Assessment of Rib Fracture in Acute Trauma Using Automatic Rib Segmentation and a Curved, Unfolded View of the Ribs: Is There a Saving of Time?

Introduction: The fast and accurate diagnosis of rib fractures in polytrauma patients is important to reduce the mortality rate and relieve long-term pain and complications. Aim: To evaluate the diagnostic accuracy and potential time savings using automatic rib segmentation and a curved, unfolded view for the detection of rib fractures in trauma patients. Methods: The multidetector computed tomography raw data of 101 consecutive polytrauma patients (72 men; mean age 45 years, age range 17 to 84 years) admitted to a university hospital were retrospectively post-processed to generate a curved, unfolded view of the rib cage. No manual corrections were performed. Patients with reconstruction errors and movement artifacts were excluded from further analysis. All fractures were identified and classified by the study coordinator using the original data set. Two readers (reader 1 and reader 2) evaluated the original axial sections and the unfolded view, separately. The fracture locations, fracture type, and reading times were recorded. Sensitivity and specificity were calculated on a per-rib basis using a ratio estimator. Cohen's Kappa was calculated as an index of inter-rater agreement. Results: 26 of 101 patients (25.7%) were excluded from further analysis owing to breathing artifacts (6.9%) or incorrect centerline computation in the unfolded view (18.8%). In total, 107 (5.9%) of 1800 ribs were fractured in 25 (33%) of 75 patients. The unfolded view had a sensitivity/specificity of 81%/100% (reader 1) and 71%/100% (reader 2) compared to 94%/100% (reader 1; p = 0.002/p = 0.754) and 63%/99% (reader 2; p < 0.001/p = 0.002). The sensitivity (reader 1; reader 2) was poor for buckled fractures (31%; 38%), moderate for undislocated fractures (78%; 62%), and good for dislocated fractures (94%; 90%). The assessment of the unfolded view was performed significantly faster than that of the original layers (19.5 ± 9.4 s vs. 68.6 ± 32.4 s by reader 1 (p < 0.001); 24.1 ± 9.5 s vs. 40.2 ± 12.7 s by reader 2 (p < 0.001)). Both readers demonstrated a very high interobserver agreement for the unfolded view (κ = 0.839) but only a moderate agreement for the original view (κ = 0.529). Conclusion: Apart from a relatively high number of incorrect centerline reconstructions, the unfolded view of the rib cage allows a faster diagnosis of dislocated rib fractures.

Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. / Aktueller Stand zu perkutanen lokalablativen Verfahren beim hepatozellulären Karzinom.

BACKGROUND: Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Because many hepatocellular carcinomas are already unresectable at the time of initial diagnosis, percutaneous tumor ablation has become established in recent decades as a curative therapeutic approach for very early (BCLC 0) and early (BCLC A) HCC. The aim of this paper is to provide a concise overview of the percutaneous local ablative procedures currently in use, based on their technical characteristics as well as clinical relevance, taking into account the current body of studies. MATERIALS AND METHODS: The literature search included all original papers, reviews, and meta-analyses available via MEDLINE and Pubmed on the respective percutaneous ablation procedures; the primary focus was on randomized controlled trials and publications from the last 10 years. RESULTS AND CONCLUSIONS: Radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established procedures that are considered equal to surgical resection in the treatment of stage BCLC 0 and A HCC with a diameter up to 3 cm due to their strong evidence in international and national guidelines. For tumors with a diameter between 3 and 5 cm, the current S3 guidelines recommend a combination of transarterial chemoembolization (TACE) and thermal ablation using RFA or MWA as combination therapy is superior to thermal ablation alone in tumors of this size and shows comparable results to surgical resection in terms of overall survival. Alternative, less frequently employed thermal procedures include cryotherapy (CT) and laser ablation (LA). Non-thermal procedures include irreversible electroporation (IRE), interstitial brachytherapy (IBT), and most recently, electrochemotherapy (ECT). Due to insufficient evidence, these have only been used in individual cases and within the framework of studies. However, the nonthermal methods are a reasonable alternative for ablation of tumors adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods. With advances in the technology of the respective procedures, increasingly good evidence, and advancements in supportive techniques such as navigation devices and fusion imaging, percutaneous ablation procedures may expand their indications for the treatment of larger and more advanced tumors in the coming years. KEY POINTS: · RFA and MWA are considered equal to surgical resection as a first-line therapy for the curative treatment of stage BCLC 0 and A HCCs with a diameter of up to 3 cm.. · For HCCs with a diameter between 3 and 5 cm, a combination of TACE and RFA or MWA is recommended. This combination therapy yields results comparable to those of surgical resection in terms of overall survival.. · Due to insufficient evidence, alternative ablation methods have only been used in individual cases and within the framework of studies. However, nonthermal methods, such as IRE, IBT, and, most recently, ECT, are a reasonable alternative for ablation of HCCs adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods.. CITATION FORMAT: · Luerken L, Haimerl M, Doppler M et al. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Fortschr Röntgenstr 2022; 194: 1075 - 1086.

Detection of Incomplete Irreversible Electroporation (IRE) and Microwave Ablation (MWA) of Hepatocellular Carcinoma (HCC) Using Iodine Quantification in Dual Energy Computed Tomography (DECT).

Early detection of local tumor progression (LTP) after irreversible electroporation (IRE) and microwave ablation (MWA) of hepatocellular carcinoma (HCC) remains challenging. The goal of this study was to identify cases with insufficient ablation and prevent HCC recurrencies by measuring iodine uptake using dual-energy computed tomography (DECT). In 54 HCC-patients, the volumetric iodine concentration (VIC) of the central and peripheral ablation area was evaluated by DECT within 24 h after IRE or MWA. Follow-up was performed with CT and/or MRI at 6 weeks, 3, 6, 9, and 12 months, respectively. In both groups, LTP was solely detected in the peripheral area (IRE: n = 4; MWA: n = 4) and LTP patients showed significantly higher VIC values in the peripheral zone than patients without LTP (IRE: * p = 0.0005; MWA: * p = 0.000). In IRE-LTP patients, no significant difference between the VIC values of non-ablated liver tissue and the peripheral zone was detected (p = 0.155). The peripheral zones of IRE patients without LTP (* p = 0.000) and MWA patients, irrespective of the presence of LTP (LTP: * p = 0.005; without LTP: * p = 0.000), showed significantly lower VIC values than non-ablated liver parenchyma. Higher BCLC tumor stages were indicative for LTP (* p = 0.008). The study suggests that elevated iodine uptake in the peripheral ablation zone could help identify LTP after IRE and MWA of HCC.

Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes.

PURPOSE: We aimed to analyze the technical success rate of manual percutaneous aspiration thrombectomy (PAT) in patients with peripheral arterial thromboembolism as a complication of infrainguinal percutaneous transluminal angioplasty (PTA) and we sought to evaluate the 30-day postintervention clinical outcome. MATERIALS AND METHODS: We retrospectively identified 29 patients (men/women, 18/11; mean age, 74 years) who underwent infrainguinal PAT to treat thromboembolic complications of infrainguinal PTA. Primary and secondary technical successes were defined as residual stenosis of < 50 % of the vessel diameter after PAT alone and PAT with additional PTA, respectively. Clinical outcome parameters (e. g., amputation, need for further intervention) were evaluated during the first 30 days after intervention. RESULTS: The primary and secondary technical success rates were 58.6 % (17/29) and 79.3 % (23/29), respectively. Clinical outcome data were available for 93.1 % (27/29) of patients. No further intervention was required within 30 days in 81.5 % (22/27) of patients. Four patients underwent minor amputations owing to preexisting ulcerations (Rutherford Category 5), and no patients underwent major amputations (Rutherford Category 6). Revascularization of the previously treated vessel segment with PTA was necessary on the first postintervention day in one patient. CONCLUSION: Manual PAT, with PTA if needed, has a good technical success rate and satisfactory early clinical outcome in patients with iatrogenic thromboembolic complications after infrainguinal PTA. KEY POINTS: · Manual PAT is a possible first-choice treatment of infrainguinal PTA-induced acute thromboembolism.. · Performing additional PTA increases the success rate of manual PAT.. · Unlike catheter-directed intraarterial lysis, manual PAT carries no risk of bleeding.. CITATION FORMAT: · Schicho A, Bäumler W, Verloh N et al. Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes. Fortschr Röntgenstr 2022; 194: 291 - 295.

Stereotactic Microwave Ablation of Hepatocellular Carcinoma: The Impact of Tumor Size and Minimal Ablative Margin on Therapeutic Success.

BACKGROUND: Microwave ablation (MWA) has gained relevance in the treatment of hepatic malignancies and especially in hepatocellular carcinoma (HCC), and it is an important alternative to surgery. The purpose of the study was to evaluate whether the minimal ablative margin (MAM) or the initial tumor size has a greater effect on the success of stereotactic MWA of HCC regarding the time to local tumor progression (LTP) and overall survival (OS). METHODS: 88 patients, who received stereotactic MWA of 127 tumor lesions with a curative intention were included in this single-center, retrospective study. The MAM was evaluated in a side-by-side comparison of pre- and post-ablative, contrast-enhanced slice imaging. A Cox proportional hazard model with a frailty term was computed to assess the influence of the MAM and the maximum tumor diameter on the time to LTP and the OS. RESULTS: The maximum tumor diameter was identified as a significant positive predictor for LTP (hazard ratio 1.04, 95% CI 1.00-1.08, p = 0.03), but it was not a significant positive predictor for the OS (p = 0.20). The MAM did not have a significant influence on LTP-free survival (p = 0.23) and OS (p = 0.67). CONCLUSION: For the successful stereotactic MWA of HCC, the MAM and maximum tumor diameter might not have an influence on the OS, but the maximum tumor diameter seems to be an independent predictor of the time to LTP.

A 3D Deep Neural Network for Liver Volumetry in 3T Contrast-Enhanced MRI.

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 96.7 ± 1.9 % (mean ±â€Šstd), an overlap of 92 ±â€Š3.5 %, and a Hausdorff distance of 24.9 ±â€Š14.7 mm compared with two expert readers who corresponded to an ICC of 0.973, a Sørensen-Dice coefficient of 95.2 ±â€Š2.8 %, and an overlap of 90.9 ±â€Š4.9 %. A second human reader achieved a Sørensen-Dice coefficient of 95 % 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 et al. A 3D Deep Neural Network for Liver Volumetry in 3T Contrast-Enhanced MRI. Fortschr Röntgenstr 2021; 193: 305 - 314.

Evaluation of Alterations to Bile Ducts and Laboratory Values During the First 3 Months After Irreversible Electroporation of Malignant Hepatic Tumors.

PURPOSE: To assess the incidence and evolution of biliary alterations adjacent to the ablation area in patients with hepatic malignancies during the first 3 months after percutaneous irreversible electroporation (IRE) and to investigate associated changes in laboratory values. MATERIAL AND METHODS: Bile ducts located within a ≤1.0 cm radius of the ablation zone were analyzed in 45 patients by preinterventional and postinterventional MRI (1-3 days, 6 weeks, and 3 months after IRE). Moreover, levels of alkaline phosphatase (AP) and serum bilirubin (SB) were examined for evidence of bile duct injury. Biliary alterations and the presence of postinterventional-elevated laboratory levels were correlated with features of the lesions, patients, ablation procedures, and laboratory values. RESULTS: A total of 80 bile ducts were located within a 1.0 cm radius of the ablation zone: 59 were encased, 16 were abutting and 5 were located within a radius of 0.1-1.0 cm of the ablation area. In total, 38 biliary injuries (narrowing, n=22; dilatation, n=14; biloma, n=2) were detected, 3 cases of narrowing occurred for the first time 6 weeks and 3 months after IRE, 21 alterations (dilatation: n=9; narrowing; n=10; biloma: n=2) had resolved during the first 6 weeks, 1 alteration (dilatation: n=1) had resolved by the last follow-up control. Three months after IRE, 19 patients showed elevated levels of AP, whereas SB levels were increased in 10 cases. No significant association between biliary alterations or postinterventional-elevated laboratory values and the investigated characteristics of lesions, patients, ablation procedures or laboratory values could be proven. CONCLUSION: Different alterations of bile ducts adjacent to an IRE ablation zone are common, of which dilatation and especially narrowing commonly represent a long-term complication after IRE. Moreover, a definite correlation between the frequently observed prolonged post-ablative elevation of AP- and SB-levels and the postinterventional biliary alterations could not be proven.

Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). / Strukturierte Befundung von soliden und zystischen Pankreasläsionen im CT und MRT: Konsensus-basierte Befundvorlagen der Deutschen Röntgengesellschaft (DRG).

BACKGROUND: Radiological reports of pancreatic lesions are currently widely formulated as free texts. However, for optimal characterization, staging and operation planning, a wide range of information is required but is sometimes not captured comprehensively. Structured reporting offers the potential for improvement in terms of completeness, reproducibility and clarity of interdisciplinary communication. METHOD: Interdisciplinary consensus finding of structured report templates for solid and cystic pancreatic tumors in computed tomography (CT) and magnetic resonance imaging (MRI) with representatives of the German Society of Radiology (DRG), German Society for General and Visceral Surgery (DGAV), working group Oncological Imaging (ABO) of the German Cancer Society (DKG) and other radiologists, oncologists and surgeons. RESULTS: Among experts in the field of pancreatic imaging, oncology and pancreatic surgery, as well as in a public online survey, structured report templates were developed by consensus. These templates are available on the DRG homepage under www.befundung.drg.de and will be regularly revised to the current state of scientific knowledge by the participating specialist societies and responsible working groups. CONCLUSION: This article presents structured report templates for solid and cystic pancreatic tumors to improve clinical staging (cTNM, ycTNM) in everyday radiology. KEY POINTS: · Structured report templates offer the potential of optimized radiological reporting with regard to completeness, reproducibility and differential diagnosis.. · This article presents consensus-based, structured reports for solid and cystic pancreatic lesions in CT and MRI.. · These structured reports are available open source on the homepage of the German Society of Radiology (DRG) under www.befundung.drg.de.. CITATION FORMAT: · Persigehl T, Baumhauer M, Baeßler B et al. Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). Fortschr Röntgenstr 2020; 192: 641 - 655.

Safety margin assessment after microwave ablation of liver tumors: inter- and intrareader variability.

Background The aim of the study was to evaluate the inter- and intrareader variability of the safety margin assessment after microwave ablation of liver tumors using post-procedure computed tomography (CT) images as well as to determine the sensitivity and specificity of identification remnant tumor tissue. Patients and methods A retrospective analysis of 58 patients who underwent microwave ablation (MWA) of primary or secondary liver malignancies (46 hepatocellular carcinoma, 9 metastases of a colorectal cancer and 3 metastases of pancreatic cancer) between September 2017 and June 2019 was conducted. Three readers estimated the minimal safety margin in millimeters using side-by-side comparison of the 1-day pre-ablation CT and 1-day post-ablation CT and judged whether ablation was complete or incomplete. One reader estimated the safety margin again after 6 weeks. Magnetic resonance imaging (MRI) after 6 weeks was the gold standard. Results The intraclass correlation coefficient (ICC) for estimation of the minimal safety margin of all three readers was 0.357 (95%-confidence interval 0.194-0.522). The ICC for repeated assessment (reader 1) was 0.774 (95%-confidence interval 0.645-0.860). Sensitivity and specificity of the detection of complete tumor ablation, defined as no remnant tumor tissue in 6 weeks follow-up MRI, were 93%/82%/82% and 33%/17%/83%, respectively. Conclusions In clinical practice, the safety margin after liver tumor ablation is often assessed using side-by-side comparison of CT images. In the study, we were able to show, that this technique has a poor reliability (ICC 0.357). From our point of view, this proves the necessity of new technical procedures for the assessment of the safety distance.

Color coded perfusion analysis and microcirculation imaging with contrast enhanced ultrasound (CEUS) for post-interventional success control following thermal ablative techniques of primary and secondary liver malignancies.

AIM: Evaluation of the post-interventional success following ablative techniques (radiofrequency and microwave) using a new color coded perfusion quantification software with CEUS in patients with primary and secondary liver malignancies. MATERIAL AND METHODS: 75 patients (60 males, 15 females, age 24-84 years, mean 62.7 years) with 128 malignant liver lesions were included in this study. Between 01/2013 and 06/2018, the therapeutic interventional procedure in 88 lesions was MWA, in 40 lesions RFA. All patients underwent CEUS using a convex multifrequency probe (1-6 MHz) following application of 1-2.4 ml sulphur hexaflouride microbubbles, before and within 24 hours following RFA and MWA to detect residual tumor tissue. Postprocessing of the stored DICOM loops from 15 sec up to 1 min using a perfusion quantification software regarding peak enhancement (pE), time to peak (TTP), mean transit time (MTT), rise time (Ri) and Wash-in area under the curve (WiAUC) in the center of the lesion, the border area and periphery was performed. RESULTS: In patients treated with RFA, pE differences between center of the lesion vs. surrounding liver were found to be statistically extremely significant (p < 0.001), differences between center of the lesion and margin were also statistically significant (p < 0.01). mTT, TTP, WiAuC and Ri showed no significant difference between center, margin or surrounding liver.In patients treated with MWA, statistically significant differences (p < 0.05) were found for pE, Ri and mTT regarding the differences between center of lesion and surrounding tissue. WiAuC and TTP showed no significant differences between center, margin or surrounding liver. CONCLUSION: CEUS with perfusion imaging is a valuable supporting tool for post-interventional success control following RFA and MWA of primary and secondary liver maligancies. Focus should be placed upon pE following MWA and pE, Ri and mTT following RFA.

Color Coded Perfusion Imaging with Contrast Enhanced Ultrasound (CEUS) for Post-Interventional Success Control Following Irreversible Electroporation (IRE) of Primary and Secondary Malignant Liver Lesions.

AIM: Evaluation of the post-interventional success following irreversible electroporation (IRE) using a new color coded perfusion quantification software with contrast-enhanced ultrasound (CEUS) in patients with malignant lesions of the liver. METHODS: Thirty-eight patients with 68 malignant liver lesions underwent IRE. All malignant lesions were investigated with CEUS before and within 24 hours following IRE to detect residual tumor tissue. The parameters analyzed by color coded perfusion quantification software were: the peak enhancement (pE), time to peak (TTP), mean transit time (mTT), rise (Ri) and wash-in area under the curve (WiAUC). Perfusion in the center, the margins of the lesions and in the surrounding liver were evaluated using these parameters. RESULTS: Hepatocellular carcinoma (HCC) with complete ablation showed significantly different changes between the center and the margin of the lesions for WiAUC (p<0.05) and pE (p<0.01). Also significant differences were noted between the center of the lesions and the surrounded tissue for the same parameters (p<0.01). In the completely ablated metastatic lesions, significant differences were found between the center of the lesion and the margins (p < 0.01) and between the center of the lesion and the surrounding liver (p < 0.05) for WiAUC. mTT, TTP and Ri showed no significant changes between the center of the lesions, margin of the lesions or surrounding tissue. Also, no significant differences were found for these parameters in the different regions of interest for HCC or the metastatic lesions with partial ablation success. CONCLUSION: CEUS with perfusion imaging is a valuable supporting tool for the post-interventional evaluation of liver lesions following IRE. Focus should be placed on the peak enhancement (pE) and the wash-in area under the curve (WiAUC).

Similar complication rates for irreversible electroporation and thermal ablation in patients with hepatocellular tumors.

Background To compare the frequency of adverse events of thermal microwave (MWA) and radiofrequency ablation (RFA) with non-thermal irreversible electroporation (IRE) in percutaneous ablation of hepatocellular carcinoma (HCC). Patients and methods We retrospectively analyzed 117 MWA/RFA and 47 IRE procedures (one tumor treated per procedure; 144 men and 20 women; median age, 66 years) regarding adverse events, duration of hospital and intensive care unit (ICU) stays and occurrence of a post-ablation syndrome. Complications were classified according to the Clavien & Dindo classification system. Results 70.1% of the RFA/MWA and 63.8% of the IRE procedures were performed without complications. Grade I and II complications (any deviation from the normal postinterventional course, e.g., analgesics) occurred in 26.5% (31/117) of MWA/RFA and 34.0% (16/47) of IRE procedures. Grade III and IV (major) complications occurred in 2.6% (3/117) of MWA/RFA and 2.1% (1/47) of IRE procedures. There was no significant difference in the frequency of complications (p = 0.864), duration of hospital and ICU stay and the occurrence of a post-ablation syndrome between the two groups. Conclusions Our results suggest that thermal (MWA and RFA) and non-thermal IRE ablation of malignant liver tumors have comparable complication rates despite the higher number of punctures and the lack of track cauterization in IRE.

Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings.

PURPOSE: Evaluation of the prevalence and significance of unsuspected extravascular findings on computed tomography angiography (CTA) of the body before endovascular or surgical treatment in vascular patients. MATERIALS AND METHODS: This study was approved by the local institutional review board. Radiology reports of 806 patients who underwent CTA of the body during January 2004 until December 2014 before endovascular or surgical treatment of vascular diseases were retrospectively reviewed. All unexpected extravascular abnormalities were classified as clinically non-significant (requiring no follow-up) or clinically significant (requiring further follow-up/immediate treatment). The course of patients with significant extravascular findings was retrospectively evaluated. RESULTS: Overall 806 patients were included in this study (592 men; mean age: 67 years). In 778 (96.5 %) of 806 patients 3293 incidental extravascular findings were diagnosed. There were 259 suspicious findings in 205 patients (25.4 %) that required further follow-up or immediate treatment. A previously unknown malignant tumor was diagnosed in 23 (2.9 %) patients. 10 patients (1.2 %) were diagnosed with lung cancer. Malignant tumors were detected more often in men than in women (3.5 % versus 0.9 %). Patients with an incidental tumor were significantly older than patients without a tumor (mean age: 72.3 vs. 67.5 years). CONCLUSION: Clinically significant unexpected extravascular findings are common in vascular patients. Especially noteworthy are malignant tumors of the lung. KEY POINTS: · Clinically relevant extravascular findings were detected in 25.4 % of the patients.. · The incidence of malignant tumors was 2.9 %.. · Lung cancer had the highest incidence among all malignancies (1.2 %).. CITATION FORMAT: · Turowski LS, Dollinger M, Wohlgemuth WA et al. Preoperative computed tomography angiography (CTA) of the body in vascular patients: prevalence and significance of unsuspected extravascular findings. Fortschr Röntgenstr 2019; 191: 716 - 724.

Presentation of Original Research at the European Congress of Radiology 2010: Frequency of Publication in Medline-Indexed Journals Within 5 Years After Presentation.

OBJECTIVES: To determine the rate at which original studies presented orally at the European Congress of Radiology (ECR) 2010 were published in Medline-indexed journals and to identify factors predictive of publication. METHODS: A total of 869 abstracts were included in the study. A Medline search of articles published between March 2010 and February 2015 was conducted to identify articles written by the first, second, and/or last authors of all abstracts published in the Scientific Program of ECR 2010. The publication year, journal, country of origin, subspecialty and nature of the research (i. e., human, animal or technical) were recorded. RESULTS: Between March 2010 and February 2015 a total of 450 abstracts (publication rate, 51.8 %) were subsequently published in 125 Medline-indexed journals, chiefly in European Radiology (11.1 %). 443/450 (98.4 %) articles were published in English language. The subspecialties of molecular imaging and cardiac imaging had the highest publication rates (75.0 % and 62.0 %, respectively), while computer application studies had the lowest (27.6 %). The nature of research, origin of the abstract and subspecialty significantly influenced the subsequent publication rate. CONCLUSION: More than half of the original studies presented orally at ECR 2010 were subsequently published in Medline-indexed journals. More articles were published in the journal European Radiology than in any other identified journal. KEY POINTS: · ECR 2010 had a high subsequent publication rate. · Most subsequently published articles were published in radiology journals. · Nearly all articles were published in the English language. CITATION FORMAT: · Dollinger M, Zeman F, Müller-Wille R et al. Presentation of Original Research at the European Congress of Radiology 2010: Frequency of Publication in Medline-Indexed Journals Within 5 Years After Presentation. Fortschr Röntgenstr 2017; 190: 327 - 333.

Characterization of Focal Liver Lesions using CEUS and MRI with Liver-Specific Contrast Media: Experience of a Single Radiologic Center.

AIM: The purpose of this study was to compare contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI) using liver-specific contrast agent and a combination of both for the characterization of focal liver lesions (FLL). METHODS: 83 patients with both benign and malignant liver lesions were examined using CEUS and MRI after the intravenous administration of liver-specific contrast media. All patients had inconclusive results from prior imaging examinations. Histopathological specimens could be obtained in 53 patients. Ultrasound was performed using a multi-frequency curved probe (1 - 6 MHz) after the injection of 1 - 2.4 ml ultrasound contrast media. The sensitivity, specificity, positive predictive value and negative predictive value of CEUS, MRI and a combination of both (CEUS + MRI) were compared. RESULTS: The sensitivity, specificity, positive and negative predictive values regarding lesion classification were 90.9 %, 70.6 %, 92.3 % and 66.6 %, respectively, for CEUS; 90.9 %, 82.4 %, 95.2 % and 70.0 %, respectively, for MRI; and 96.9 %, 70.6 %, 92.7 % and 85.7 % respectively, for CEUS + MRI. There were no statistically significant differences. 6 malignant lesions were missed using CEUS or MRI alone (false negatives). The use of both modalities combined reduced the false-negative results to 2. CONCLUSION: CEUS and MRI with liver-specific contrast media are very reliable and of equal informative value in the characterization of focal liver lesions. The number of false-negative results can be decreased using a combination of the two methods.

Evaluation of a Robotic Assistance-System For Percutaneous Computed Tomography-Guided (CT-Guided) Facet Joint Injection: A Phantom Study.

BACKGROUND The aim of this study was to compare robotic assisted and freehand facet joint puncture on a phantom model in regards to time requirements and puncture accuracy. MATERIAL AND METHODS Forty facet joints were punctured, 20 using a robotic guidance system and 20 using a freehand procedure. Side and height of the facet joints were randomized and identical for both groups. Procedural accuracy, defined as axial and sagittal deviation, as well as the number of corrections were assessed. Procedure times for each step were documented and time requirements for pre-positioning, reconstruction, planning, and total intervention were calculated. RESULTS Total procedure time for robotic guidance was 259±111 seconds versus 119±77 seconds for freehand procedure (p=1.0). Procedural accuracy for robotic guidance was significantly higher with 0 corrections versus 1.3 corrections for freehand procedure (p=0.02). Needle deviation in the robotics arm was 0.35±1.1 mm in the axial and 2.15±1.2 mm in the sagittal reconstruction. CONCLUSIONS Robotic assisted puncture of the facet joint allowed accurate positioning of the needle with a lower number of needle readjustments. Higher procedural accuracy was marginally offset by a slightly longer intervention time.

Adverse effects of irreversible electroporation of malignant liver tumors under CT fluoroscopic guidance: a single-center experience.

PURPOSE: We aimed to describe the frequency of adverse events after computed tomography (CT) fluoroscopy-guided irreversible electroporation (IRE) of malignant hepatic tumors and their risk factors. METHODS: We retrospectively analyzed 85 IRE ablation procedures of 114 malignant liver tumors (52 primary and 62 secondary) not suitable for resection or thermal ablation in 56 patients (42 men and 14 women; median age, 61 years) with regard to mortality and treatment-related complications. Complications were evaluated according to the standardized grading system of the Society of Interventional Radiology. Factors influencing the occurrence of major and minor complications were investigated. RESULTS: No IRE-related death occurred. Major complications occurred in 7.1% of IRE procedures (6/85), while minor complications occurred in 18.8% (16/85). The most frequent major complication was postablative abscess (4.7%, 4/85) which affected patients with bilioenteric anastomosis significantly more often than patients without this condition (43% vs. 1.3%, P = 0.010). Bilioenteric anastomosis was additionally identified as a risk factor for major complications in general (P = 0.002). Minor complications mainly consisted of hemorrhage and portal vein branch thrombosis. CONCLUSION: The current study suggests that CT fluoroscopy-guided IRE ablation of malignant liver tumors may be a relatively low-risk procedure. However, patients with bilioenteric anastomosis seem to have an increased risk of postablative abscess formation.

Transarterial coil embolization of a symptomatic posttraumatic plantar pseudoaneurysm.

Posttraumatic pseudoaneurysms of the lateral plantar artery are rare. We report the case of a 31-year-old woman with a painful pseudoaneurysm of the lateral plantar artery resulting from a deep plantar cut injury. The pseudoaneurysm was successfully treated by performing a transarterial "frontdoor-backdoor" coil embolization technique, which is a minimally invasive alternative to conventional ligature of the artery.

Continuous dynamic registration of microvascularization of liver tumors with contrast-enhanced ultrasound.

Aim. To evaluate the diagnostic value of quantification of liver tumor microvascularization using contrast-enhanced ultrasound (CEUS) measured continuously from the arterial phase to the late phase (3 minutes). Material and Methods. We present a retrospective analysis of 20 patients with malignant (n = 13) or benign (n = 7) liver tumors. The tumors had histopathologically been proven or clearly identified using contrast-enhanced reference imaging with either 1.5 T MRI (liver specific contrast medium) or triphase CT and follow-up. CEUS was performed using a multifrequency transducer (1-5 MHz) and a bolus injection of 2.4 mL sulphur hexafluoride microbubbles. A retrospective perfusion analysis was performed to determine TTP (time-to-peak), RBV (regional blood volume), RBF (regional blood flow), and Peak. Results. Statistics revealed a significant difference (P < 0.05) between benign and malignant tumors in the RBV, RBF, and Peak but not in TTP (P = 0.07). Receiver operating curves (ROC) were generated for RBV, RBF, Peak, and TTP with estimated ROC areas of 0.97, 0.96, 0.98, and 0.76, respectively. Conclusion. RBV, RBF, and Peak continuously measured over a determined time period of 3 minutes could be of valuable support in differentiating malignant from benign liver tumors.