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.

PURPOSE:Good training is the basis for high job satisfaction and high-quality patient care in radiology. The aim of this survey was to record the current state of working conditions for residents in radiology training in Germany and to focus on the aspects of training and psychosocial workload. The description of the actual state should help to identify possible problem areas and to develop improvement approaches. MATERIALS AND METHODS:At the beginning of 2018, we sent an electronic questionnaire to the German Roentgen Society (DRG), the German Association of Chairmen in Academic Radiology (KLR), the Chief Physician Forum of the DRG (CAFRAD) and the Forum of Registered Radiologists (FUNRAD) with the request to forward it to radiology residents. With 63 questions, the questionnaire covered seven essential areas of medical working and training conditions. In order to ensure interdisciplinary comparability, most questions were identical to previous surveys among residents of other disciplines. RESULTS:643 residents started the survey. 501 (78 %) questionnaires were fully processed and included in the final analysis. 65 % of respondents were satisfied with their current job situation. At the same time, shortcomings, especially with regard to the reconciliation of family and work as well as scientific and clinical work, became clear. Only 36 % of participants with children were satisfied with the compatibility of family and work at their workplace. Only 31 % of the researchers were satisfied with their research conditions. In addition, residents experienced a high psychosocial workload. CONCLUSION:Job satisfaction is high among radiology residents in direct comparison to other disciplines. However, based on this survey, adjustments to working conditions and training in radiology seem necessary to maintain the health of the physicians concerned, to encourage motivation for scientific work and to enhance development opportunities, especially for women, through a better compatibility of work and family life. The present survey identifies strategies and leadership tools that can help to achieve this. KEY POINTS:Residents in radiology training ... · have a relatively high job satisfaction.. · experience a high psychosocial workload.. · evaluate the compatibility of family and work as in need of improvement.. · are interested in research, but evaluate research conditions as insufficient. CITATION FORMAT:· Oechtering TH, Panagiotopoulos N, Völker M et al. Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Röntgenstr 2020; 192: 458 - 469.

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 Citation Format

Ziel: Evaluation der diagnostischen Wertigkeit der Schnittbildverfahren MRT, CT und Sonographie in der präoperativen Diagnostik des Pleuramesothelioms. Methoden: Bei insgesamt 51 Patienten mit histologisch gesichertem malignen Pleuramesotheliom wurde die Genauigkeit von MRT (n = 24), CT (n = 41) und Sonographie (n = 37) in der Erfassung von Infiltrationen des Diaphragmas, der Lunge, der Brustwand, des Perikards, des Myokards und des (Retro)Peritoneums eingeschätzt. Dazu wurden jeweils Sensitivitäten, Spezifitäten, positive und negative Vorhersagewerte und Treffsicherheiten berechnet. Ergebnisse: Die Treffsicherheiten betrugen für die genannten anatomischen Regionen im CT 85 %, 98 %, 83 %, 73 %, 71 %, und 83 %, im MRT 71 %, 92 %, 71 %, 83 %, 71 % bzw. 96 %, während sich für die thorakale Ultraschalluntersuchung Treffsicherheiten von 76 %, 63 %, 51 %, 60 %, 71 % und 89 % errechneten. Schlußfolgerungen: Die CT bleibt damit das Verfahren erster Wahl in der präoperativen Diagnostik des malignen Pleuramesothelioms. Eine unbedingte Forderung nach präoperativer Durchführung einer MRT-Untersuchung ergibt sich nach der vorliegenden Studie nicht. Die Sonographie des Thorax und oberen Abdomens liefert einen wichtigen ergänzenden Beitrag bei der Planung der Operation des malignen Pleuramesothelioms.

BACKGROUND:In most patients, severity of valvular aortic stenosis can be accurately assessed non-invasively by echocardiography. However, retrograde catheterisation of the aortic valve is often undertaken. This procedure has a potential risk of neurological complications, with an unknown incidence of clinically silent embolism. We aimed to establish the frequency of clinically apparent and silent cerebral embolism after this procedure.METHODS:We prospectively randomised 152 consecutive patients with valvular aortic stenosis at a German university hospital to receive either cardiac catheterisation with (n=101) or without (n=51) passage through the aortic valve. Patients underwent cranial MRI and neurological assessment within 48 h before and after the procedure to assess cerebral embolism. Controls were 32 patients without valvular aortic stenosis who underwent coronary angiography and laevocardiography.FINDINGS:22 of 101 patients (22%) who underwent retrograde catheterisation of the aortic valve had focal diffusion-imaging abnormalities in a pattern consistent with acute cerebral embolic events after the procedure; three of these patients (3%) had clinically apparent neurological deficits. By contrast, none of the patients without passage of the valve, or any of the controls, had evidence of cerebral embolism as assessed by MRI.INTERPRETATION:Patients with valvular aortic stenosis who undergo retrograde catheterisation of the aortic valve have a substantial risk of clinically apparent cerebral embolism, and frequently have silent ischaemic brain lesions. Patients should be informed about these risks, and this procedure should be used only in patients with unclear echocardiographical findings when additional information is necessary for clinical management.

BACKGROUND:Long-acting somatostatin analogues have been suggested as an alternative to propranolol for the prevention of variceal rebleeding.AIM:To compare the effectiveness of lanreotide SR, a new depot formulation injected once-weekly, and propranolol in reducing circadian portal blood flow (PVF) and meal-stimulated hepatic venous pressure gradient (HVPG) in patients with liver cirrhosis.METHODS:Patients were randomized to receive either lanreotide SR intramuscularly (30 mg once weekly, n=12) or propranolol (n=12) orally. Hemodynamic measurements were performed on day 0 and on day 21 after a 3-week period of drug administration, while patients received three standard oral liquid test meals. On each study day 27 PVF measurements were performed over 24 h and eight measurements of HVPG during the first postprandial period.RESULTS:Propranolol was more effective than lanreotide SR in reducing baseline HVPG (-21.9 vs. -13.6%, P=0.04) and meal-stimulated HVPG (-16.6 vs. -3.8%, P=0.04). Propranolol reduced circadian PVF significantly by 9.3% (P=0.03) but not lanreotide SR.CONCLUSIONS:Long-term treatment with propranolol reduced baseline and postprandial HVPG and circadian PVF, while lanreotide SR did not. The results of our study do not encourage clinical testing of lanreotide SR 30 mg for the prevention of variceal haemorrhage.

Background. The combination of photodynamic therapy and biliary drainage by plastic endoprosthesis insertion has produced promising results in the treatment of nonresectable hilar cholangiocarcinoma. The feasibility and efficacy of intraductal photodynamic therapy with subsequent biliary drainage by self-expandable metal stent insertion were evaluated in a prospective phase II study.Methods: Twenty-four patients were treated with photodynamic therapy after sensitization with porfimer sodium. A plastic endoprosthesis was inserted immediately thereafter and replaced by a metal stent 4 weeks later. A retrospectively analyzed group of 20 patients treated only with biliary drainage served as a historical control group.Results: In 19 of the 24 patients, insertion of a metal stent was technically feasible. The 30-day and 60-day mortality rates were 0%. A significant decrease in serum bilirubin was noted in all patients and quality of life remained stable throughout follow-up. Mean and median survival were, respectively, 15.9(3.1) and 9.9: 95% CI [6.4,13.4] months after photodynamic therapy. In the control group, mean and median survival were, respectively, 12.5(3.4) and 5.6: 95% CI [3.7, 7.6] months, which was not statistically significantly different from the photodynamic therapy group.Conclusions: Photodynamic therapy with consecutive biliary drainage by insertion of a self-expandable metal stent is feasible. With respect to the small benefit in overall survival, randomized controlled trials are warranted.

Zusammenfassung Ziel. Ziel dieser Studie war die Beschreibung der Auswirkungen einer G-CSF-Medikation auf Magnetresonanztomographie (MRT) und -spektroskopie (MRS) des lumbalen und femoralen Knochenmarks unter besonderer Berücksichtigung potenzieller Probleme in der Differenzialdiagnose zwischen malignen Knochenmarkinfiltrationen (KMI) und Rekonversionsphänomenen im Rahmen der Knochenmarkstimulation. Methode. Vor und während der G-CSF-Therapie wurden 13 Patienten untersucht, nur während der Therapie 6 weitere. Die Ergebnisse der Bildanalyse T1-gewichteter und fettunterdrückter gegenphasierter Aufnahmen und der spektroskopischen Daten (T2-Zeiten, Wasseranteil) wurden vor und während der Therapie verglichen und im Vergleich zu Patienten mit bekannter Knochenmarkinfiltration im Rahmen maligner Grunderkrankungen analysiert. Ergebnisse. Nach G-CSF-Medikation wurde bei 8/13 (lumbal) bzw. 11/13 (femoral) Patienten in T1w- und opGE-Bildgebung ein pathologischer Knochenmarkbefund erhoben. Die Veränderung waren in der Mehrzahl diffus (6 bzw. 8), seltener fokal (2 bzw. 3). Bei den erfolgreich stimulierten Patienten wurde ein signifikanter Anstieg der Wasserfraktion nachgewiesen (+17 bzw. +24%). Die T2-Zeiten änderten sich nicht signifikant und korrelierten nicht mit dem Stimulationserfolg. Diskussion. Die MRT und MRS der LWS sind geeignet, die zentrale Knochenmarkstimulation nach G-CSF-Medikation qualitativ und (semi)quantitativ zu erfassen. Der G-CSF-Effekt kann das Bild einer malignen KMI simulieren. Die Beurteilung einer möglichen malignen KMI ist daher ohne Ausgangsbefund nach G-CSF-Therapie nicht möglich.

PURPOSE:To assess the efficacy of intraarterial chemoperfusion (CP) with mitoxantrone in patients with bleeding bladder cancer; comparison with the results of intraarterial embolization therapy (ET).MATERIALS AND METHODS:Thirty patients with urinary bladder cancer and intractable bladder hemorrhage were treated with intraarterial (i.a.) CP (15 patients) using Mitoxantron 820 mg/m2/1-2 h) and i.a. ET (15 patients) using Histoacryl or Ethibloc. Bleeding control rate, recurrence of hemorrhage, survival rate and complications were evaluated.RESULTS:Complete control of the hemorrhage was achieved in 14/15 and 12/15 of the patients with CP and ET, respectively. Hemorrhage stopped in CP patients after an interval of (4 to 15) 10 days, and within 24 hours in ET patients. Recurrence of hemorrhage was observed in 3/14 of CP and 4/13 of ET patients. The survival rate was 4-5 months in both groups. Complications were observed in ET patients only (7/22). Posttherapeutic pain occurred significantly more often in ET patients (20/22) than in CP patients (6/31 versus 20/22).CONCLUSION:Intra-arterial chemoperfusion using Mitoxantron is an effective therapy in patients with intractable urinary bladder hemorrhage. Due to the delayed effect in CP, ET should be used in patients with life-threatening bleeding.

AIM:To study the effect of G-CSF therapy directly by MRI and 1H MRS in the lumbar and femoral bone marrow and differentiate between malignant bone marrow infiltration (MBMI) and reconversion of red marrow.METHODS:Thirteen patients could be examined twice, before and during G-CSF medication and another six only during treatment. T1 weighted spin-echo and opposed-phase gradient-echo images as well as the spectroscopic data (T2 values, water content) were analysed.RESULTS:After G-CSF a pathologic bone marrow signal intensity was seen in 8/13 (lumbar) and 11/13 (femoral) patients respectively. The majority of the signal alterations were diffuse (6 and 8), the minority focal (2 and 3). If a patient was successfully stimulated, a significant increase in water content occurred (21% lumbar, 34% femoral). T2 values did not change significantly, nor did they correlate with the stimulation success.CONCLUSIONS:MR tomography and -spectroscopy are suitable to detect lumbar and femoral bone marrow stimulation by G-CSF quantitatively and qualitatively. The changes may simulate MBMI. The adequate judgement of G-CSF treated bone marrow without pretherapeutic images is not possible.

PURPOSE:To evaluate the accuracy of spiral computed tomography during arterial portography (SCTAP) in the detection, localization, and resectability of liver tumors in a correlative study between radiology and intraoperative findings.METHOD AND MATERIALS:Retrospectively, SCTAP images of 168 consecutive patients before liver tumor resection were analyzed. The SCTAP studies (100 ml lopromid 300 by automated injector with a flow of 3 ml/s; slice thickness, table feed and reconstruction index 5 mm each; scan-delay 30 s; 120 kV; 250 mAs) were evaluated for the detection, localization, and resectability of focal liver lesions by three experienced radiologists in consensus and were correlated with histopathological and intraoperative findings where available (59/168).RESULTS:The sensitivity of SCTAP for the detection of liver tumors was 91% for all lesions and 84% for lesions < 1 cm. The specificity was only 19% due to a high rate of false-positive lesions (30%) and preselection effects. Typical pitfalls in false positive lesions were inhomogeneous liver perfusion near the portal vein, the falciform ligament, and the gallbladder (19/42). In 30% of the patients SCTAP correctly diagnosed inoperability, in 23% the intraoperative tumor expansion was larger than expected from SCTAP images, which would have changed operability.CONCLUSION:The SCTAP has a high sensitivity in the detection and localization of liver tumors and is a valuable method in the preoperative diagnostic procedure. The method is limited by many false-positive lesions often due to inhomogeneous liver perfusion and the insufficient evaluation of local tumor spread. Therefore, SCTAP should be replaced by MRI in the near future.

PURPOSE:To determine if scanning in the arterial phase improves detection of squamous cell carcinomas in the pharynx and larynx.METHODS:In a prospective clinical study 20 patients with a pharyngeal or laryngeal carcinoma were examined with by spiral CT. 80 ml lopromid were intravenously injected as a bolus with a rate of 3 ml/sec. Two consecutive spiral CT scans were performed with start-delay times of 20 and 70 seconds respectively. Delineation and contrast enhancement of tumours, cervical lymph nodes and vessels were evaluated. The radiodensities (HU) of tumors, lymph nodes vessels, pharyngeal wall and muscle were measured.RESULTS:Comparing early and late start delay time scans tumor assessment in the early phase was better in 58%, less in 16% and equal in both scans in 26%. 82% of the pathologic lymph nodes had more peripheral enhancement than surrounding muscle tissue. During the arterial phase the measured radiodensities of the common carotid artery and jugular vein were significantly higher than in the second phase.CONCLUSION:Contrast-enhanced special CT permits accurate morphologic assessment (size, infiltration) of pharyngeal and supraglottic laryngeal squamous cell carcinoma, while pathologic lymph nodes already have a sufficient contrast enhancement for the detection.

Evaluation of the diagnostic value of the imaging modalities computed tomography (CT), magnetic resonance imaging (MRI), and thoracic sonography in the preoperative staging of malignant pleural mesothelioma. Materials and Methods: The diagnostic accuracy of CT (n=41), MRI (n=24), and thoracic sonography (n = 37) were evaluated in 51 patients with histologically proven diffuse malignant pleural mesothelioma. Values of sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for the assessment of the diaphragm, lung, thoracic wall, pericardial wall, myocardium, and (retro)peritoneal space. Results: The accuracy rates for CT were 85 %, 98 %, 83 %, 73 %, 71 %, and 83 %. MRI had an accuracy of 71 %, 92%, 71 %, 83 %, 71 %, and 96%, the thoracic ultrasound examinations of 76 %, 63 %, 51 %, 60 %, 71 %, and 89%. Conclusions: According to these results CT remains the method of choice in the preoperative assessment of T-stage of malignant pleural mesothelioma. MRI is of nearly the same value, but is not a must. Sonography may be supplementary method for operation planning.

Zusammenfassung Trotz der Fortschritte der Schnittbildverfahren und der operativen Verfahren kommen bildgesteuerte Interventionen bei Lebertumoren sowohl im Rahmen der Diagnostik als auch der onkologischen Therapie weiterhin zum Einsatz. CT-gesteuerte Biopsien sollten mit 16–18 g-Stanzbiopsienadeln entnommen werden und sind den Fällen vorbehalten, die sonographisch unmöglich oder risikoreich sind. MRT gesteuerte Eingriffe sind noch selten. Die Treffsicherheiten der perkutanen Biopsiegewinnung liegen >90%, die Komplikationsraten, v.a. Blutung <1%. Palliative bildgesteuerte Interventionen von primären und sekundären Lebermalignomen sind thermoablative Verfahren über Laser (LITT), Kryoablation, Radiofrequenztherapie, die perkutane Alkoholinjektion (PEI) sowie lokale Chemotherapieverfahren über operativ oder perkutan implantierte Portsysteme in die A. hepatica oder über wiederholte transarterielle Katheterisierung im Rahmen von Chemoembolisationen und Chemoperfusionen (TACE). Bei Lebermetastasen sind bei geringer Größe (<4 cm) und Zahl (<5) LITT und PEI empfehlenswert, in fortgeschrittenen Fällen die Chemotherapie via Port. Für das HCC zeigt die PEI gute Ergebnisse, in den Stadien UICC IIIB und IV kommt die TACE zum Einsatz.

BACKGROUND Bone marrow is a common site of metastases in patients with small cell lung carcinoma (SCLC) and female breast carcinoma (FBC). Metastatic bone marrow involvement is found in approximately 50% of SCLC patients and up to 85% of FBC patients at autopsy. Initial staging procedures detect malignant bone marrow lesions in only 2–30% of patients with these tumors. This study was performed to assess whether MRI can improve the detection rate of bone marrow metastases in tumors with a high incidence of skeletal involvement. METHODS Fifty-two patients with histologically verified SCLC (25 with limited stage disease and 27 with extensive stage disease) and 33 women with FBC were entered into a prospective study. The MRI protocol was comprised of coronal slices in the pelvic region and sagittal slices of the whole spine utilizing a T1-weighted spin echo sequence with a field of view of 50 cm. All patients underwent initial routine diagnostic staging procedures including bone scintigraphy, unilateral crest biopsy, and plain film radiography of suspicious skeletal areas. RESULTS Only in two SCLC patients, MRI was positive in 25 cases. All SCLC patients with bone marrow lesions histologically verified, diagnosed by crest biopsy (six patients) or by bone scan (seven patients) had the correct diagnosis of metastases by MRI. In addition MRI revealed hypointense bone marrow foci in 14 cases. In contrast, 28 of 33 FBC patients examined during the initial staging procedure showed no evidence of bone marrow involvement. MRI was not superior compared with bone scintigraphy in FBC patients. CONCLUSIONS The staging results obtained in SCLC and FBC patients are different, although both tumors have a high incidence of bone marrow metastases. It may be assumed that the biologic behavior of these tumors is reflected by the initial bone marrow involvement. Because of its superiority compared with biopsy and bone scan, the authors believe MRI should become an integral part of the initial staging procedures in patients with SCLC. When staging patients with FBC, MRI should be applied only in clinically indicated cases. Cancer 1999;85:1004–9. © 1999 American Cancer Society.