Ventilation/perfusion single-photon emission computed tomography (V/Q-SPECT) is the standard first-line imaging method for chronic thromboembolic pulmonary hypertension (CTEPH), but it lacks anatomical detail. Photon-counting computed tomography (PCCT) enables high-resolution assessment of perfusion, vasculature, and parenchyma in one scan, potentially improving diagnostic accuracy. To compare quantitative lobar lung perfusion between PCCT and V/Q-SPECT in patients with suspected or confirmed CTEPH. This retrospective single-centre study included twenty-three patients (ten females, thirteen males; mean age 67.9 ± 10.7 years). The median interval between PCCT and V/Q-SPECT imaging was 3 days (range: 0–11 days). Lung perfusion was analysed on a lobar basis using PCCT-derived perfused blood volume (PBV) maps and V/Q-SPECT perfusion images. Data were normalised using a z-score approach based on the 95

To evaluate a fully automated bone removal software for cone beam computed tomography (CBCT) of the thorax, abdomen, and pelvis, enhancing vascular visualization by eliminating bone interference and improving diagnostic quality. 1035 CBCT scans from adults age 66.5 ± 11.9 18–87 years (mean ± std min–max) across nine centers were retrospectively analyzed, divided into training (n = 855, 515 abdomen, 229 pelvis, 111 thorax) and testing (n = 180, 60 for each region, 114 male, 53 female, 13 unknown). Manual bone segmentation was performed using ITK-SNAP. A modified 3D U-Net was trained and clinically evaluated through multireader analysis using ordinal scales from 1 (perfect) to 4 (not usable) bone subtraction (B-rating) and erosion of non-target structures (V-rating) in addition to a vessel assessment (VA-rating), categorizing the subtracted image as “better” (1), “same” (2), or “worse” (3). Quantitative metrics include Sørensen–Dice coefficient and intersection over union (IoU). The software demonstrated high accuracy with a B-rating of 1.01 ± 0.07 and a V-rating of 1.02 ± 0.13, indicating minimal erosion of non-target structures. A VA-rating of 1.0 ± 0 suggests an improved vessel assessment and the depiction of contrast material deposition, enhancing the diagnostic quality of CBCT images. Quantitative analysis closely matched the manual expert delineation (Sørensen–Dice coefficient 0.95 ± 0.02, IoU of 0.9 ± 0.03). The software provides robust, fully automated bone removal in CBCT scans. This technology may enhance vascular system visualization without compromising non-target structures, potentially improving the accuracy and efficiency of interventional and diagnostic radiology procedures.

Flow diverter (FD) braid stability is crucial for optimal wall apposition, thereby reducing the risk of device-related complications following intracranial aneurysm treatment. We compared wall apposition characteristics across different FD designs to evaluate inter-device differences. Retrospective single-center analysis of 104 patients with 127 aneurysms treated with 121 FD (35 Derivo Embolization Devices (DED; Acandis, Pforzheim, Germany), 50 p64 (Phenox Wallaby, Bochum, Germany), 24 p48 (Phenox), 11 Silk (Balt, Montmorency, France), and 1 Pipeline (Medtronic, Dublin, Ireland)) between February 2013 and June 2023. The analysis focused on fish-mouthing-like deformities (≥ 10

Background:Quantitative MRI (qMRI) might detect subtle changes in recurrent high-grade glioma earlier than conventional imaging. The purpose of this study was to investigate whether WHO grade 4 glioma patients demonstrate alterations in multiparameter mapping (MPM) and diffusion tensor imaging (DTI)-derived measures within radiologically normal-appearing brain regions that subsequently exhibit tumor recurrence in follow-up scans. Methods:For 16 WHO grade 4 glioma patients with confirmed recurrence at follow-up, qMRI parametric maps [proton density (PD), longitudinal relaxation rate (R1), transverse relaxation rate (R2*)] were generated using an MPM protocol. Additionally, diffusion tensor imaging (DTI)-derived free water (FW) and FW-corrected tissue fractional anisotropy (FAt) were evaluated. We mapped recurrent tumor areas onto baseline scans to identify regions that subsequently progressed to contrast-enhancing tumor (CET) or FLAIR-hyperintense areas. Results:Normal-appearing gray matter (NAGM) that progressed into FLAIR-hyperintense areas in follow-up scans showed significantly lower median PD values, while median FW was significantly elevated across all subregions compared to their reference regions. This potentially reflects an early redistribution of water from bound tissue compartments into the extracellular space, most evident in gray matter. R1 demonstrated significantly lower median values in NAGM progressing to tumor compared to stable NAGM. Variance was significantly increased for PD, R2*, and FW in multiple subregions, consistent with heterogeneous tumor infiltration. Conclusions:MPM and DTI-derived metrics reveal subtle alterations in radiologically normal-appearing brain tissue months before recurrence becomes visible on conventional imaging. This could support earlier identification of subclinical progression and allow for personalized surveillance strategies.

BACKGROUND:Odontoid fractures of the second cervical vertebra commonly affect elderly patients due to osteoporosis and low-energy trauma. Treatment is controversial, with prolonged cervical collar immobilization risking non-union and complications, and surgical C1-C2 stabilization involving higher upfront surgical risks. High-level evidence from randomized controlled trials to guide optimal treatment decisions is lacking. The SCORE study aims to determine whether surgical stabilization is non-inferior to conservative collar management in maintaining functional independence for elderly patients with unstable odontoid fractures. METHODS:SCORE is a multicenter, parallel-group, randomized controlled non-inferiority trial enrolling 322 patients aged ≥70 years with acute (≤2 weeks) unstable odontoid Type II, III, or atypical fractures. Participants will be randomized 1:1, stratified by center, to receive surgical stabilization via posterior C1-C2 fixation or conservative management with a rigid cervical collar. The primary outcome measure is the change in Barthel Index (BI) from baseline to 12 weeks. Secondary outcomes include quality of life (EQ-5D), neck pain (Visual Analog Scale, VAS), neck disability (Neck Disability Index, NDI), radiographic fusion, treatment compliance, cross-over rates to surgery, and incidence of adverse and serious adverse events up to 6 months. Follow-ups will take place at 12 weeks and 6 months post-injury, with an additional visit at approximately 2 weeks post-surgery for surgical patients. Analysis will use mixed models for repeated measures, targeting 90% power to detect non-inferiority within a 5-point margin on the BI (one-sided α = 0.025), accounting for 15% attrition. DISCUSSION:This trial addresses a critical evidence gap by directly comparing surgical and conservative treatments, aiming to guide clinical decision-making and improve functional outcomes and quality of life in elderly patients. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT06961578.

Background Remote ischemic preconditioning (RIPC) has shown potential in reducing vasospasm-induced secondary ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Research suggests RIPC may help the brain adapt to periods of reduced blood flow, thereby reducing the risk of cerebral infarction secondary to delayed cerebral ischemia. This study aimed to analyze the possible impact of RIPC in patients with vasospasm following aSAH. Methods We performed a prospective, randomized, controlled, and rater-masked trial at our high-volume neurovascular center. Patients treated for aSAH between November 2019 and September 2023 were randomly allocated to either the control or RIPC intervention group. The RIPC intervention involved three upper arm blood pressure cuff inflations (20 mm Hg above systolic pressure) for 5 min, followed by 5 min of reperfusion, administered for 10 consecutive days within the initial 14 days after aSAH. The primary end point was postinterventional computed tomography to identify new cerebral infarction areas. Results Among 60 patients (29 in the intervention group, 31 in the control group) the entire cohort averaged 62.0 years, with no significant age difference between groups ( p = 0.41). RIPC did not significantly affect the initial occurrence of symptomatic vasospasms or the incidence of cerebral infarctions (RIPC 24.1% vs. control 16.1%, p = 0.44). No significant difference was found between the two groups with respect to incidence of new neurological symptoms ( p = > 0.99) or in-hospital mortality ( p = 0.5). Conclusions Remote ischemic preconditioning does not appear to influence the occurrence of vasospasms or the development of new infarcts on computed tomography. Larger studies are needed to further explore whether RIPC may have a role in specific high-risk subgroups or clinical settings.

BACKGROUND:Refractory ascites (RA) remains a serious complication in patients with cirrhosis. Currently, the insertion of a TIPS is considered the standard of care in these patients. To achieve symptom control in those with TIPS contraindications, tunneled peritoneal catheters (PeCa) or ascites pumps were introduced. However, data comparing the available treatment options are scarce. This study aims to compare outcomes among patients with RA treated either with TIPS, PeCa, or ascites pump. METHODS:All patients with RA and cirrhosis treated at Hannover Medical School between 2009 and 2023 were evaluated. Endpoints included mortality, acute kidney injury (AKI), hyponatremia, peritonitis, and rehospitalization rate. Propensity score matching was conducted to adjust for group differences. RESULTS:First, 31 patients with ascites pump were compared to 62 patients with a PeCa after propensity score matching. There were no differences regarding mortality nor incidences of AKI, hyponatremia, or rehospitalization. However, incidences of peritonitis and explantation were lower in those with ascites pump (HR 0.32, 95% CI: 0.15-0.70, and HR 0.32, 95% CI: 0.14-0.71, respectively). Second, 35 ascites pump patients were matched with 70 individuals with TIPS. No differences regarding mortality or peritonitis incidence were observed. Ascites pump patients showed higher incidences of AKI (HR 4.55, 95% CI: 2.53-8.18) and hyponatremia (HR 4.13, 95% CI: 2.08-8.22). Last, 129 patients with TIPS were compared to 129 with PeCa. Mortality was comparable, while incidences of AKI (HR 5.01, 95% CI: 3.36-7.47), hyponatremia (HR 4.64, 95% CI: 3.03-7.12), and peritonitis (HR 2.19, 95% CI: 1.41-3.41) were higher in those with PeCa. CONCLUSIONS:While ascites pump was associated with lower incidences of device infections and explantations, TIPS was associated with the lowest incidence of clinical complications in patients with RA.

Portale Hypertonie ist mit erheblicher Morbidität und Mortalität verbunden. Die Leberzirrhose macht bis zu 90 % der Fälle von portaler Hypertonie aus, während etwa 10 % auf nicht-zirrhotische Faktoren, einschließlich vaskulärer Lebererkrankungen, zurückzuführen sind. Diese Erkrankung kann zu schweren Komplikationen führen, wie der Entwicklung von gastroösophagealen Varizen, die das Risiko von varikösen Blutungen erheblich erhöhen. Weitere häufige Komplikationen der portalen Hypertonie sind Aszites und hepatorenales Syndrom (HRS). Eine transjuguläre intrahepatische portosystemische Shunt (TIPS)-Implantation wird als die effektivste Behandlung zur Bewältigung der portalen Hypertonie angesehen. Studien zeigen, dass die TIPS-Implantation die Überlebensraten bei Patienten mit wiederkehrendem Aszites sowie bei ausgewählten Patienten mit refraktärem Aszites und varikösen Blutungen verbessern kann. Allerdings können periinterventionelle und postinterventionelle Komplikationen die Anwendung von TIPS einschränken. Neueste Entwicklungen bei Geräten, Techniken und prophylaktischen Medikamenten zielen darauf ab, das Risiko von Komplikationen nach dem Eingriff zu minimieren. Dieses interdisziplinäre Positionspapier fasst Empfehlungen und Anleitung zur Patientenwahl, zu Indikationen und Kontraindikationen, zu Techniken sowie zur Nachsorge von Patienten zusammen, die in Deutschland ein TIPS-Verfahren erhalten.