PURPOSE:Accurate preoperative localization of parathyroid adenomas is essential to enable targeted and minimally invasive surgery in patients with primary hyperparathyroidism (pHPT). A variety of imaging techniques are available for this purpose. In routine clinical practice, cervical ultrasound (US) combined with scintigraphy is most commonly used as the initial diagnostic approach. However, the optimal strategy or combination of imaging modalities for reliable localization prior to surgery and its relevance for postoperative outcomes remains a matter of ongoing discussion. The aim of this study was therefore to evaluate the diagnostic performance of different preoperative imaging modalities and their combinations for the detection and localization of parathyroid pathology in a large cohort of patients treated at a specialized thyroid center. This study investigated how well the values reported under controlled study conditions translate to clinical practice and real-world application. METHODS:This retrospective study included 325 patients who underwent minimally invasive parathyroidectomy for primary hyperparathyroidism between January 2015 and December 2023. All patients were evaluated with respect to the preoperative imaging modalities used for localization of the pathological parathyroid gland. In most cases, the standard diagnostic approach consisting of cervical US and scintigraphy was performed initially. When these examinations did not provide conclusive localization, additional imaging techniques were applied, including magnetic resonance imaging (MRI), computed tomography (CT), or 18-fluorocholine PET-CT (18-F PET-CT). In selected cases, invasive selective venous blood sampling (SVS) was also performed. The diagnostic performance of the different imaging modalities was assessed with regard to correct preoperative localization of the adenoma. Furthermore, the influence of factors such as concomitant thyroid disease, previous thyroid or parathyroid surgery, adenoma size and weight, as well as biochemical parameters including calcium and parathyroid hormone levels before, during, and after surgery was analyzed. RESULTS:The primary endpoint of postoperative normalization of parathyroid hormone levels after minimally invasive parathyroidectomy was achieved in 94.2% of patients undergoing surgery. The combination of US and scintigraphy as the primary examination procedures was able to provide clear information regarding the localization of the adenoma in 51% of cases, in all other cases one or more additional imaging procedure had to be performed. On average, three examination modalities (triple localization methods) had to be performed per patient (IQR 2.00 - 3.00), with MRI as the most common supplemented procedure, so that in the end a median of two examinations (IQR 1.00 - 3.00) consistently indicated the correct localization. Related to the individual method, US had the highest over-all sensitivity (69.4%) of the imaging procedures. Scintigraphy and SPECT-CT had a similarly high sensitivity of 58.0% for scintigraphy and 56.4% for SPECT-CT. MRI still achieved a sensitivity of 52.9%, CT 36.6%, 18-fluocholine PET-CT 100% and selective venous blood sampling only 60%. The values in clinical practice and broader real-world application with exception of 18-fluocholine PET-CT were below those reported under controlled study conditions. US, scintigraphy, SPECT-CT and MRI each showed a decrease in the sensitivity of correct preoperative localization in the presence of simultaneous thyroid disease. Selective venous blood sampling showed a drop in sensitivity from 80% without prior surgery to 28.6% with prior thyroid or parathyroid surgery. The mean values of correctly selected parathyroid adenomas suggested that larger and more heavy parathyroid adenomas were more likely to be recognized. It was shown that parathyroid adenomas examined by US, scintigraphy, SPECT-CT and additional MRI had a significantly lower volume (p = 0.004) and weight (p = 0.045) than those examined by US and scintigraphy alone. The possibility of successful preoperative localization did not depend on the specific parathyroid hormone level. In contrast, it was shown that higher preoperative calcium levels do not necessarily correlate with easier imaging detection, but lower calcium levels are more often associated with greater diagnostic effort. In contrast, preoperatively determined parathyroid hormone correlated moderately with adenoma weight (r = 0.44; p < 0.001) and adenoma volume (r = 0.17, p = 0.024), whereas calcium showed only weak, albeit significant, correlations with adenoma weight (r = 0.20; p = 0.005) and volume (r = 0.17; p = 0.024). Without concomitant thyroid disease, the US determined volume correlated very strongly with the histopathologically determined volume with a Spearman correlation coefficient of 0.702 (p <.001). With concomitant thyroid disease, the Spearman correlation coefficient decreased to 0.60 (p <.001), although there was still a strong correlation. CONCLUSION:The findings of this study indicate that the combination of cervical ultrasound and scintigraphy remains an effective first-line imaging strategy for the localization of parathyroid adenomas in the majority of patients undergoing surgery for primary hyperparathyroidism in routine clinical practice. This approach was associated with a high success rate of minimally invasive parathyroidectomy in a specialized thyroid center. Nevertheless, a considerable proportion of patients required additional imaging modalities to achieve reliable preoperative localization, with MRI representing the most frequently used supplementary technique.

Auswertung der bildgebend gesteuerten Schmerztherapien im Bereich der Wirbelsäule anhand der erfassten Daten aus dem DeGIR-QS-Register für das Jahr 2021 zur Analyse der radiologischen Versorgungssituation in Deutschland. Insgesamt wurden 28915 Interventionen der im DeGIR-Register dokumentierten klinischen und prozeduralen Daten zu schmerztherapeutischen Eingriffen für das Jahr 2021 nach Selektion der Therapien im Bereich der Wirbelsäule nach Art, Lokalisation und Methodik der angewandten Therapien sowie aufgetretenen Komplikationen analysiert. In die Auswertung flossen 27139 als schmerztherapeutische Infiltrationen im Bereich der gesamten Wirbelsäule codierte Eingriffe ein. Das Durchschnittsalter war 62 Jahre. Wiederholungseingriffe wurden in 4923 Fällen (29,1%) durchgeführt. 95,6% der Fälle wurden CT-gesteuert durchgeführt. In 15623 (57,6%) der Eingriffe erfolgte zur Dokumentation eine lokale Kontrastmittelapplikation. 7848 (28,9%) der Eingriffe wurden im Bereich von Gelenkstrukturen durchgeführt, 19291 (71,1%) an Spinalnerven (transforaminal oder translaminär); hierbei erfolgte die große Mehrzahl der Eingriffe mit 22184 (81,7%) im lumbalen und sakralen Abschnitt der Wirbelsäule. Komplikationen wurden bei 53 Fällen (0,2%) genannt, die überwiegende Mehrzahl hiervon waren leichtgradige Komplikationen der Kategorien A oder B (49 Fälle), in einem Fall wurde ein Tod berichtet (0,004%). Neuro-zerebrale Komplikationen wurden nicht dokumentiert. Die Auswertung der Registerdaten zeigt ein typisches Verteilungsmuster der radiologisch interventionellen Schmerztherapien an der Wirbelsäule im Hinblick auf epidemiologische Daten, Lokalisation und Art der Therapien. Diese werden in der großen Mehrzahl sehr komplikationsarm unter CT-Steuerung vorgenommen. Ein Ziel zukünftiger Erhebungen sollte auch exaktere Angaben zur Anamnese, Indikation, Durchführung und insbesondere der klinischen Erfolgsqualität beinhalten. Radiologisch interventionelle Schmerztherapien an der Wirbelsäule werden in Deutschland sicher und in der überwiegenden Anzahl der Fälle unter bildgebender Steuerung im CT durchgeführt.

Background: The aim of this study was to examine the validity of PET/CT scans in the preoperative identification of lymph node metastases (LNM) and compare them with postoperative outcomes. Methods: In this retrospective study, we included 87 patients with a solitary lung nodule or biopsy-proven non-small cell lung cancer treated in our institution from 2009 to 2015. Patients were divided into two groups and four subgroups, depending on pre- and postoperative findings. Results: According to our analysis, PET/CT scan has a sensitivity of 50%, a specificity of 88.89%, a positive predictive value of 63.16%, and a negative predictive value of 82.35%. Among the patients, 13.8% were downstaged in PET-CT, while 8% were upstaged. In 78.2% of cases, the PET/CT evaluation was consistent with the histology. Metastases without extracapsular invasion were seldom recognized on PET/CT. Conclusions: This analysis showed the significance of extracapsular tumor invasion, which causes an inflammatory reaction, on LNM, which is probably responsible for preoperative false-positive findings. In conclusion, PET/CT scans are very effective in identifying patients without tumors. Furthermore, it is highly probable that patients with negative findings are free of disease.

History and clinical findings In the following case report, we describe a patient with acute renal failure due to an urinary congestion level II-III under BCG-(Bacillus Calmette-Guerin)-therapy because of bladder cancer. Cystoscopy revealed the diagnosis of BCG-induced intramural narrowing of distal ureters bilaterally. Therapy and further development After receiving a double-J-catheter the renal function returned to normal. Conclusions Although postrenal failure is relatively rare (5 %), also seldom causes such as medication-induced (e. g. BCG) ureter stenosis has to be included into the differential diagnosis.

To evaluate the safety and impact of biopsy tract plugging with gelatin sponge slurry in percutaneous liver biopsy. 300 consecutive patients (158 females, 142 males; median age, 63 years) who underwent computed tomography-guided core biopsy of the liver in coaxial technique (16/18 Gauge) with and without biopsy tract plugging were retrospectively reviewed (January 2013 to May 2018). Complications were rated according to the common criteria for adverse events (NCI-CTCAE). The study cohort was dichotomized into a plugged (71%; n = 214) and an unplugged (29%; n = 86) biopsy tract group. Biopsy tract plugging with gelatin sponge slurry was technically successful in all cases. Major bleeding events were only observed in the unplugged group (0.7%; n = 2), whereas minor bleedings (4.3%) were observed in both groups (plugged, 3.6%, n = 11; unplugged, 0.7%, n = 2). Analysis of biopsies and adverse events showed a significant association between number of needle-passes and overall (P = 0.038; odds ratio: 1.395) as well as minor bleeding events (P = 0.020; odds ratio: 1.501). No complications associated with gelatin sponge slurry were observed. Biopsy tract plugging with gelatin sponge slurry is a technically easy and safe procedure that can prevent major bleeding events following liver biopsy.

Little is known about the specific anaesthesiological and multidisciplinary management of high-intensity focused ultrasound (HIFU) in uterine fibroids. This observational single-center study is the first reporting on an interdisciplinary approach to optimize outcome following ultrasound (US)-guided HIFU in German-speaking countries. A sample of forty patients with symptomatic uterine fibroids was treated by HIFU. Relevant treatment parameters such as total treatment time for intervention, anaesthesia, and sonication time as well as total energy, body temperature, peri-interventional medication and complications were analyzed. Interventional variables did not correlate significantly either with opioid dose or with body temperature. The average fibroid volume reduction rate was 37.8% ± 23.5%, 48.5% ± 22.0% and 70.2% ± 25.5% after 3, 6 and 12 months, respectively. No major anaesthesiological complications occurred apart from an epileptic seizure prior to HIFU treatment in one patient. Peri-procedural hyperthermia (> 37.5 °C) occurred in two patients. Post-procedural two patients experienced a sciatic nerve irritation up to one year; one patient with very large treated fibroid experienced strong short-lasting post-procedural pain. There were two complication-free pregnancies of HIFU-treated patients. Multidisciplinary management is crucial to optimize safety and outcome of US-guided HIFU for uterine fibroids. Peri-procedural pain and temperature management are critical points where an adequate collaboration between anesthesiologist and interventionalist is mandatory.

Zusammenfassung Anamnese Es erfolgt die Aufnahme einer 82-jährigen Patientin zur weiteren Abklärung zunehmender kognitiver Defizite und Gangunsicherheit. Diagnostik und Befunde In der durchgeführten Computertomografie des Kopfes zeigten sich die Zeichen einer fortgeschrittenen subkortikalen arteriosklerotischen Enzephalopathie (SAE). Laborchemisch fiel ein erhöhter Hämoglobinwert von 19,9 g/dl auf. Bei zusätzlicher Mutation in der JAK-2-Analyse wurde die Diagnose einer Polycythämia vera (Pv) gestellt. Nach Aderlass-Therapie zeigte sich eine Verbesserung der Kognition. Diskussion Die progredienten kognitiven Defizite sind bei vorbestehender SAE im Zusammenhang mit der neu diagnostizierten Pv zu sehen. Nach entsprechender Therapie der Pv ist auch langfristig eine Besserung der Kognition zu beobachten, sodass in diesem Fallbericht die Wichtigkeit einer Abklärung sekundärer, potenziell behandelbarer Ursachen von kognitiven Defiziten hervorgehoben wird.

History A 82-years old woman was admitted with a progressive cognitive decline for further investigations and treatment. Findings and Diagnosis In the computed tomography of the brain findings of subcortical artherosclerotic encephalopathy (SAE) were present. Laboratory findings revealed elevated hemoglobin-levels (19.9 g/dl). In further investigations we found a mutation in JAK-2 as diagnostic sign for polycythemia vera (Pv). After specific treatment of the Pv cognition improved significantly. Discussion In this case report we were able to relate the progressive cognitive impairment in the context of newly diagnosed Pv in conjunction with pre-existing SAE. After Pv-directed therapy cognition improved. This case report underlines the importance of a good diagnostic work-up of patients with cognitive impairment to rule out secondary and possible treatable causes.

Radioembolisation is part of the multimodal treatment of hepatocellular carcinoma (HCC) at specialist liver centres. This study analysed the impact of prior treatment on tolerability and survival following radioembolisation.This was a retrospective analysis of 325 consecutive patients with a confirmed diagnosis of HCC, who received radioembolisation with yttrium-90 resin microspheres at eight European centres between September 2003 and December 2009. The decision to treat was based on the clinical judgement of multidisciplinary teams. Patients were followed from the date of radioembolisation to last contact or death and the nature and severity of all adverse events (AEs) recorded from medical records.Most radioembolisation candidates were Child-Pugh class A (82.5%) with multinodular HCC (75.9%) invading both lobes (53.1%); 56.3% were advanced stage. Radioembolisation was used first-line in 57.5% of patients and second-line in 34.2%. Common prior procedures were transarterial (chemo)embolisation therapies (27.1%), surgical resection/transplantation (17.2%) and ablation (8.6%). There was no difference in AE incidence and severity between prior treatment subgroups. Median (95% confidence interval [CI]) survival following radioembolisation was similar between procedure-naive and prior treatment groups for Barcelona Clinic Liver Cancer (BCLC) stage A: 22.1 months (15.1-45.9) versus 30.9 months (19.6-46.8); p = 0.243); stage B: 18.4 months (11.2-19.4) versus 22.8 months (10.9-34.2); p = 0.815; and stage C: 8.8 months (7.1-10.8) versus 10.8 months (7.7-12.6); p = 0.976.Radioembolisation is a valuable treatment option for patients who relapse following surgical, ablative or vascular procedures and remain suitable candidates for this treatment.

Background The aim of this study was to evaluate long-term dilatation of Hemashield Gold and Hemashield Platinum vascular prostheses in ascending aortic position using different measurement methods to obtain precise results. Methods Between 1999 and 2007, 73 patients with Stanford type A dissection received ascending aortic replacement with Hemashield Gold and Hemashield Platinum prostheses. Measurements were performed using multiplanar reconstruction mode of electrocardiogram (ECG)-gated, multislice spiral computed tomography (MSCT) in strictly orthogonal cross-sectional planes. Different methods of measurement were compared and maximum dilatation was estimated for different time spans. Results Diameters calculated from the measured circumference showed a significant (p = 0.037) but clinically not relevant difference (0.1 mm) to the mean between the largest and the shortest cross-sectional diameter of the prosthesis. Dilatation after 24.2 ± 10.2 months was 8.5 ± 4.5%. Long-term dilatation after 91.8 ± 34 months amounted to 11.8 ± 4.2%. Conclusion Based on ECG-gated MSCT images, the presented methods of measurement provided reliable results. Long-term analysis shows low dilatation rates for Hemashield prostheses, which therefore can be considered as safe from this point of view. Nevertheless, a maximal dilatation of 20% could be relevant in valve sparing root replacement. It remains unclear if a dilatation like this contributes to the formation of suture aneurysms.

Malignant obstructions of the inferior vena cava (IVC) are a common cause of the IVC syndrome. As reports on interventional treatment of malignant inferior caval obstructions are very sparse, the purpose of this study was to retrospectively assess the outcome of endovascular treatment of symptomatic, malignant IVC syndromes.