Die Bildgebung steuert beim Urothelkarzinom die Stadieneinteilung und damit zentrale Therapieentscheidungen. In aktuellen Leitlinien gewinnt die multiparametrische MRT (mpMRT) der Harnblase mit standardisierter Befundung nach VI-RADS (Vesical Imaging-Reporting and Data System) an Bedeutung. Der Beitrag listet ein narratives, leitlinienorientiertes Update auf Basis der EAU-( European Association of Urology, Update 2025) und S3-Leitlinie (Langversion 3.0, 2025) sowie aktueller Schlüsselarbeiten zu VI-RADS/biparametrische MRT (bpMRT), Positronenemissionstomographie (PET)-basierten Verfahren und frühen Target-imaging-Ansätzen auf. Die mpMRT der Harnblase mit Klassifikation der Befunde nach VI-RADS zeigt für die Unterscheidung nicht-muskelinvasiver/muskelinvasiver Blasentumoren (NMIBC/MIBC) eine hohe Genauigkeit (AUC [„area under the curve“] im Bereich ≈ 0,93–0,95) bei guter Interobserver-Reliabilität. Hinsichtlich der Frage „Muskelinvasion: ja/nein“ ist die kontrastmittelfreie bpMRT der mpMRT in ausgewählten Settings häufig nicht unterlegen und reduziert die Untersuchungszeit; die Kontrastmittelapplikation kann bei Unklarheiten allerdings hilfreich sein. Für das Fern- und Nodal-Staging zeigt die Fluordesoxyglukose (FDG)-PET/CT in selektionierten Situationen einen inkrementellen Nutzen gegenüber der CT. Während die Hybrid-PET/MRT bereits vielversprechend, aber nicht flächendeckend implementiert ist, befindet sich die die NECTIN4-gerichtete PET-Bildgebung noch in einem frühen Stadium und ist dabei auch durch die heterogene Target-Expression limitiert. Für das lokale Staging eines Urothelkarzinoms sollte eine mpMRT – alternativ in geeigneten Fällen bpMRT – der Harnblase bevorzugt vor der transurethralen Resektion der Harnblase (TURB) nach VI-RADS-Standards durchgeführt werden. Die FDG-PET/CT ist nur fallbezogen für N/M-Staging und Restaging zu nutzen. Target-Imaging (z. B. NECTIN4) und künstliche Intelligenz (KI) bleiben derzeit Forschungsgegenstand.s Priorität haben prospektive Studien mit Decision-impact-Endpunkten und standardisierte Implementierungs‑/Qualitätsprozesse.

Background and purpose Motion management strategies such as gating under breath-hold can reduce breathing-induced motion during stereotactic arrhythmia radioablation (STAR) for refractory ventricular tachycardia. However, heartbeat-induced motion is essential to define an appropriate cardiac internal target volume (ITV) margin. In this study, we introduce a patient- and segment-specific cardiac motion estimation method and cardiac motion data of the clinical target volume (CTV), ICD lead tips and left ventricle (LV) segments. Materials and methods Data from 10 STAR-treated patients were retrospectively analyzed. The LV was semi-automatically segmented according to the 17-segment model. Electrocardiogram-gated contrast-enhanced breath-hold cardiac CTs were automatically non-rigidly registered for motion estimation. The correlation and significant differences between ICD tip motion and CTV motion were assessed using the Pearson correlation coefficient (PCC) and Wilcoxon signed-rank test, while spatial discrepancies with both CTV and segment motion were quantified using the Euclidean distance. Results The CTVs (center of mass) moved 3.4 ± 1.4 mm and the ICD lead tips moved 4.9 ± 2.2 mm. The maximum motion per patient was observed in basal and mid-cavity LV segments in 3D. The PCC showed a strong positive motion correlation between the ICD tip and CTV in 3D (0.84), while the p-values indicated statistically significant differences in the right-left, anterior-posterior and 3D directions. Conclusion The proposed methods enable patient- and segment-specific cardiac ITV margin estimation. The motion in most LV segments was limited, however, cardiac ITV margins may need adjustment in individual cases. The impact of cardiac motion on the dosimetry needs further investigation.

Background: Transcatheter mitral valve replacement (TMVR) is an emerging treatment strategy for multimorbid patients with severe mitral regurgitation.

Background: Adherence to a Mediterranean-style dietary pattern is likely to have variable effects on body composition, but the impact of gut microbiome on this relationship is unknown. Objectives: To examine the potential mediating effect of the gut microbiome on the associations between Alternate Mediterranean Diet (aMed) scores, abdominal adiposity, and inflammation in population-level analysis. Design: In a community-based sample aged 25 to 83 y (n = 620; 41% female) from Northern Germany, we assessed the role of the gut microbiome, sequenced from 16S rRNA genes, on the associations between aMed scores, estimated using validated food-frequency questionnaires, magnetic reso-nance imaging-determined visceral (VAT) and subcutaneous (SAT) adipose tissue and C-reactive protein (CRP). Results: Higher aMed scores were associated with lower SAT (-0.86 L (95% CI:-1.56,-0.17), P = 0.01), VAT (-0.65 L (95% CI:-1.03,-0.27), P = 0.01) and CRP concentrations (-0.35 mg/L; beta: -20.1% (95% CI: 35.5,-1.09), P = 0.04) in the highest versus lowest tertile after multivariate adjustment. Of the taxa significantly associated with aMed scores, higher abundance of Porphyromonadaceae mediated 11.6%, 9.3%, and 8.7% of the associations with lower SAT, VAT, and CRP, respectively. Conversely, a lower abundance of Peptostreptococcaceae mediated 13.1% and 18.2% of the association with SAT and CRP levels. Of the individual components of the aMed score, moderate alcohol intake was associated with lower VAT (-0.2 (95% CI:-0.4,-0.1), P =0.01) with a higher abundance of Oxalobacteraceae and lower abundance of Burkholderiaceae explaining 8.3% and 9.6% of this association, respectively. Conclusion: These novel data suggest that abundance of specific taxa in the Porphyromonadaceae and Peptostreptococcaceae families may contribute to the association between aMed scores, lower abdominal adipose tissue, and inflammation.

BACKGROUND:Liver fibrosis has been recognized as a long-term morbidity associated with Fontan circulation (Fontan-associated liver disease, FALD). The pathophysiology of FALD is not completely understood and abnormal flow dynamics may be associated with this condition. Liver hemodynamics can be quantitatively evaluated with four-dimensional phase-contrast flow magnetic resonance imaging (4D PC flow MRI). The study aimed to evaluate suitability of liver 4D PC flow MRI in Fontan patients and relate flow measurements to normal values and FALD severity. PATIENTS AND METHODS:Twenty-two Fontan patients were examined by 4D PC flow MRI at 1.5 Tesla to assess mesenteric, portal, splenic, and hepatic venous blood flow. Severity of FALD was graded based on routine screening, including abdominal ultrasound and laboratory tests. RESULTS:Median age was 18.5 (interquartile range, IQR 15.5-20.2) years. FALD was graded as "none or mild" in 16 and as "moderate to severe" in six cases. Ten patients presented at least one feature of portal hypertension (ascites, splenomegaly, or thrombocytopenia). For the entire cohort, blood flow in the superior mesenteric, splenic, and portal vein was lower than reported in the literature. No significant differences were observed in relation to FALD severity. Features of portal hypertension were associated with a higher splenic vein blood flow (0.34 ± 0.17 vs. 0.20 ± 0.07 l/min, p = 0.046). Splenic vein blood flow was negatively correlated to platelet count (r = -0.590, p = 0.005). CONCLUSIONS:4D PC flow MRI appears suitable to assess liver hemodynamics in Fontan patients and integration into clinical follow-up might help to improve our understanding of FALD.

ABSTRACT Background The aim of this work was to create and evaluate a preoperative non-contrast-enhanced (CE) magnetic resonance imaging (MRI)/angiography (MRA) protocol to assess renal function and visualize renal arteries and any abnormalities in potential living kidney donors. Methods In total, 28 subjects were examined using scintigraphy to determine renal function. In addition, 3D-pseudocontinuous arterial spin labeling (pCASL), a 2D-non-CE electrocardiogram-triggered radial quiescent interval slice-selective (QISS-MRA), and 4D-CE time-resolved angiography with interleaved stochastic trajectories (CE-MRA) were performed to assess renal perfusion, visualize renal arteries and detect any abnormalities. Two glomerular filtration rates [described by Gates (GFRG) and according to the Chronic Kidney Disease Epidemiology Collaboration formula (GFRCKD-EPI)]. The renal volumes were determined using both MRA techniques. Results The mean value of regional renal blood flow (rRBF) on the right side was significantly higher than that on the left. The agreements between QISS-MRA and CE-MRA concerning the assessment of absence or presence of an aberrant artery and renal arterial stenosis were perfect. The mean renal volumes measured in the right kidney with QISS-MRA were lower than the corresponding values of CE-MRA. In contrast, the mean renal volumes measured in the left kidney with both MRA techniques were similar. The correlation between the GFRG and rRBF was compared in the same manner as that between GFRCKD-EPI and rRBF. Conclusion The combination of pCASL and QISS-MRA constitute a reliable preoperative protocol with a total measurement time of <10 min without the potential side effects of gadolinium-based contrast agents or radiation exposure.

Osteoporosis is underdiagnosed and undertreated. To improve timely fracture risk assessment optimized densitometry methods are required such as opportunistic spinal quantitative computed tomography (QCT). However, it is unclear how to best calibrate these scans and correct for potential scanner drift of QCT when used for monitoring bone mineral density (BMD) changes. We compared gold standard simultaneous calibration with asynchronous calibration methods, assessing mid-term (12 weeks) and long-term (1.5 years) reproducibility of BMD measurements. Cortical and trabecular compartments of the European Spine Phantom were studied with ten different protocols including low dose and high resolution (HR)-modes. Based on weekly phantom data, we compared simultaneous calibration to asynchronous single (termed global) or monthly calibration. The accuracy was better for trabecular measurements than for cortical measurements for all calibration methods. Reproducibility was excellent for all methods and slightly better for asynchronous than for simultaneous calibration both for trabecular and cortical bone. For HR protocols, reproducibility was better than for low dose measurements. In trabecular compartments averaged HR-BMD remained stable for global (− 0.1

Emergency computed tomography (CT) often does not allow for comprehensive coronary artery assessment. However, CT may reveal pathological myocardial hypoperfusion suggestive of acute myocardial infarction (AMI), especially in patients presenting with a different diagnostic hypothesis. CT hypoperfusion is known to be associated with myocardial infarction, however the diagnostic value of CT hypoperfusion for the detection of AMI is still not well evaluated. This was a single-centre retrospective study including patients who underwent invasive coronary angiography (ICA) due to suspected AMI based on incidental perfusion defects upon emergency CT imaging between 2018 and 2023. A total of 22 patients (mean age 66.3 +/- 10.8 years, 11 female) were included in this analysis. The diagnosis of AMI was established in all cases leading to ICA. Culprit coronary artery lesions with an indication of percutaneous coronary intervention were detected in all patients who underwent ICA. Spearmann correlation for hypoperfused segments on CT imaging and the corresponding vascular territory upon ICA was significantly substantial (rho = 0.73, p = < 0.001). The higher the number of affected myocardial segments, the faster ICA was initiated. Mean time between the suspicion of AMI on CT imaging and ICA was 196 (29-4044) minutes. Myocardial hypoperfusion on emergency CT imaging should be considered as AMI until proven otherwise, independent of the clinical scenario leading to performance of CT imaging and whether imaging was performed for the exclusion of non-cardiac pathologies. Early initiation of further diagnostic workup may potentially avoid delays to invasive treatment and reduce the CT-to-catheter-time. Our study explicitly underlines that myocardial hypoperfusion upon contrast enhanced CT imaging needs to be considered as sign of acute myocardial infarction and indicates targeted clinical workup to rule out this diagnosis and to shorten the timeframe from imaging diagnosis to interventional treatment.

Nowadays, a minimally invasive surgical approach is increasingly being chosen to treat distal esophageal tumors. Here, postoperative hiatal herniation has been identified as a potentially severe complication. In such cases, it is still not known whether surgical or conservative treatment is preferable. In this report, we elaborate the case of a 62-year-old male patient who presented at our emergency department with severe chest pain. This patient had undergone minimally invasive esophagectomy with gastric pull-up 2 years prior to this event. Emergency computed tomography revealed a left-sided tension pneumothorax based on transhiatal herniation of the transverse colon causing an intrathoracic closed-loop obstruction with subsequent perforation. Immediate surgical treatment was initiated and the transverse colon could be successfully repositioned and resected. Nevertheless, the patient died due to postoperative septic shock in the setting of fecal peritonitis, mediastinitis, and pleuritis within 48 hours after surgery. We provide a detailed description of this rare case and provide a review of the literature concerning intrathoracic colonic herniations.

Introduction: Unilateral pulmonary edema (UPE) is a potential complication after mitral valve surgery (MVS), and its cause is not yet fully understood. Definitions are inconsistent, and previous studies have reported wide variance in the incidence of UPE. This research aims at the evaluation of the Radiographic Assessment of Lung Edema (RALE) score concerning assessment of UPE after MVS in order to provide an accurate and consistent definition of this pathology. Methods and Results: Postoperative chest X-ray images of 676 patients after MVS (minimally invasive MVS, n = 434; conventional MVS, n = 242) were retrospectively analyzed concerning presence of UPE. UPE was diagnosed only after exclusion of other pathologies up until the eighth postoperative day. RALE values were calculated for each patient. ROC analysis was performed to assess diagnostic performance. UPE was diagnosed in 18 patients (2.8%). UPE occurred significantly more often in the MI-MVS group (p = 0.045; MI-MVS n = 15; C-MVS n = 3). Postoperative RALE values for the right hemithorax (Q1 + Q2) > 12 and the right-to-left RALE difference ((Q1 + Q2) − (Q3 + Q4)) > 13 provide a sensitivity of up to 100% and 94.4% and a specificity of up to 88.4% and 94.2% for UPE detection. Conclusion: The RALE score is a practical tool for assessment of chest X-ray images after MVS with regard to UPE and provides a clear definition of UPE. In addition, it enables objective comparability when assessing of the postoperative course. The given score thresholds provide a sensitivity and specificity of up to 94%. Further, UPE after MVS seems to be a rather rare pathology with an incidence of 2.6%.

Background: Liver fibrosis has been recognized as a long-term morbidity associated with Fontan circulation (Fontan associated liver disease [FALD]). Chronic central venous congestion is suspected to be the main driver of FALD. The optimal imaging modality to screen for FALD and to monitor progression has not yet been defined. The study aimed to quantitatively evaluate liver hemodynamics with four-dimensional phase contrast flow magnetic resonance imaging (4D PC flow MRI).

Idiopathic vasculitides are rare inflammatory systemic diseases grouped in the Chapel-Hill concensus nomenclature by the size of the predominantly affected vessels (large, medium, small and variable vessel vasculitis). Vasculitis mimics are syndromes that cause a clinical image similar to idiopathic vasculitides or can easily be confused with them. Sometimes they even cause the full-blown clinical and histological pattern of a vasculitis disease. There are numerous vasculitis mimics: depending on the affected vessel size, hereditary connective tissue diseases, genetic immunodeficiency and autoinflammatory syndromes, infectious diseases, rare inflammatory systemic diseases, malignancies, drug-induced syndromes and several others should be considered. This review presents a selection of classical mimickers of vasculitides grouped by vessel size and discusses constellations that can be typical "pitfalls " in the clinical workup.

The value of biofeedback before elective coronary computed tomography angiography (CCTA) to reduce patients’ heart rates (HR) was investigated in the current work. Sixty patients who received CCTA to exclude coronary artery disease were included in our study and separated into two groups: with biofeedback (W-BF) and without biofeedback (WO-BF). The W-BF group used a biofeedback device for 15 min before CCTA. HR was determined in each patient at four measurement time points (MTP): during the pre-examination interview (MTP1), positioning on the CT patient table before CCTA (MTP2), during CCTA image acquisition (MTP3), and after completing CCTA (MTP4). If necessary, beta-blockers were administered in both groups after MTP2 until a HR of less than 65 bpm was achieved. Two board-certified radiologists subsequently assessed the image quality and analyzed the findings. Overall, the need for beta-blockers was significantly lower in patients in the W-BF group than the WO-BF group (p = 0.032). In patients with a HR of 81–90, beta-blockers were not required in four of six cases in the W-BF group, whereas in the WO-BF group all patients needed beta-blockers (p = 0.03). The amount of HR reduction between MTP1 and MTP2 was significantly higher in the W-BF compared to the WO-BF group (p = 0.028). There was no significant difference between the W-BF and WO-BF groups regarding image quality (p = 0.179). By using biofeedback prior to elective CCTA, beta-blocker use could be decreased without compromising CT image quality and analysis, especially in patients with an initial HR of 81–90 bpm.

We aimed to relate circulating plasma zinc and copper to a broad spectrum of adiposity-related traits in a cross-sectional Northern German study (n = 841, 42% female, age: 61 ± 12 years). Zinc and copper were measured by inductively coupled plasma–mass spectrometry. Subcutaneous (SAT) and visceral (VAT) adipose tissue and liver fat were derived from 534 and 538 participants, respectively, via magnet resonance imaging. Associations were assessed using multivariable-adjusted linear regression analysis. An increase per one standard deviation (SD) in zinc was associated with direct linear increases in body mass index (BMI) (1.17%; 95% confidence interval (95%CI) 0.15–2.20%), waist circumference (0.85%; 95%CI 0.04–1.67%) and waist-to-hip ratio (0.64%; 95%CI 0.18–1.09%). A 1-SD increment in copper was directly associated with BMI (1.64%; 0.41–2.88%) and waist circumference (1.22%; 95%CI 0.25–2.20%) but not waist-to-hip ratio. Independent of fat intake, zinc displayed associations with VAT (5.73%; 95%CI 2.04–9.56%) and with liver fat (3.84%; 95%CI 1.49–6.25%), the latter association being also independent of BMI. Copper was directly associated with SAT (4.64%; 95%CI 0.31–9.15%) before accounting for BMI, but showed no association with VAT or liver fat. Observed associations suggest a possible relevance of zinc and copper to adiposity. Particularly zinc displayed associations with traits of abdominal adiposity and liver fat.

Background and purpose: In patients with recurrent ventricular tachycardia (VT), STereotactic Arrhythmia Radioablation (STAR) shows promising results. The STOPSTORM.eu consortium was established to investigate and harmonise STAR treatment in Europe. The primary goals of this benchmark study were to standardise contouring of organs at risk (OAR) for STAR, including detailed substructures of the heart, and accredit each participating centre. Materials and Methods: Centres within the STOPSTORM.eu consortium were asked to delineate 31 OAR in three STAR cases. Delineation was reviewed by the consortium expert panel and after a dedicated workshop feedback and accreditation was provided to all participants. Further quantitative analysis was performed by calculating DICE similarity coefficients (DSC), median distance to agreement (MDA), and 95th percentile distance to agreement (HD95).Results: Twenty centres participated in this study. Based on DSC, MDA and HD95, the delineations of well-known OAR in radiotherapy were similar, such as lungs (median DSC = 0.96, median MDA = 0.1 mm and median HD95 = 1.1 mm) and aorta (median DSC = 0.90, median MDA = 0.1 mm and median HD95 = 1.5 mm). Some centres did not include the gastro-oesophageal junction, leading to differences in stomach and oesophagus delineations. For cardiac substructures, such as chambers (median DSC = 0.83, median MDA = 0.2 mm and median HD95 = 0.5 mm), valves (median DSC = 0.16, median MDA = 4.6 mm and median HD95 = 16.0 mm), coronary arteries (median DSC = 0.4, median MDA = 0.7 mm and median HD95 = 8.3 mm) and the sinoatrial and atrioventricular nodes (median DSC = 0.29, median MDA = 4.4 mm and median HD95 = 11.4 mm), deviations between centres occurred more frequently. After the dedicated workshop all centres were accredited and contouring consensus guidelines for STAR were established.Conclusion: This STOPSTORM multi-centre critical structure contouring benchmark study showed high agree-ment for standard radiotherapy OAR. However, for cardiac substructures larger disagreement in contouring occurred, which may have significant impact on STAR treatment planning and dosimetry evaluation. To stan-dardize OAR contouring, consensus guidelines for critical structure contouring in STAR were established.

Lower bone mass in older adults may be mediated by the endocrine crosstalk between muscle, adipose tissue and bone. In 150 community-dwelling adults (59–86 years, BMI 17–37 kg/m 2 ; 58.7% female), skeletal muscle mass index, adipose tissue and fat mass index (FMI) were determined. Levels of myokines, adipokines, osteokines, inflammation markers and insulin were measured as potential determinants of bone mineral content (BMC) and density (BMD). FMI was negatively associated with BMC and BMD after adjustment for mechanical loading effects of body weight (r-values between −0.37 and −0.71, all p < 0.05). Higher FMI was associated with higher leptin levels in both sexes, with higher hsCRP in women and with lower adiponectin levels in men. In addition to weight and FMI, sclerostin, osteocalcin, leptin × sex and adiponectin were independent predictors of BMC in a stepwise multiple regression analysis. Muscle mass, but not myokines, showed positive correlations with bone parameters that were weakened after adjusting for body weight (r-values between 0.27 and 0.58, all p < 0.01). Whereas the anabolic effect of muscle mass on bone in older adults may be partly explained by mechanical loading, the adverse effect of obesity on bone is possibly mediated by low-grade inflammation, higher leptin and lower adiponectin levels.

Single-session cardiac stereotactic radiation therapy (SBRT) has demonstrated promising results for patients with refractory ventricular tachycardia (VT). However, the full safety profile of this novel treatment remains unknown and very limited data from prospective clinical multicenter trials are available. The prospective multicenter multiplatform RAVENTA (radiosurgery for ventricular tachycardia) study assesses high-precision image-guided cardiac SBRT with 25 Gy delivered to the VT substrate determined by high-definition endocardial and/or epicardial electrophysiological mapping in patients with refractory VT ineligible for catheter ablation and an implanted cardioverter defibrillator (ICD). Primary endpoint is the feasibility of full-dose application and procedural safety (defined as an incidence of serious [grade ≥ 3] treatment-related complications ≤ 5