Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma.

AIM: To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome. MATERIALS AND METHODS: Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred. RESULTS: Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure. CONCLUSION: Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.

Whole-body MRI: a powerful alternative to bone scan for bone marrow staging without radiation and gadolinium enhancer.

PURPOSE: Whole-body magnetic resonance imaging (WB-MRI) is a radiation-free alternative to the 99mTc-HDP bone scan (BS) for the detection of bone metastasis. The major drawback is the long examination time and application of gadolinium enhancer. The aim of this study is to analyze (i) the performance of WB-MRI versus the BS and (ii) the diagnostic benefit of gadolinium (WB-MRI + Gd) compared to a non-enhanced protocol (NE WB-MRI). METHODS AND MATERIALS: 1256 eligible WB-MRI scans were analyzed retrospectively with a single inclusion criterion, a clinical 12-month follow-up or a biopsy as ground truth. N = 285 patients received both a WB-MRI and a BS within 12 months. All the patients were imaged with a coronal T1w and a STIR, and n = 528 (42%) received an additional T1w-mDixon with gadoteridol (0.1 mmol Gd-DTPA/kg). RESULTS: From 1256 eligible patients, n = 884 (70%) had breast cancer as a primary disease, n = 101(8%) prostate cancer, and n = 77(6%) lung cancer. The sensitivity (Se) and negative predictive value (NPV) of the WB-MRI was 98/99%, significantly higher compared to BS with 82/89%, P < 0.001 Mc Nemar's test. The specificity (Spe) and positive predictive value (PPV) of the WB-MRI and BS was 85/82% and 91/86%, respectively. The interobserver agreement between WB-MRI and BS was 71%, Cohen's kappa 0.42. Analysis of the added diagnostic value of gadolinium revealed Se/Spe/PPV/NPV of 98/93/92/98% for the NE WB-MRI and 99/93/85/100% for the WM-MRI + Gd, P > 0.05 binary logistic regression with Fischer's exact test. CONCLUSION: WB-MRI exceeds the sensitivity of BS without compromising the specificity, even after omitting the gadolinium enhancer.

[Selective internal radioembolization in nonresectable hepatocellular carcinoma]. / Selektive interne Radioembolisation beim nichtresektablen hepatozellulären Karzinom.

INTRODUCTION: The role of selective internal radioembolization (SIRT) in the treatment of hepatocellular carcinoma (HCC) is currently unclear. MATERIALS AND METHODS: We investigated 52 patients with nonresectable HCC in cirrhosis who underwent SIRT at the Department of General, Visceral and Vascular Surgery in co-operation with the Department of Nuclear Medicine and the Institute of Diagnostic and Interventional Radiology between April 2011 and October 2015. RESULTS: In five patients, SIRT was employed for bridging to liver transplantation. In patients who had undergone pre-treatment with SIRT, histological examination of the explanted livers showed extensive tumor necrosis in the targeted areas with only minor remnant vital tissue at the margins. Four of the patients who underwent SIRT as local bridging treatment are tumor-free after transplantation. In the 47 palliatively treated patients, a total of 76 radioembolizations were performed. The observed 1­ and 2­year survival rates in these patients were 58 and 29 %, respectively, after the first SIRT. In the multivariate analysis of the observed survival, AFP before the first SIRT >30ng/ml, time interval of <12 months between the initial diagnosis and the first SIRT, largest tumor diameter >5 cm and portal vein thrombosis were independent negative prognostic factors. In the multi-variate analysis, the time to progression was independently influenced only by the AFP level before the first SIRT. In addition to standard treatment with transarterial chemoembolization (TACE), SIRT is feasible in nonresectable HCC, in particular with portal vein thrombosis, with identical results, less interventions and few side effects.

[Evaluation of the display quality of different modalities in digital radiology]. / Evaluation der Abbildungsqualität unterschiedlicher Befundungsmodalitäten in der digitalen Radiologie.

PURPOSE: To evaluate the display quality of digital radiographies on different monitors in comparison to hard-copy films on view boxes. MATERIALS AND METHODS: Radiographs of different statistical phantoms simulating common pathologies of the chest, such as interstitial pneumonia, pneumothorax and pulmonary nodules, were acquired. Under same ambient light condition, the radiographs were rated as to the presence or absence of a simulated pathological finding using a confidence scale. The evaluation was performed on a grey-scale monitor, a color monitor, two LC displays and two different light boxes by four experienced radiologists. Sensitivity and specificity were determined in a ROC analysis for each viewing modality and phantom. The area under the curve (Az) was acquired cumulatively including the results of all investigators. A total of 4200 rating decisions were included. The chi (2)-test was performed for significance analysis using the a and b parameters of two ROC-curves (alpha = 0.05). RESULTS: The rating of the included LC displays (Az = 0.7009 - 0.9608) and color monitors (Az = 0.7993 - 0.9591) showed a significant loss of diagnostic validity in comparison to the grey-scale monitor (Az = 0.8435 - 0.9762) and the view boxes (Az = 0.8228 - 0.9891). CONCLUSION: LC displays and color monitor included in this study cannot be recommended for diagnostic viewing. The loss of diagnostic validity might be attributable to the viewing-angle-dependent contrast of LC displays. However, no loss in diagnostic validity could be assessed for the tested grey-scale monitor.

Effect of dose on image quality in a detector-based dual-exposure, dual-energy system for chest radiography.

PURPOSE: To assess the image quality of subtracted soft tissue and bone images of a CsI-detector-based dual-energy system for chest radiography at varying dose levels. MATERIAL AND METHODS: We evaluated a CsI-detector-based, dual-exposure, dual-energy prototype system; 126 patients were categorized into groups of small, medium, and large. Fixed values were applied for mAs and mA. The patients were randomized into two groups with intended higher and lower speed pairs of approximately 400/1000 (high and low energy shot) and 200/500, respectively. True speed equivalents were calculated retrospectively using the detector dose. Image quality was evaluated by two highly experienced radiologists in consensus applying a rating scale of 1 to 5 for quality indicators such as image noise, residual bone structures, motion artifacts, and others. RESULTS: Significantly decreased noise and a significant improvement for display of bone details in the bone image were noted with the higher dose, whereas a significant increase in motion artifacts reduced image quality at the higher dose. CONCLUSION: Radiation dose did not significantly influence the perception of dual-energy image quality. Dual-energy subtraction, as described, has the potential to become a future routine application in chest radiography.