.. CITATION FORMAT: · Schmidbauer M, Grenacher L, Juchems MS etâal. Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. Fortschr Röntgenstr 2022; 194: 625â-â633.
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COVID-19 , Radiologia , Controle de Doenças Transmissíveis , Alemanha/epidemiologia , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2RESUMO
We aimed to evaluate whether U-shaped convolutional neuronal networks can be used to segment liver parenchyma and indicate the degree of liver fibrosis/cirrhosis at the voxel level using contrast-enhanced magnetic resonance imaging. This retrospective study included 112 examinations with histologically determined liver fibrosis/cirrhosis grade (Ishak score) as the ground truth. The T1-weighted volume-interpolated breath-hold examination sequences of native, arterial, late arterial, portal venous, and hepatobiliary phases were semi-automatically segmented and co-registered. The segmentations were assigned the corresponding Ishak score. In a nested cross-validation procedure, five models of a convolutional neural network with U-Net architecture (nnU-Net) were trained, with the dataset being divided into stratified training/validation (n = 89/90) and holdout test datasets (n = 23/22). The trained models precisely segmented the test data (mean dice similarity coefficient = 0.938) and assigned separate fibrosis scores to each voxel, allowing localization-dependent determination of the degree of fibrosis. The per voxel results were evaluated by the histologically determined fibrosis score. The micro-average area under the receiver operating characteristic curve of this seven-class classification problem (Ishak score 0 to 6) was 0.752 for the test data. The top-three-accuracy-score was 0.750. We conclude that determining fibrosis grade or cirrhosis based on multiphase Gd-EOB-DTPA-enhanced liver MRI seems feasible using a 2D U-Net. Prospective studies with localized biopsies are needed to evaluate the reliability of this model in a clinical setting.
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PURPOSE: Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT). METHODS: In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT's level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded. Each RiT performed two punctures. The first puncture was performed with a transaxial or single angulated needle path and the second with a single or double angulated needle path. Puncture deviation and puncture duration were compared between the procedures and were correlated with the self-assessments. RESULTS: RiTs in both the CT guidance and CACT guidance groups did not differ with respect to radiologic experience (pâ=â1), angiographic experience (pâ=â0.415), and number of ultrasound-guided puncture procedures (pâ=â0.483), CT-guided puncture procedures (pâ=â0.934), and CACT-guided puncture procedures (pâ=â0.466). The puncture duration was significantly longer with CT guidance (without navigation tool) than with CACT guidance with navigation software (pâ<â0.001). There was no significant difference in the puncture duration between the first and second puncture using CT guidance (pâ=â0.719). However, in the case of CACT, the second puncture was significantly faster (pâ=â0.006). Puncture deviations were not different between CT-guided and CACT-guided puncture (pâ=â0.337) and between the first and second puncture of CT-guided and CACT-guided puncture (CT: pâ=â0.130; CACT: pâ=â0.391). The self-assessment of manual skills did not correlate with puncture deviation (pâ=â0.059) and puncture duration (pâ=â0.158). The self-assessed spatial skills correlated positively with puncture deviation (pâ=â0.011) but not with puncture duration (pâ=â0.541). CONCLUSION: The RiTs achieved a puncture deviation that was clinically adequate with respect to their level of training and did not differ between CT-guided and CACT-guided puncture. The puncture duration was shorter when using CACT. CACT guidance with navigation software support has a potentially steeper learning curve. Spatial skills might accelerate the learning of image-guided puncture. KEY POINTS: · The CT-guided and CACT-guided puncture experience of the RiTs selected as part of the program "Researchers for the Future" of the German Roentgen Society was adequate with respect to the level of training.. · Despite the lower collective experience of the RiTs with CACT-guided puncture with navigation software assistance, the learning curve regarding CACT-guided puncture may be faster compared to the CT-guided puncture technique.. · If the needle path is complex, CACT guidance with navigation software assistance might have an advantage over CT guidance.. CITATION FORMAT: · Meine TC, Hinrichs JB, Werncke T etâal. Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology. Fortschr Röntgenstr 2022; 194: 272â-â280.
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Radiologia , Tomografia Computadorizada por Raios X , Humanos , Imagens de Fantasmas , Punções/métodos , Software , Tomografia Computadorizada por Raios X/métodosRESUMO
Renal cell carcinoma (RCC) is a cancer that mainly occurs in elderly patients. Percutaneous image-guided ablation of small RCC (<â4âcm) is a validated therapeutic option, especially as many patients are no candidates for surgery due to comorbidities. This article presents and discusses established local ablative techniques such as radiofrequency (RFA), microwave (MWA) and cryoablation for the treatment of small RCC based on current literature and in the context of the latest guidelines.
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Carcinoma de Células Renais , Ablação por Cateter , Criocirurgia , Neoplasias Renais , Ablação por Radiofrequência , Idoso , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Micro-Ondas , Resultado do TratamentoRESUMO
PURPOSE: To assess the value of the administration of positive rectal contrast at CT in patients referred for suspected diverticular disease (DD) of the colon. MATERIALS AND METHODS: 460 patients (253 male, 207 female; median age 62 years; interquartile range 24) with clinical suspicion of DD of the colon were included in this retrospective IRB-approved study. CT was performed with i.âv. contrast only (nâ=â328, group M1), i.âv. + positive rectal contrast (nâ=â82, group M2), neither i.âv. nor rectal contrast (nâ=â32, group S1), or positive rectal contrast only (nâ=â19, group S2). Two readers in consensus evaluated all CT datasets concerning diagnosis of DD (yes/no) and categorized findings (classification of diverticular disease (CDD)). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of DD were calculated for all groups, using either clinical follow-up (nâ=â335) or intraoperative findings (nâ=â125) as the reference standard. In patients undergoing surgery, radiological staging of DD was correlated with the histopathology (weighted Cohen-k). RESULTS: 224 patients (48.7â%) were diagnosed with DD. The sensitivity, specificity, PPV, and NPV were as follows. Group M1â/âM2: 92â%/92â%, 97â%/94â%, 96â%/96â%, 94â%/89â%, respectively; group S1â/âS2: 94â%/86â%, 93â%/80â%, 94â%/92â%, 93â%/67â%, respectively. Radiological staging and histopathology correlated substantially in all groups (kâ=â0.748-0.861). CONCLUSION: Abdominal CT had a high sensitivity and specificity for the diagnosis of DD. Disease staging correlated well with the findings at surgery. Additional positive rectal contrast administration did not have a significant advantage and may therefore be omitted in patients with suspected DD. KEY POINTS: · CT has a high sensitivity and specificity for diagnosis of DD.. · CT staging using the CDD algorithm correlates very well with surgery.. · Positive rectal contrast administration does not improve diagnosis and radiological staging.. CITATION FORMAT: · Meyer S, Schmidbauer M, Wacker FK etâal. To Fill or Not to Fill? - Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon. Fortschr Röntgenstr 2021; 193: 804â-â812.
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Doenças do Colo/diagnóstico por imagem , Meios de Contraste , Doenças Diverticulares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Doenças do Colo/classificação , Doenças Diverticulares/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Follicular thyroid carcinoma is the second most common malignancy of the thyroid gland. In 2016, the so-called Hurthle cell thyroid carcinoma, formerly known as the oxyphilic variant of the follicular thyroid carcinoma, was reclassified by the World Health Organization as a separate pathological entity, which accounts for approximately 3% of all thyroid cancers. Although Hurthle cell thyroid carcinomas are known for their more aggressive tumor biology, metastases are observed in a minority of cases, and long-term survival can be expected. However, disseminated disease is often associated with poor outcome. CASE PRESENTATION: In the presented case, a 63-year-old Caucasian female was incidentally diagnosed with Hurthle cell thyroid carcinoma after undergoing hemithyroidectomy for a nodular goiter. Following completion thyroidectomy, two courses of radioactive iodine therapy were administered. After 4 years of uneventful follow-up, the patient gradually developed metastases in five different organs, with the majority representing unusual sites, such as heart, kidney, and pancreas over a course of 14 years. The lesions were either treated with radioactive iodine therapy or removed surgically, depending on iodine avidity. CONCLUSION: Follicular and Hurthle cell thyroid carcinoma are known to potentially spread hematogenously to typical sites, such as lung or bones, however; unusual metastatic sites as presented in our case can also be observed. A search of the literature revealed only scattered reports on patients with multiple metastases in unusual locations. Furthermore, the observed long-term survival of our patient is contradictory to the existing data. As demonstrated, recurrent disease may appear years after the initial diagnosis, emphasizing the importance of consistent aftercare. Radioactive iodine therapy, extracorporeal radiation therapy, and surgical metastasectomy are central therapeutic components. In summary, our case exemplifies that thorough aftercare and aggressive treatment enables long-term survival even in recurrent Hurthle cell thyroid carcinoma displaying unusual multisite metastases.
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Adenoma Oxífilo , Neoplasias da Glândula Tireoide , Adenoma Oxífilo/cirurgia , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Pessoa de Meia-Idade , Células Oxífilas , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
The Atlanta classification published in 1992 was supposed to classify the severity and complications in acute pancreatitis with the goal of providing uniform terminology for clinicians and researchers. After continuous evolution, the revised Atlanta classification was published in 2012. In this updated classification, imaging aspects were better integrated and unclear terms were better defined. To date, this terminology for disease grading, severity, and local complications has been solely available in English. This prevented wide acceptance of the classification by the German-speaking medical community. Therefore, an expert team of the German Radiological Society translated the terms based on German medical literature. This translation was approved by consensus in the new S3 guideline meeting in February 2020 with an approval rate of 97.3â%. This manuscript explains the translated and approved German terminology of the revised Atlanta classification and offers additional imaging examples. KEY POINTS:: · The revised Atlanta classification allows correct definition of the grading and complication assessment of acute pancreatitis.. · An expert group translated the terms into the German language. The translation was approved by the S3 guideline committee for pancreatitis.. · Based on the new German S3 guideline for pancreatitis, the translated terms should be employed consistently.. CITATION FORMAT: · Schreyer AG, Seidensticker M, Mayerle J etâal. German Terminology of the Revised Atlanta Classification of Acute Pancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis. Fortschr Röntgenstr 2021; 193: 909â-â918.
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Pancreatite Autoimune , Pancreatite , Doença Aguda , Diagnóstico por Imagem , Humanos , Idioma , Pancreatite/diagnóstico por imagem , Índice de Gravidade de DoençaRESUMO
PURPOSE: The working group for gastrointestinal and abdominal imaging within the German Radiological Society performed a nationwide online survey in order to assess the current status regarding the awareness and application of LI-RADS, a classification for evaluation of liver lesions in patients at risk. MATERIALS AND METHODS: Using the website www.deutsches-krankenhausverzeichnis.de a list of hospitals was generated meeting the criteria internal medicine, gastroenterology, general and visceral surgery and radiology (nâ=â391). Randomly, 102 department directors were contacted, and asked to name one consultant and one resident from their department in order to participate in the survey. 177 potential participants were invited to fill out an approximately 10-minute online survey in the form of 17 questions regarding the awareness and application of LI-RADS.âThe results of the survey were analyzed by means of descriptive statistics. RESULTS: 77 participants were registered, which corresponds to a response rate of 43.5â%. 47â% of all participants were radiologists, 30â% surgeons and 23â% internal doctors/gastroenterologists, respectively, many with more than 13 years of professional experience (37.2â%). The majority of participants worked in a hospital with a focus (37.2â%) or a university hospital (29.1â%). Even though the majority of participants knows about or has heard of LI-RADS (73.2â%), only a minority uses the classification themselves (26â%) or within the context of tumor boards (19.2â%). CONCLUSION: The results of our survey demonstrate that LI-RADS is relatively known in Germany, the application however quite sparse. This is in contrast to the general desire and endeavor for more standardized reporting in radiology. KEY POINTS: · LI-RADS is not yet broadly implemented in clinical routine in Germany. · The sparse application is in contrast to the general desire for more standardized reporting in radiology. · Interdisciplinary education may support the propagation and use of the LI-RDAS classification. CITATION FORMAT: · Ringe KI, Gut A, Grenacher L etâal. LI-RADS in the year 2020 - Are you already using it or still considering? Fortschr Röntgenstr 2021; 193: 186â-â193.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/classificação , Neoplasias Hepáticas/diagnóstico por imagem , Radiologia/educação , Adulto , Conscientização/ética , Carcinoma Hepatocelular/patologia , Gastroenterologistas/provisão & distribuição , Alemanha , Humanos , Comunicação Interdisciplinar , Medicina Interna/estatística & dados numéricos , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética/métodos , Radiologistas/estatística & dados numéricos , Radiologia/organização & administração , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosRESUMO
PURPOSE: To create a fully automated, reliable, and fast segmentation tool for Gd-EOB-DTPA-enhanced MRI scans using deep learning. MATERIALS AND METHODS: Datasets of Gd-EOB-DTPA-enhanced liver MR images of 100 patients were assembled. Ground truth segmentation of the hepatobiliary phase images was performed manually. Automatic image segmentation was achieved with a deep convolutional neural network. RESULTS: Our neural network achieves an intraclass correlation coefficient (ICC) of 0.987, a Sørensen-Dice coefficient of 96.7â± 1.9â% (meanâ±âstd), an overlap of 92â±â3.5â%, and a Hausdorff distance of 24.9â±â14.7âmm compared with two expert readers who corresponded to an ICC of 0.973, a Sørensen-Dice coefficient of 95.2â±â2.8â%, and an overlap of 90.9â±â4.9â%. A second human reader achieved a Sørensen-Dice coefficient of 95â% on a subset of the test set. CONCLUSION: Our study introduces a fully automated liver volumetry scheme for Gd-EOB-DTPA-enhanced MR imaging. The neural network achieves competitive concordance with the ground truth regarding ICC, Sørensen-Dice, and overlap compared with manual segmentation. The neural network performs the task in just 60 seconds. KEY POINTS: · The proposed neural network helps to segment the liver accurately, providing detailed information about patient-specific liver anatomy and volume.. · With the help of a deep learning-based neural network, fully automatic segmentation of the liver on MRI scans can be performed in seconds.. · A fully automatic segmentation scheme makes liver segmentation on MRI a valuable tool for treatment planning.. CITATION FORMAT: · Winther H, Hundt C, Ringe KI etâal. A 3D Deep Neural Network for Liver Volumetry in 3T Contrast-Enhanced MRI. Fortschr Röntgenstr 2021; 193: 305â-â314.
Assuntos
Processamento de Imagem Assistida por Computador , Fígado , Imageamento por Ressonância Magnética , Redes Neurais de Computação , Humanos , Processamento de Imagem Assistida por Computador/métodos , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodosAssuntos
Dor nas Costas/cirurgia , Ablação por Cateter , Lipoma/cirurgia , Dor Intratável/cirurgia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Humanos , Lipoma/complicações , Lipoma/diagnóstico , Imageamento por Ressonância Magnética , Medição da Dor , Dor Intratável/diagnóstico , Dor Intratável/etiologia , Sacro/diagnóstico por imagem , Sacro/patologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: The aim of this investigation is to establish the relationship between the size-dependent conversion factor (fsize) and the body-mass-index (BMI) and to test whether BMI can be substituted for the conventionally used patients' anterior-posterior (AP) and lateral (LAT) dimensions for calculation of fsize. By calculating fsize on the basis of BMI instead of the AP and LAT measurements, size-specific dose estimates (SSDE) could be determined prior to image acquisition. METHODS: Our institute utilizes a dose monitoring software to record radiation exposure during CT examinations. The datasets gathered during each examination contain information regarding the scan protocol, the volumetric computed tomography dose index (CTDIvol), SSDE and BMI. fsize is traditionally calculated through measurement of AP and LAT dimensions. In this work, the dose monitoring system calculates AP and LAT diameters at the middle of scout views. For purpose of this investigation, we used data from 13544 patients who underwent CT examinations of the torso, head or knee (both) to compare fsize as calculated from the AP and LAT dimensions to fsize calculated as a function of BMI. RESULTS: In the examinations of the torso, we observed an exponentially decreasing correlation between fsize and BMI. In the examinations of the head and knee (both), fsize reflected an almost independent behavior to BMI. CONCLUSION: This study demonstrates that it is possible to estimate fsize by using the patients' BMI for the torso as well as the head and knee CT, thereby enabling calculation of the probable SSDE prior to image acquisition on the basis of the presumed CTDIvol provided by the scanner. By providing information on the expected patient dose prior to image acquisition, this method is advantageous over the traditional calculation of fsize via the AP and LAT dimensions.