Availability of Transcatheter Vessel Occlusion Performed by Interventional Radiologists to Treat Bleeding in Germany in the Years 2016 and 2017 - An Analysis of the DeGIR Registry Data. / Flächendeckende Versorgung mit radiologisch durchgeführten gefäßverschließenden Maßnahmen zur interventionellen Behandlung von Blutungen in Deutschland in den Jahren 2016 und 2017 ­ Eine Analyse der DeGIR-Registerdaten.

PURPOSE: Acute bleeding is a life-threatening condition that can be effectively treated minimally invasively by interventional radiologists using transcatheter vessel occlusion (TCVO). The purpose of this study was to evaluate the availability of TCVO performed by interventional radiologists in Germany based on the DeGIR registry. MATERIALS AND METHODS: TCVO interventions from the years 2016 and 2017 were included (DeGIR module B). The number of interventions was assessed by state and region. RESULTS: TCVO interventions were reported by 242 clinics in Germany. 16 763 module B interventions were reported in 2016 and 16 399 in 2017. DeGIR requirements for certification as a training center were fulfilled by 160 facilities in 2016 and by 162 facilities in 2017. Normalized to one million citizens, an average of 211 TCVO interventions were performed in 2016 and 200 in 2017 (standard deviation was 101 and 109); the median was 202 and 222, respectively. In all regions TCVO interventions were reported. Only a minimal number of small regions showed a lower number of clinics offering TCVO interventions. CONCLUSION: The results from the DeGIR registry indicate comprehensive nationwide availability of TCVO performed by interventional radiologists with the necessary experience in Germany on the state level for the treatment of acute bleeding. Furthermore, the distribution of facilities fulfilling the requirements of training centers allows for good educational possibilities for young interventional radiologists in Germany. Only the distribution of clinics offering TCVO in a few small regions might lead to increased transfer times in the case of acute bleeding. KEY POINTS: · As a treatment for life-threatening acute bleeding in Germany, transcatheter vessel occlusion led by interventional radiologists is readily available on the state level.. · Furthermore, the distribution of facilities fulfilling the requirements of training centers allows for good educational possibilities for young interventional radiologists in Germany.. · Due to the good training conditions in Germany, it might be possible to further improve the situation in smaller regions by training more interventional radiologists and employing them in regions with less coverage.. CITATION FORMAT: · Nadjiri J, Schachtner B, Bücker A et al. Availability of Transcatheter Vessel Occlusion Performed by Interventional Radiologists to Treat Bleeding in Germany in the Years 2016 and 2017 - An Analysis of the DeGIR Registry Data. Fortschr Röntgenstr 2020; 192: 952 - 960.

Assessment of Therapy Response to Transarterial Radioembolization for Liver Metastases by Means of Post-treatment MRI-Based Texture Analysis.

INTRODUCTION: To determine whether post-treatment magnetic resonance imaging (MRI)-based texture analysis of liver metastases (LM) may be suited predicting therapy response to transarterial radioembolization (TARE) during follow-up. MATERIALS AND METHODS: Thirty-seven patients with LM treated by TARE (mean age 63.4 years) between January 2006 and December 2014 were identified in this retrospective feasibility study. They underwent dynamic contrast-enhanced and hepatocellular phase MRI after TARE (mean 2.2 days). Response was evaluated on follow-up imaging scheduled in intervals of 3 months (median follow-up, 7.3 months) based on response evaluation criteria in solid tumors 1.1 (RECIST 1.1). Results of texture analysis [mean, standard deviation, skewness (s), kurtosis (k), entropy and uniformity] were compared between patients with progressive disease (PD) and patients with stable disease (SD), partial or complete response (PR/CR). Receiver operating characteristics including the area under the curve (AUC) and cutoff values including the sensitivity and specificity were calculated. RESULTS: According to RECIST 1.1, 24 patients (64.9%) had PD, 8 SD (21.6%) and 5 PR (13.5%). MRI-based texture analysis showed an earlier differentiation between patients with and without PD when compared with RECIST 1.1. Median k (2.88 vs. 2.35) in arterial phase MRI and median s (0.48 vs. 0.25) and k (2.85 vs. 2.25) in venous phase MRI were significantly different (p < 0.05). The AUC for k derived from arterial phase MRI was 0.73 (cutoff = 2.55, sensitivity = 0.83, specificity = 0.62) (p < 0.05). The AUC for s and k in venous phase MRI was 0.76 (cutoff = 0.35, sensitivity = 0.71, specificity = 0.85) (p > 0.05) and 0.83 (cutoff = 2.50, sensitivity = 0.75, specificity = 0.85) (p < 0.05). CONCLUSION: This study indicates the potential of MRI-based texture analysis at arterial and venous phase MRI for the early prediction of PD after TARE. LEVEL OF EVIDENCE: IV.

Characterization of Severe Arterial Phase Respiratory Motion Artifact on Gadoxetate Disodium-Enhanced MRI - Assessment of Interrater Agreement and Reliability.

PURPOSE: To assess the interrater agreement and reliability of experienced abdominal radiologists in the characterization and grading of arterial phase gadoxetate disodium-related respiratory motion artifact on liver MRI. MATERIALS AND METHODS: This prospective multicenter study was initiated by the working group for abdominal imaging within the German Roentgen Society (DRG), and approved by the local IRB of each participating center. 11 board-certified radiologists independently reviewed 40 gadoxetate disodium-enhanced liver MRI datasets. Motion artifacts in the arterial phase were assessed on a 5-point scale. Interrater agreement and reliability were calculated using the intraclass correlation coefficient (ICC) and Kendall coefficient of concordance (W), with p < 0.05 deemed significant. RESULTS: The ICC for interrater agreement and reliability were 0.983 (CI 0.973 - 0.990) and 0.985 (CI 0.978 - 0.991), respectively (both p < 0.0001), indicating excellent agreement and reliability. Kendall's W for interrater agreement was 0.865. A severe motion artifact, defined as a mean motion score ≥ 4 in the arterial phase was observed in 12 patients. In these specific cases, a motion score ≥ 4 was assigned by all readers in 75 % (n = 9/12 cases). CONCLUSION: Differentiation and grading of arterial phase respiratory motion artifact is possible with a high level of inter-/intrarater agreement and interrater reliability, which is crucial for assessing the incidence of this phenomenon in larger multicenter studies. KEY POINTS: · Inter- and intrarater agreement for motion artifact scoring is excellent among experienced readers.. · Interrater reliability for motion artifact scoring is excellent among experienced readers.. · Characterization of severe motion artifacts proved feasible in this multicenter study.. CITATION FORMAT: · Ringe KI, Luetkens JA, Fimmers R et al. Characterization of Severe Arterial Phase Respiratory Motion Artifact on Gadoxetate Disodium-Enhanced MRI - Assessment of Interrater Agreement and Reliability. Fortschr Röntgenstr 2017; 190: 341 - 347.