Ossification of the posterior capitellum: description of a new pathology and its radiological appearance.

BACKGROUND: Boxer elbow and handball goalkeeper elbow are causes of impingement characterized by osteophytes formation at the olecranon and coronoid tip as well as their corresponding fossae. Herein, we present another distinct pathology in these patients: the formation of an exostosis at the posterolateral aspect of the elbow. METHODS: Between April 2016 and May 2020, 12 athletes with boxer elbow and handball goalkeeper elbow (mean age of 22 years) suffering from elbow pain were enrolled in the present study. Plain radiography, magnetic resonance imaging (MRI), and computer tomography (CT) scans were used to evaluate the bone conformation of the posterolateral aspect of the elbow. Assessment and staging of the ossification was performed by two independent fellowship-trained elbow surgeons. RESULTS: Bone marrow edema of the posterior aspect of the elbow at the origin of the anconeus muscle was initially detected in MRI scans. With the progression of the condition, imaging revealed an ossification posterior to the capitellum with bony bridges. In the advanced stage of the disease, the exostoses was unstable as the ossification had no adherence to the posterior capitellum during surgical excision. Plain radiographs are limited in their ability to detect the condition, whereas MRI and CT scans allow to identify a signal enhancement at the posterolateral aspect of the elbow. CONCLUSION: In patients without history of elbow trauma, bony irregularities of the posterior aspect of the capitellum may indicate ossification of the posterolateral aspect of the elbow, most likely caused by repetitive hyperextensions.

[Unexpected emergencies and emergency findings in outpatient radiology practice]. / Unerwartete Notfälle und Notfallbefunde in der radiologischen Praxis.

CLINICAL/METHODICAL ISSUE: Radiological emergencies or incidental findings that require rapid treatment are part of the daily routine of radiological units in clinics-but also in outpatient radiology. What is special about the care of these patients in the outpatient radiological area? STANDARD RADIOLOGICAL METHODS: An acute or incidental diagnosis of an emergency situation generally occurs with CT or MRI. Outpatient radiology serves as a gatekeeper by preselecting critical cases and then, in close cooperation with all those involved, providing optimal therapy. METHODOLOGICAL INNOVATIONS: Use of CT and MRI to assess the emergency situation allows optimal therapy for the patient to be initiated. In outpatient radiology, close cooperation in the team with the patient and the referring physicians means achieving an optimal result, which can be a great opportunity. ACHIEVEMENTS: Close personal collaboration in the team with the referring physician and the patient is a decisive strength of outpatient radiology and can guarantee optimum care for the patient, especially in the case of acute emergencies or incidental findings which turn out to be clinical-radiological emergencies. The largest challenge in outpatient radiology is to select the critical cases of the many noncritical cases in the face of growing time and cost pressure in a time-economic manner. PRACTICAL RECOMMENDATIONS: Outpatient radiology should be aware of the chance for close cooperation and communication with referring physician and patient, especially in emergency situations-for the well-being of the patient, but also to increase the acceptance and significance of the field of radiology.

The value of dynamic magnetic resonance imaging in interdisciplinary treatment of pelvic floor dysfunction.

PURPOSE: The purpose of this study was to determine the value of dynamic pelvic floor MRI relative to standard clinical examinations in treatment decisions made by an interdisciplinary team of specialists in a center for pelvic floor dysfunction. METHODS: 60 women were referred for dynamic pelvic floor MRI by an interdisciplinary team of specialists of a pelvic floor center. All patients were clinically examined by an urologist, gynecologist, a proctological, and colorectal surgeon. The specialists assessed individually and in consensus, whether (1) MRI provides important additional information not evident by physical examination and in consensus whether (2) MRI influenced the treatment strategy and/or (3) changed management or the surgical procedure. RESULTS: MRI was rated essential to the treatment decision in 22/50 cases, leading to a treatment change in 13 cases. In 12 cases, an enterocele was diagnosed by MRI but was not detected on physical exam. In 4 cases an enterocele and in 2 cases a rectocele were suspected clinically but not confirmed by MRI. In 4 cases, MRI proved critical in assessment of rectocele size. Vaginal intussusception detected on MRI was likewise missed by gynecologic exam in 1 case. CONCLUSION: MRI allows diagnosis of clinically occult enteroceles, by comprehensively evaluating the interaction between the pelvic floor and viscera. In nearly half of cases, MRI changed management or the surgical approach relative to the clinical evaluation of an interdisciplinary team. Thus, dynamic pelvic floor MRI represents an essential component of the evaluation for pelvic floor disorders.

Multi-parametric MRI of rectal cancer - do quantitative functional MR measurements correlate with radiologic and pathologic tumor stages?

PURPOSE: The purpose of this study is two-fold. First, to evaluate, whether functional rectal MRI techniques can be analyzed in a reproducible manner by different readers and second, to assess whether different clinical and pathologic T and N stages can be differentiated by functional MRI measurements. MATERIALS AND METHODS: 54 patients (38 men, 16 female; mean age 63.2 ± 12.2 years) with pathologically proven rectal cancer were included in this retrospective IRB-approved study. All patients were referred for a multi-parametric MRI protocol on a 3 Tesla MR-system, consisting of a high-resolution, axial T2 TSE sequence, DWI and perfusion imaging (plasma flow -s PFTumor) prior to any treatment. Two experienced radiologists evaluated the MRI measurements, blinded to clinical data and outcome. Inter-reader correlation and the association of functional MRI parameters with c- and p-staging were analyzed. RESULTS: The inter-reader correlation for lymph node (ρ 0.76-0.94; p<0.0002) and primary tumor (ρ 0.78-0.92; p<0.0001) apparent diffusion coefficient and plasma flow (PF) values was good to very good. PFTumor values decreased with cT stage with significant differences identified between cT2 and cT3 tumors (229 versus 107.6 ml/100ml/min; p=0.05). ADCTumor values did not differ significantly. No substantial discrepancies in lymph node ADCLn values or short axis diameter were found among cN1-3 stages, whereas PFLn values were distinct between cN1 versus cN2 stages (p=0.03). In the patients without neoadjuvant RCT no statistically significant differences in the assessed functional parameters on the basis of pathologic stage were found. CONCLUSION: This study illustrates that ADC as well as MR perfusion values can be analyzed with good interobserver agreement in patients with rectal cancer. Moreover, MR perfusion parameters may allow accurate differentiation of tumor stages. Both findings suggest that functional MRI parameters may help to discriminate T and N stages for clinical decision making.

Diffusion-weighted imaging of focal renal lesions: a meta-analysis.

OBJECTIVES: Contrast-enhanced MRI can only distinguish to a limited extent between malignant and benign focal renal lesions. The aim of this meta-analysis is to review renal diffusion-weighted imaging (DWI) to compare apparent diffusion coefficient (ADC) values for different renal lesions that can be applied in clinical practice. METHODS: A PubMed search was performed to identify relevant articles published 2004-2011 on renal DWI of focal renal lesions. ADC values were extracted by lesion type to determine whether benign or malignant. The data table was finalised in a consensus read. ADC values were evaluated statistically using meta-regression based on a linear mixed model. Two-sided P value <5 % indicated statistical significance. RESULTS: The meta-analysis is based on 17 studies with 764 patients. Renal cell carcinomas have significant lower ADC values than benign tissue (1.61 ± 0.08 × 10(-3) mm(2)/s vs 2.10 ± 0.09 × 10(-3) mm(2)/s; P < 0.0001). Uroepithelial malignancies can be differentiated by lowest ADC values (1.30 ± 0.11 × 10(-3) mm(2)/s). There is a significant difference between ADC values of renal cell carcinomas and oncocytomas (1.61 ± 0.08 × 10(-3) mm(2)/s vs 2.00 ± 0.08 × 10(-3) mm(2)/s; P < 0.0001). CONCLUSIONS: Evaluation of ADC values can help to determine between benign and malignant lesions in general but also seems able to differentiate oncocytomas from malignant tumours, hence potentially reducing the number of unnecessarily performed nephrectomies. KEY POINTS: • This meta-analysis assesses the role of diffusion-weighted MRI in renal lesions. • ADC values obtained by DW MRI have been compared for different renal lesions. • ADC values can help distinguish between benign and malignant tumours. • Differentiating oncocytomas from malignant tumours can potentially reduce inappropriate nephrectomies.

Adjuvant IMRT/XELOX radiochemotherapy improves long-term overall- and disease-free survival in advanced gastric cancer.

PURPOSE: In a retrospective analysis, adjuvant intensity-modulated radiation therapy (IMRT) combined with modern chemotherapy improved advanced gastric cancer survival rates compared to a combination of three-dimensional conformal radiation therapy (3D-CRT) and conventional chemotherapy. We report on the long-term outcomes of two consecutive patient cohorts that were treated with either IMRT and intensive chemotherapy, or 3D-CRT and conventional chemotherapy. PATIENTS AND METHODS: Between 2001 and 2008, 65 consecutive gastric cancer patients received either 3D-CRT (n = 27) or IMRT (n = 38) following tumor resection. Chemotherapy comprised predominantly 5-fluorouracil/folinic acid (5-FU/FA) in the earlier cohort and capecitabine plus oxaliplatin (XELOX) in the latter. The primary endpoints were overall survival (OS) and disease-free survival (DFS). RESULTS: Median OS times were 18 and 43 months in the 3D-CRT and IMRT groups, respectively (p = 0.0602). Actuarial 5-year OS rates were 26 and 47 %, respectively. Within the IMRT group, XELOX gave better results than 5-FU/FA in terms of OS, but this difference was not statistically significant. The primary cause of death in both groups was distant metastasis. Median DFS times were 14 and 35 months in the 3D-CRT and IMRT groups, respectively (p = 0.0693). Actuarial 5-year DFS rates were 22 and 44 %, respectively. Among patients receiving 5-FU/FA, DFS tended to be better in the IMRT group, but this was not statistically significant. A similar analysis for the XELOX group was not possible as 3D-CRT was almost never used to treat these patients. No late toxicity exceeding grade 3 or secondary tumors were observed. CONCLUSION: After a median follow-up period of over 5 years, OS and DFS were improved in the IMRT/XELOX treated patients compared to the 3D-CRT/5-FU/FA group. Long-term observation revealed no clinical indications of therapy-induced secondary tumors or renal toxicity.

Assessment of renal function after conformal radiotherapy and intensity-modulated radiotherapy by functional 1H-MRI and 23Na-MRI.

PURPOSE: Adjuvant radiochemotherapy (RCHT) improves survival of patients with locally advanced gastric cancer. Conventional three-dimensional conformal radiotherapy (3D-CRT) results in ablative doses to a significant amount of the left kidney, while image-guided intensity-modulated radiotherapy (IG-IMRT) provides excellent target coverage with improved kidney sparing. Few long-term results on IMRT for gastric cancer, however, have been published. Functional magnetic resonance imaging (fMRI) at 3.0 T including blood oxygenation-level dependent (BOLD) imaging, diffusion-weighted imaging (DWI) and, for the first time, (23)Na imaging was used to evaluate renal status after radiotherapy with 3D-CRT or IG-IMRT. PATIENTS AND METHODS: Four disease-free patients (2 after 3D-CRT and 2 after IMRT; FU for all patients > 5 years) were included in this feasibility study. Morphological sequences, axial DWI images, 2D-gradient echo (GRE)-BOLD images, and (23)Na images were acquired. Mean values/standard deviations for ((23)Na), the apparent diffusion coefficient (ADC), and R2* values were calculated for the upper/middle/lower parts of both kidneys. Corticomedullary (23)Na-concentration gradients were determined. RESULTS: Surprisingly, IG-IMRT patients showed no morphological alterations and no statistically significant differences of ADC and R2* values in all renal parts. Values for mean corticomedullary (23)Na-concentration matched those for healthy volunteers. Results were similar in 3D-CRT patients, except for the cranial part of the left kidney. This was atrophic and presented significantly reduced functional parameters (p = 0.001-p = 0.033). Reduced ADC values indicated reduced cell density and reduced extracellular space. Cortical and medullary R2* values of the left cranial kidney in the 3D-CRT group were higher, indicating more deoxygenated hemoglobin due to reduced blood flow/oxygenation. ((23)Na) of the renal cranial parts in the 3D-CRT group was significantly reduced, while the expected corticomedullary (23)Na-concentration gradient was partially conserved. CONCLUSIONS: Functional MRI can assess postradiotherapeutic renal changes. As expected, marked morphological/functional effects were observed in high-dose areas (3D-CRT), while, unexpectedly, no alteration in kidney function was observed in IG-IMRT patients, supporting the hypothesis that reducing total/fractional dose to the renal parenchyma by IMRT is clinically beneficial.

Evaluation of MR imaging with T1 and T2* mapping for the determination of hepatic iron overload.

OBJECTIVES: To evaluate MRI using T1 and T2* mapping sequences in patients with suspected hepatic iron overload (HIO). METHODS: Twenty-five consecutive patients with clinically suspected HIO were retrospectively studied. All underwent MRI and liver biopsy. For the quantification of liver T2* values we used a fat-saturated multi-echo gradient echo sequence with 12 echoes (TR = 200 ms, TE = 0.99 ms + n × 1.41 ms, flip angle 20°). T1 values were obtained using a fast T1 mapping sequence based on an inversion recovery snapshot FLASH sequence. Parameter maps were analysed using regions of interest. RESULTS: ROC analysis calculated cut-off points at 10.07 ms and 15.47 ms for T2* in the determination of HIO with accuracy 88 %/88 %, sensitivity 84 %/89.5 % and specificity 100 %/83 %. MRI correctly classified 20 patients (80 %). All patients with HIO only had decreased T1 and T2* relaxation times. There was a significant difference in T1 between patients with HIO only and patients with HIO and steatohepatitis (P = 0.018). CONCLUSIONS: MRI-based T2* relaxation diagnoses HIO very accurately, even at low iron concentrations. Important additional information may be obtained by the combination of T1 and T2* mapping. It is a rapid, non-invasive, accurate and reproducible technique for validating the evidence of even low hepatic iron concentrations. KEY POINTS: • Hepatic iron overload causes fibrosis, cirrhosis and increases hepatocellular carcinoma risk. • MRI detects iron because of the field heterogeneity generated by haemosiderin. • T2* relaxation is very accurate in diagnosing hepatic iron overload. • Additional information may be obtained by T1 and T2* mapping.

[Functional magnetic resonance imaging for evaluation of radiation-induced renal damage]. / Funktionelle MRT der Niere zur Erfassung strahleninduzierter Nierenschädigungen.

The diagnosis of radiation-induced (especially chronic) renal alterations/damage is difficult and currently relies primarily on clinical evaluation. The importance of renal diagnostic evaluation will increase continuously due to the increasing number of long-term survivors after radiotherapy. This article evaluates the potentia diagnostic contribution of magnetic resonance (MR) imaging with a focus on functional MRI. The following functional MRI approaches are briefly presented and evaluated: blood oxygenation level-dependent imaging (BOLD), diffusion-weighted imaging (DWI) or diffusion tensor imaging (DTI), MR perfusion measurements and (23)Na imaging. In summary, only DWI and contrast-enhanced MR perfusion currently seem to be suitable approaches for a broader, clinical implementation. However, up to now valid data from larger patient studies are lacking for both techniques in regard to radiation-induced renal alterations. The BOLD and (23)Na imaging procedures have a huge potential but are currently neither sufficiently evaluated with regard to radiation-induced renal alterations nor technically simple and reliable for implementation into the clinical routine.

[The impact of ultrasound in urology]. / Stellenwert des Ultraschalls in der Urologie.

Ultrasound is of great importance in the diagnosis of acute and chronic diseases in urology, such as kidney colic, testicular torsion, low-grade kidney trauma or for follow-up of vesicoureteral reflux, evaluation of infertility, measurement of residual urinary volume and the detection of cancer. An ultrasound examination is time and cost-effective without exposure to ionizing radiation and is routinely performed by practitioners as well as in the clinical daily routine. With technical innovations, such as contrast-enhanced ultrasound or real time elastography, it would for instance be possible to extend the application field of ultrasound. However, in some fields of investigation ultrasound still lacks accuracy and despite its many advantages the validity of ultrasound findings sometimes has to be verified with computed tomography (CT) or magnetic resonance imaging (MRI).

Insights into the location of type I ECG in patients with Brugada syndrome: correlation of ECG and cardiovascular magnetic resonance imaging.

BACKGROUND: Brugada syndrome is characterized by ST-segment abnormalities in V1-V3. Electrocardiogram (ECG) leads placed in the 3rd and 2nd intercostal spaces (ICSs) increased the sensitivity for the detection of a type I ECG pattern. The anatomic explanation for this finding is pending. OBJECTIVE: The purpose of the study was to correlate the location of the Brugada type I ECG with the anatomic location of the right ventricular outflow tract (RVOT). METHODS: Twenty patients with positive ajmaline challenge and 10 patients with spontaneous Brugada type I ECG performed by using 12 right precordial leads underwent cardiovascular magnetic resonance imaging (CMRI). The craniocaudal and lateral extent of the RVOT and maximal RVOT area were determined. Type I ECG pattern and maximal ST-segment elevation were correlated to extent and maximal RVOT area, respectively. RESULTS: In all patients, Brugada type I pattern was found in the 3rd ICS in sternal and left-parasternal positions. RVOT extent determined by using CMRI included the 3rd ICS in all patients. Maximal RVOT area was found in 3 patients in the 2nd ICS, in 5 patients in the 4th ICS, and in 22 patients in the 3rd ICS. CMRI predicted type I pattern with a sensitivity of 97.2%, specificity of 91.7%, positive predictive value of 88.6%, and negative predictive value of 98.0%. Maximal RVOT area coincided with maximal ST-segment elevation in 29 of 30 patients. CONCLUSION: RVOT localization determined by using CMRI correlates highly with the type I Brugada pattern. Lead positioning according to RVOT location improves the diagnosis of Brugada syndrome.

"Number needed to read"--how to facilitate clinical trials in MR-angiography.

PURPOSE: To evaluate the effect of the number of readers on the statistical results in peripheral MRA. MATERIALS AND METHODS: 40 patients with peripheral arterial occlusive disease were included as a sample dataset in this study, randomly separated into two matched groups with n = 20 patients (group 1--gadobutrol, group 2--gadoterate meglumine) who underwent a continuous table movement MRA of the peripheral vessels at 3 T. Image quality (IQ) of 17 vessel segments was evaluated by 5 independent readers. The effect of the number of readers on significance and statistical power was statistically analyzed. RESULTS: Image quality in group 1 (gadobutrol) ranks significantly higher compared to group 2 (gadoterade meglumine) with a diagnostic IQ in 97% vs. 78% (p < 0.0001). For the diagnostic/non-diagnostic IQ assessment significance was reached with one reader 1/5 times (20%), with two readers in 4/10 (40%), with three readers in 6/10 (60%), with four readers in 4/5 (80%), with five readers in 1/1 (100%). Power considerations showed considerable gain when increasing the number of readers. CONCLUSION: Increasing the number of readers in a diagnostic MRA-study can be used to achieve a higher power or to decrease the number of subjects included with maintained statistical validity.

Image quality of T2w-TSE of the abdomen and pelvis with Cartesian or BLADE-type k-space sampling: a retrospective interindividual comparison study.

PURPOSE: The purpose of this study was to evaluate the image quality of T2-weighted (T2w) imaging of the abdomen and pelvis based on the acquisition of rotating rectangular stripes of k-space data after successive radiofrequency excitation (BLADE technique) in comparison to T2w turbo-spin-echo (TSE) sequences with Cartesian k-space sampling. MATERIALS AND METHODS: A total number of 107 patients with MR imaging of the abdomen or the pelvis were included in this retrospective interindividual study. All exams were performed in the clinical routine at 1.5T. The T2w images were randomly performed in BLADE technique or as TSE sequences. Two blinded radiologists assessed the images, presented in a random order, concerning the delineation of the abdominal and the musculoskeletal structures, the artifacts of these structures, and the overall image qualities. RESULTS: For the abdomen the mean overall image quality of the T2w-BLADE was rated 3.2 vs. 3.1 for T2w-TSE (p=0.871). The mean musculoskeletal/visceral artifacts of the T2w-BLADE were scored as 2.9/3.0 vs. 3.2/2.6 for the T2w-TSE (p=0.101/p=0.051). The delineation of the musculoskeletal, respectively of the visceral structures was assessed for the T2w-BLADE as 3.0/3.4 vs. 3.2/3.1 for the T2w-TSE (p=0.263; p=0.185). For the pelvis the mean overall image quality of the T2w-BLADE was 3.4 vs. 2.9 for the T2w-TSE (p=0.005). Furthermore the musculoskeletal/visceral artifacts were assessed with a mean of 3.6/3.3 for the T2w-BLADE vs. 3.0/2.8 for the T2w-TSE (p=0.005; p=0.011). The musculoskeletal/visceral delineation of the T2w-BLADE was rated 3.6/3.4 vs. 3.0/2.8 for the T2w-TSE sequence (p<0.001; p=0.008). CONCLUSION: In imaging of the pelvis the overall quality of T2w sequences with k-space sampling in BLADE technique was rated significantly superior compared with the standard Cartesian sampling. Similar results were assessed for the reduction of the amount of artifacts and blurring. By contrast, no significant benefit could be demonstrated for the T2w-BLADE in the abdomen.

Comparison of a new whole-body continuous-table-movement protocol versus a standard whole-body MR protocol for the assessment of multiple myeloma.

OBJECTIVES: To evaluate a whole body (WB) continuous-table-movement (CTM) MR protocol for the assessment of multiple myeloma (MM) in comparison to a step-by-step WB protocol. METHODS: Eighteen patients with MM were examined at 1.5T using a WB CTM protocol (axial T2-w fs BLADE, T1-w GRE sequence) and a step-by-step WB protocol including coronal/sagittal T1-w SE and STIR sequences as reference. Protocol time was assessed. Image quality, artefacts, liver/spleen assessability, and the ability to depict bone marrow lesions less than or greater than 1 cm as well as diffuse infiltration and soft tissue lesions were rated. Potential changes in the Durie and Salmon Plus stage and the detectability of complications were assessed. RESULTS: Mean protocol time was 6:38 min (CTM) compared to 24:32 min (standard). Image quality was comparable. Artefacts were more prominent using the CTM protocol (P = 0.0039). Organ assessability was better using the CTM protocol (P < 0.001). Depiction of bone marrow and soft tissue lesions was identical without a staging shift. Vertebral fractures were not detected using the CTM protocol. CONCLUSIONS: The new protocol allows a higher patient throughput and facilitates the depiction of extramedullary lesions. However, as long as vertebral fractures are not detectable, the protocol cannot be safely used for clinical routine without the acquisition of an additional sagittal sequence.

[Imaging of prostate cancer by diagnostic radiology and nuclear medicine]. / Radiologisch-nuklearmedizinische Bildgebung des Prostatakarzinoms.

The diagnostic methods in radiology and nuclear medicine for the imaging of prostate cancer as well as for the detection of locoregional recurrent disease and positive lymph nodes have progressed dramatically over the past years. Regarding technical advances in magnetic resonance imaging (MRI) and the new tracers used in nuclear medicine, an increase in sensitivity up to 85-90% and in specificity up to 75-90% has been achieved. Especially in MRI, efforts had been made to implement multiparametric imaging using the diagnostic methods of spectroscopy and diffusion-weighted sequences and by including dynamic contrast enhancement studies. In addition, by the use of dedicated, lymph-node specific contrast media, "ultrasmall paramagnetic iron particles" (USPIO), up to 100% of all pathological lymph nodes were detected in the published studies. Also in the field of nuclear medicine there have been relevant advances such as the development of specific tracer substances, which can be coupled to 18fluorine, a nuclide that is characterised by a longer half-life time than 11C and is therefore usable even in sites without an in-house cyclotron. Using this nuclide, the sensitivity and specificity rates in the detection of primary prostate cancer as well as in locoregional recurrences have been increased to values between 85 and 95%.

[Primary biphasic synovial sarcoma of the kidney]. / Biphasisches primäres Synovialsarkom der Niere.

Primary synovial sarcoma of the kidney is a rare neoplasm, which was first described by Argani et al. in 2000. We report a case of a 47-year-old man presenting with a renal mass of 11.7 x 9.3 x 8.1 cm size and a caval thrombus, which was classified as a biphasic differentiated spindle cell tumor. Fluorescence in situ hybridization (FISH) revealed a translocation t(X;18), specific for synovial sarcoma. In younger patients presenting with spindle cell-like renal tumors, a primary synovial sarcoma should be considered as a differential diagnosis.

Plesiomonas shigelloides pneumonia.

Plesiomonas shigelloides is known to cause mild to cholera-like diarrhea in most infected persons. In immunocompromised patients extra-intestinal manifestations have been described. We report the first case of pneumonia caused by P. shigelloides in a 76-year-old woman who had undergone a curative gastrectomy and esophageal-jejunostomy due to a low differentiated adenocarcinoma of the stomach (pT2, pN1 pMx, G3, R0, Lauren: intestinal type). The patient was admitted in hospital with clinical signs of pulmonary infection. CT-scan revealed a cavernous lesion in the right upper pulmonary lobe. Bronchial lavage showed a granulocytic inflammation 105CFU/ml P. shigelloides. Although antibiotic treatment led to a decrease of inflammation parameters and decrease of the pulmonary infiltrate the patient died due to development of torsades de pointes tachycardia leading to ventricular fibrillation and hypoxic brain damage.

[Vascular and parenchymal diseases of the kidney]. / Vaskuläre und parenchymale Erkrankungen der Nieren.

Diseases of the kidney often progress to end-stage renal failure over a period of several years and might lead to life-long dialysis. To avoid loss of renal function, kidney disease should be diagnosed as early as possible in order to initiate therapeutic measures in time. Several invasive and non-invasive radiological imaging techniques for the detection and characterization of renal disease are available. Particularly, non-invasive computed tomography (CT) and magnetic resonance imaging (MRI) have seen substantial technical advances in recent years. Today, both modalities offer a comprehensive diagnostic evaluation of renal diseases in a single examination, comprising detailed information of the parenchyma as well as of arterial and venous vasculature. This review article describes the most important vascular and parenchymal kidney diseases and their radiological characteristics with a focus on MRI and CT.

Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism: initial results.

To evaluate the feasibility of dual-energy CT angiography (CTA) of the lung in patients with suspected pulmonary embolism (PE). 24 patients with suspected PE were examined with a single-acquisition, dual-energy CTA protocol (A-system: 140 kV/65 mAsref, B-system: 80kV/190 mAsref) on a dual-source CT system. Lung perfusion was visualized by color-coding voxels containing iodine and air using dedicated dual-energy postprocessing software. Perfusion defects were classified by two blinded radiologists as being consistent or non-consistent with PE. Subjective image quality of perfusion maps and CTA was rated using a 5-point scale (1: excellent, 5: poor). The reading of a third independent radiologist served as the standard of reference for the diagnosis of PE. In all patients with PE (n=4), perfusion defects classified as being consistent with PE were identified in lung areas affected by PE. Both readers did not record perfusion defects classified as being consistent with PE in any of the patients without PE. Thus, on a per patient basis the sensitivity and specificity for the assessment of PE was 100% for both readers. On a per segment basis the sensitivity and specificity ranged between 60-66.7% and 99.5-99.8%. The interobserver agreement was good (k= 0.81). Perfusion defects rated as non-consistent with PE were most frequently caused by streak artifacts from dense contrast material in the great thoracic vessels. The median score of the image quality of both the perfusion maps and CTA was 2. In conclusion, dual-energy CTA of pulmonary embolism is feasible and allows the assessment of perfusion defects caused by pulmonary embolism. Further optimization of the injection protocol is required to reduce artifacts from dense contrast material.