Die Mehrzahl der Patient*innen mit neuroendokrinen Tumoren (NET) bilden im Verlauf der Krankheit Lebermetastasen aus, welche die Prognose sowie die Lebensqualität deutlich verschlechtern. Radiologisch-interventionelle Therapieverfahren, wie die Thermoablation, die transarterielle Embolisation (TAE)/Chemoembolisation (TACE) und die selektive interne Radiotherapie (transarterielle Radioembolisation, TARE) können somit bei der Behandlung des metastasierten NET eine entscheidende Rolle spielen. Aufgrund der Seltenheit der Erkrankung basiert der Großteil der Evidenz auf retrospektiven Studien. Für die Thermoablation konnten je nach Studien komplette Ansprechraten von 31,6–95,3

BACKGROUND:The majority of patients with neuroendocrine tumors (NET) develop liver metastases during the course of the disease, significantly impacting prognosis and quality of life. CLINICAL ISSUE:Radiologically guided interventional therapies, such as thermal ablation, transarterial embolization (TAE)/chemoembolization (TACE), and selective internal radiotherapy (TARE), can play a crucial role in the treatment of metastatic NET. DATA:Due to the rarity of the disease, the majority of evidence is based on retrospective studies. For thermal ablation, the complete response rates ranging from 31.6 to 95.3% depending on the study. No significant differences in outcomes were found between TAE, TACE, and TARE. In several studies, all intra-arterial procedures led to a reduction of tumor-related symptoms and achieved disease control. CONCLUSION:Thermal ablation can be used as a curative therapy in oligometastatic patients with nonresectable liver metastases from NETs. In cases of disseminated liver metastases, intra-arterial therapy using TAE, TACE, or TARE can be employed.

BACKGROUND:Lesions of the paravertebral mediastinum are rare, and knowledge of possible differential diagnoses is essential for clinical practice.OBJECTIVE/METHODS:To review common lesions of the paravertebral mediastinum.RESULTS:The paravertebral mediastinum mainly includes fatty tissue and neurogenic structures. Imaging is commonly performed using computed tomography (CT) and magnetic resonance imaging (MRI). Neurogenic tumors are the most common lesions of the paravertebral mediastinum. Other pathologies include extramedullary hematopoiesis, lipomatous, lymphogenic, inflammatory, and cystic lesions. Moreover, also diaphragmatic hernias, vascular and esophageal pathologies may be found in the paravertebral mediastinum.

Läsionen des paravertebralen Mediastinums sind selten, und die Kenntnis möglicher Differenzialdiagnosen ist für den klinischen Alltag unerlässlich. Übersicht häufiger Läsionen des paravertebralen Mediastinums. Dem paravertebralen Mediastinum werden vor allem Fettgewebe und neurogene Strukturen zugeordnet. Goldstandard der radiologischen Diagnostik stellen die Computertomographie (CT) und Magnetresonanztomographie (MRT) dar. Neurogene Tumoren sind die häufigsten Läsionen des paravertebralen Mediastinums. Weitere Pathologien umfassen die extramedulläre Hämatopoese, lipomatöse, lymphogene, inflammatorische und zystische Läsionen. Zwerchfellhernien, Gefäß- und Ösophaguspathologien können ebenfalls das paravertebrale Mediastinum einbeziehen.

To investigate the accuracy of liver diameters for estimation of liver size and to evaluate their application as tool for assessment of parenchymal liver disease. In the course of a population-based study, (SHIP) one thousand nine hundred thirty-nine volunteers underwent magnetic resonance imaging (MRI) of the liver including 3D gradient echo MRI sequences. Maximum liver diameters were measured in cranio-caudal (CC), anterior–posterior (AP), medial–lateral (ML) orientation. Diameters were compared with true liver volume assessed by liver segmentation. Additionally, age-dependent reference values for diameters were defined. Finally, accuracy of liver diameters was assessed to discriminate volunteers with healthy livers and participants with parenchymal changes, measured by MRI and laboratory. Reference values of liver diameters within the healthy population (n = 886) were defined as follows (mean ± standard deviation, confidence interval CI in cm): CC 17.2 ± 2, CI 13.6/21.2; AP 15.8 ± 1.9, CI 12.6/19.8; ML 19.7 ± 2.3, CI 15.8/24.6. There was a poor correlation using linear regression between liver diameter and true liver volume; CC 0.393, AP 0.359; ML 0.137. The AP direction shows the best correlation to discriminate between healthy and pathologic liver changes; AUC 0.78; p < 0.001, CC AUC 0.53; p < 0.001 and ML AUC 0.52; p = 0.008. Measurement of liver diameter, especially in the anterior–posterior direction is a simple option to detect chronic liver disease but less suitable for prediction of liver volume.

Die aortoiliakalen Stenosen sind eine häufige Ursache für die periphere arterielle Verschlusskrankheit (PAVK), welche insbesondere im höheren Alter (> 60 Jahre) mit einer Prävalenz von 20 % gehäuft auftritt. In frühen Stadien (TASC [Trans-Atlantic Inter-Society Consensus] II A/B) lassen sich diese Stenosen mittels endovaskulärer Therapieverfahren erfolgreich behandeln. Bei den komplexeren aortoiliaklen Stenosen (TASC II C/D) wurden in der Vergangenheit vornehmlich die offen-chirurgischen Therapieverfahren durchgeführt. Aufgrund des hohen Alters und den multiplen Komorbiditäten der PAVK-Patienten mit komplexen aortoiliaklen Stenosen stellt die offen-chirurgische Therapie meist ein hohes Risiko dar, weshalb die endovaskulären Verfahren trotz ihres schlechteren Outcomes eine Alternative darstellen. Durch die Methode der gecoverten endovaskulären Rekonstruktion der Aortenbifurkation (CERAB) soll die primäre Offenheitsrate gegenüber der üblichen endovaskulären Implantation von Kissing-Stents verbessert werden. Hinsichtlich der primären Offenheitsrate ist die offen-chirurgische Therapie den beiden endovaskulären Verfahren weiterhin überlegen, allerdings zeigt die CERAB-Technik ein besseres 5‑Jahres-Outcome als die Kissing-Stent-Technik. Bei der sekundären Offenheitsrate finden sich bei keinem der 3 Verfahren Unterschiede. Die Morbidität und Mortalität der CERAB- und Kissing-Stent-Technik sind vergleichbar niedrig, beide Verfahren sind der offen-chirurgischen Therapie überlegen. Aufgrund des besseren Langzeit-Outcomes der CERAB- gegenüber der Kissing-Stent-Technik sollte diese bei Patienten mit komplexen aortoiliakalen Stenosen mit einem erhöhten Komplikationsrisiko bei der offenen chirurgischen Versorgung angewandt werden.

To evaluate the suitability of volume index measurement (VI) by either ultrasound (US) or computed tomography (CT) for the assessment of liver volume. Fifty-nine patients, 21 women, with a mean age of 66.8 ± 12.6 years underwent US of the liver followed immediately by abdominal CT. In US and CT imaging dorsoventral, mediolateral and craniocaudal liver diameters in their maximum extensions were assessed by two observers. VI was calculated by multiplication of the diameters divided by a constant (3.6). The liver volume determined by a manual segmentation in CT (“true liver volume”) served as gold standard. True liver volume and calculated VI determined by US and CT were compared using Bland–Altman analysis. Mean differences of VI between observers were − 34.7% (− 90.1%; 20.7%) for the US-based and 1.1% (− 16.1%; 18.2%) for the CT-based technique, respectively. Liver volumes determined by semi-automated segmentation, US-based VI and CT-based VI, were as follows: 1.500 ± 347cm 3 ; 863 ± 371cm 3 ; 1.509 ± 432cm 3 . Results showed a great discrepancy between US-based VI and true liver volume with a mean bias of 58.3 ± 66.9%, and high agreement between CT-based VI and true liver volume with a low mean difference of 4.4 ± 28.3%. Volume index based on CT diameters is a reliable, fast and simple approach for estimating liver volume and can therefore be recommended for clinical practice. The usage of US-based volume index for assessment of liver volume should not be used due to its low accuracy of US in measurement of liver diameters.

Zielsetzung Die Studie evaluiert den Stellenwert der präoperativen CT-Bildgebung in der Vorhersage einer postoperativen Pancreasfistel (POPF) nach Pankreaskopfresektion mit Hilfe einer Radiomics-basierten Analyse.

AIM:To evaluate the technical and clinical success of embolisation in patients with life-threatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome.MATERIALS AND METHODS:Thirty patients (mean age: 71.9±9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred.RESULTS:Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2-cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9±16.1 g/l to 87±11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58±38 to 30±9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3±2.2 to 1±1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure.CONCLUSION:Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and influenced by pre-interventional coagulation status and by the amount of transfused concentrated red cells.

Aim of this study was to investigate frequency, incidence and risk factors of liver cysts in the general population in a longitudinal survey. Cyst frequency was investigated in 607 adult volunteers (288 women, 319 men, mean age 55 years) using strong T2-weighted magnetic resonance imaging. Risk factors were investigated for occurrence, frequency and size of cystic lesions at baseline. Incidence and physiological growing of the lesions were observed in a 5-years follow-up. At baseline, 431 volunteers had 1,479 cysts (71.0%). The mean number of cysts per person was 3.4 ± 9.0. The mean size of cysts was 13.1 ± 11.7 mm. Women had a higher number of cysts than men (p = 0.026). Older and male volunteers demonstrated a higher cyst frequency (p = 0.002 and p = 0.025). Per one-year increase in age the chance for a liver cyst increased by 2%. Four-hundred seventeen volunteers had cysts in the follow-up, in 24.6% new lesions had occurred. Lesion size significantly increased in follow-up (p < 0.001). Age and male sex were associated with the occurrence of at least one liver cyst. Women had a higher average number of cysts. Cystic lesion progression is a physiological phenomenon in the long-term follow-up.

Die interventionelle Radiologie ist ein noch junges, aber rasant wachsendes und zunehmend differenziertes Teilgebiet der Radiologie. Ihre Methoden finden Eingang in die Therapieoptionen und -leitlinien zahlreicher Tumorerkrankungen. In diesem Übersichtsartikel werden sowohl diagnostisch-interventionelle Verfahren, wie die bildgesteuerte Biopsie; kurative Methoden, wie die thermoablativen Verfahren der Mikrowellenablation (MWA), Radiofrequenzablation (RFA), der laserinduzierten Thermotherapie (LITT); als auch palliative Interventionen, wie die transarterielle Chemoembolisation (TACE) oder die selektive interne Radiotherapie (SIRT) jeweils mit ihren Indikationen und Komplikationen vorgestellt. Selektive Literaturrecherche in der Datenbank PubMed sowie in wissenschaftlichen Leitlinien unter Einbezug eigener Fallbeispiele und Erfahrungen aus dem eigenen Behandlungskollektiv. Die in der Zielsetzung genannten Verfahren werden methodisch vorgestellt und ihrem aktuellen klinischen Stellenwert zugeordnet. Das Angebot interventionsradiologischer Verfahren in der onkologischen Therapie wird sich aller Voraussicht nach in Zukunft noch mehr erweitern und die bereits etablierten Methoden flächendeckender verfügbar werden.

AIM:To investigate the accuracy of ultrasonography in the assessment of hepatic steatosis using magnetic resonance imaging (MRI) as standard of reference and to explore the influence of additional hepatic iron overload.MATERIAL AND METHODS:A total of 2,783 volunteers (1,442 women, 1,341 men; mean age, 52.3±13.8 years) underwent confounder-corrected chemical-shift-encoded MRI of the liver at 1.5 T. Proton-density fat fraction (PDFF) and transverse relaxation rate (R2*) were calculated to estimate hepatic steatosis and liver iron overload, respectively. In addition, the presence of hepatic steatosis was assessed by B-mode ultrasonography. The sensitivity, specificity, and accuracy of hepatic ultrasonography were determined for different degrees of hepatic steatosis and different amounts of liver iron.RESULTS:MRI revealed hepatic steatosis in 40% of participants (n=1,112), which was mild in 68.9% (n=766), moderate in 26.7% (n=297), and severe in 4.4% (n=49) of patients. Ultrasonography detected hepatic steatosis in 37.8% (n=1,052), corresponding to 74.5% sensitivity and 86.6% specificity. The sensitivity of ultrasound increased with the amount of hepatic fat present and was 65.1%, 95%, and 96% for low, moderate, and high fat content; whereas the specificity was constantly high at 86.6%. The diagnostic accuracy of ultrasound for detection of hepatic steatosis did not vary significantly with the amount of liver iron present.CONCLUSION:Ultrasonography is an excellent tool to assess hepatic steatosis in the clinical setting with some limitations in patients with a low liver fat content. The detection of hepatic steatosis by ultrasonography is not influenced by liver iron.

Purpose: To investigate how personality traits and professional experience of interventional radiologists affect outcome and complications in computed-tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of pulmonary nodules.

Perkutane Interventionen der Gallenwege und der Gallenblase sind fester Bestandteil in der Diagnostik und Therapie von Gallenwegerkrankungen.

New protocols for coronary computed tomography angiography (CCTA) could lower the radiation dose for patients but influence the image quality. To compare image quality and radiation exposure in step-and-shoot CCTA and high-pitch spiral CCTA. Fifty-nine pairs of patients matched for weight, height, sex and heart rate were included in this study (74 m, 44 f, average age 60 years, age range 29–94 years). Step-and-shoot CCTA and high-pitch spiral CCTA was performed on a third generation dual-source CT in equally sized patient groups. The signal-to-noise ratio (SNR) in the ascending aorta and the coronary arteries were determined for each dataset. Image quality was rated using a five-point scale. We used the t-test for paired samples to compare SNR and effective dose, and the Wilcoxon test to compare image quality scores. Mean effective dose for the step-and-shoot protocol (4.15 ± 3.07 mSv) was significantly higher in comparison to the high-pitch spiral protocol (1.2 ± 0.69 mSv; p < 0.0001). Mean SNR was higher with the step-and-shoot protocol compared to the high-pitch spiral protocol in the aorta, in the left main and peripheral coronary arteries (p < 0.01), in the proximal right coronary artery (p = 0.027). Image quality scores were significantly better for the step-and-shoot protocol (p = 0.0003). Step-and-shoot CCTA has significantly better SNR and overall image quality compared to high-pitch spiral CCTA, but with a mean effective dose more than thrice as high.

Purpose: To investigate factors influencing liver size and to determine reference values of liver volume (LV) for healthy subjects. Methods: 2773 volunteers underwent magnetic resonance imaging (MRI) of the liver in the setting of the population based Study of Health in Pomerania. Based on measurement of maximum diameters in three orientations, LVs were calculated and correlated with demographic factors such as age, gender, and body mass index. In addition, LVs of healthy volunteers and participants with parenchymal liver diseases such as fatty liver disease, iron overload, fibrosis/cirrhosis were compared. Adjusted reference values of liver volumes were defined for the group of healthy participants. Results: In general, mean LV (mean +/- standard deviation) was 1505 +/- 385 cm(3). Age, gender and body mass index correlated significantly with the liver volume (p <= 0.001). Parenchymal liver diseases significantly influence LV (with: 1624 +/- 420 cm(3), n = 1525 and without parenchymal liver diseases: 1360 +/- 273 cm(3); n = 1.248, p <= 0.001). Compared to LV of participants without liver diseases, LV was increased in volunteers with hepatic steatosis (1717 +/- 419 cm(3); n = 1111), liver iron overload (1558 +/- 367 cm(3); n = 553; p <= 0.001) as well as in participants with fibrosis/cirrhosis (1494 +/- 459 cm(3); n = 383). Conclusions: LV is influenced by age, body mass index and parenchymal liver diseases. Reference values were established to aid in the diagnosis of parenchymal liver diseases.

Depending on the type and acuteness, diseases of the aorta can be imaged by a variety of techniques. Modalities and quality of imaging have developed rapidly in recent years. In combination with the clinical assessment of patients, the results obtained by imaging determine the further management. They not only establish the underlying diagnosis but provide the information essential for indications, planning and reassessment of therapy, as well as for evaluation of the clinical course and surveillance. Whereas conventional catheter-guided angiography and intravascular ultrasound are only used in exceptional cases and then in conjunction with interventional therapy, cross-sectional imaging modalities, such as contrast-enhanced computed tomography (CT) angiography and magnetic resonance imaging (MRI) are nowadays the mainstay of diagnostics. Ultrasound techniques are improving steadily and are gaining increasing importance, e. g. for screening purposes and for pretherapeutic and posttherapeutic surveillance. Additional information of therapeutic relevance may be acquired by means of molecular imaging with positron emission tomography (PET) CT.

Aortenerkrankungen können je nach Krankheitsbild und Akuität mit unterschiedlichen bildgebenden Verfahren untersucht werden. Modalitäten und Qualität der Bildgebung haben sich in den vergangenen Jahren rasant weiterentwickelt. Gemeinsam mit der klinischen Einschätzung eines betroffenen Patienten ist sie wegweisend für das weitere Management. Neben der eigentlichen Diagnosestellung sind die erhobenen Befunde auch Basis für die weitere Indikationsstellung, Therapieplanung, Therapiekontrolle und Verlaufsbeurteilung. Während die Katheterangiographie und der intravaskuläre Ultraschall nur noch in Ausnahmefällen und dann in Kombination mit einer interventionellen Therapie zur Anwendung kommen, stehen heute Schnittbildverfahren wie die kontrastverstärkte computertomographische Angiographie und die Magnetresonanztomographie im Zentrum der diagnostischen Abklärung. Den sich stetig verbessernden sonographischen Verfahren kommt vor allem im Rahmen von Screeninguntersuchungen, aber auch in der prä- und posttherapeutischen Verlaufsbeobachtung eine immer wichtigere Rolle zu. Therapeutisch relevante Zusatzinformationen können mithilfe der molekularen Bildgebung in der Positronenemissionstomographie/Computertomographie gewonnen werden.

Interventional radiology provides a wide variety of vascular, nonvascular, musculoskeletal, and oncologic minimally invasive techniques aimed at therapy or palliation of a broad spectrum of pathologic conditions. Outcome data for these techniques are globally evaluated by hospitals, insurance companies, and government agencies targeting in a high-quality health care policy, including reimbursement strategies. To analyze effectively the outcome of a technique, accurate reporting of complications is necessary. Throughout the literature, numerous classification systems for complications grading and classification have been reported. Until now, there has been no method for uniform reporting of complications both in terms of definition and grading. The purpose of this CIRSE guideline is to provide a classification system of complications based on combining outcome and severity of sequelae. The ultimate challenge will be the adoption of this system by practitioners in different countries and health economies within the European Union and beyond.