Radiologe最新文献

{"title":"Ultrasound fusion biopsy.","authors":"Markus Herbert Lerchbaumer,&nbsp;Thomas Fischer","doi":"10.1007/s00117-021-00893-5","DOIUrl":"https://doi.org/10.1007/s00117-021-00893-5","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound (US)-guided biopsy is widely used for the diagnostic confirmation of focal lesions. For sampling of prostate tissue, magnetic resonance imaging (MRI)/US fusion-guided biopsy has already been implemented in routine clinical practice and has shown a superior detection rate of significant prostate cancer in risk assessment compared with standard systematic biopsy. Newer three-dimensional software tools with volumetric mapping of the prostate and biopsy core channels provide a better overview of systematic biopsy and thus contribute to more accurate treatment planning. Automatic fusion is a time-saver and can reduce potential examiner errors through greater standardization of the fusion process itself.</p><p><strong>Methodical innovations: </strong>In abdominal pathologies, US fusion biopsy can improve the rate of successful tissue sampling by using fused imaging to target lesions that are barely visible or difficult to delineate on B‑mode US scans. In addition, solid portions within larger tumors with enhancement on contrast-enhanced US can be targeted selectively, thereby avoiding sampling of necrotic areas and improving the quality of tissue cores for histopathological work-up.</p><p><strong>Conclusion: </strong>Especially in complex situations, use of US fusion not only saves time but also improves sampling accuracy, which in turn reduces the rate of insufficient tissue specimens that necessitate repeat biopsy.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Granulomatous skeletal lesions].","authors":"Jürgen Freyschmidt","doi":"10.1007/s00117-021-00938-9","DOIUrl":"https://doi.org/10.1007/s00117-021-00938-9","url":null,"abstract":"<p><p>The main granulomatous diseases of the musculoskeletal system are Langerhans cell histiocytosis, sarcoidosis, Erdheim-Chester disease (lipoidgranulomatosis) and mastocytosis. In most cases the patients have only a few symptoms, and the disease is detected coincidentally. The diagnosis is usually made by a synopsis of topographical presentation, clinical appearance and the radiological pattern (destruction, reactive new bone formation).</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39801510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Individual aspects in eldery patients with fragility fractures].","authors":"E Fleischhacker,&nbsp;J Gleich,&nbsp;E Hesse,&nbsp;B Bücking,&nbsp;U C Liener,&nbsp;Carl Neuerburg","doi":"10.1007/s00117-021-00928-x","DOIUrl":"https://doi.org/10.1007/s00117-021-00928-x","url":null,"abstract":"<p><strong>Background: </strong>Due to our ageing population, the number of elderly patients who are treated in the emergency department due to low-energy trauma (e.g., tripping) continues to rise. These minor accidents often result in fragility fractures classically located in the proximal humerus, distal radius, spine, pelvis, and near the hip joint. Pre-existing conditions, polypharmacy, and general frailty increase the risk of fragility fractures in this patient population.</p><p><strong>Methods: </strong>Geriatric trauma fractures and especially insufficiency fractures of the posterior pelvic ring are often difficult to diagnose by plain X‑ray. Therefore, in geriatric trauma patients, cross-sectional imaging, e.g., computed tomography (CT), dual-energy CT (DECT), or magnetic resonance imaging (MRI), should be considered early for reliable evaluation of a suspected fracture. This also allows for the identification of older fractures. Particularly in cognitively impaired elderly patients, difficult examination conditions or an unclear fall event, cross-sectional imaging is often indicated. However, this may also involve risks, e.g., use of contrast medium in patients with impaired renal function, so that each case must be considered individually. Furthermore, the diagnosis and treatment of osteoporosis, which is an underlying disease that leads to fragility fractures, is of particular importance. In the diagnostic workup, measurement of bone density using dual energy X‑ray absorptiometry (DXA) is the standard method according to guidelines. In specific situations, high-resolution peripheral quantitative CT (HR-pQCT) may also be used.</p><p><strong>Conclusion: </strong>Due to the special challenges of correctly detecting fragility fractures and being able to quickly initiate adequate therapy, good cooperation between radiologists and trauma surgeons is necessary.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39722291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dank an die Gutachter.","authors":"","doi":"10.1007/s00117-021-00937-w","DOIUrl":"https://doi.org/10.1007/s00117-021-00937-w","url":null,"abstract":"","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39801508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Skeletal manifestations of systemic hematologic disorders].","authors":"J Luitjens,&nbsp;A Baur-Melnyk","doi":"10.1007/s00117-021-00934-z","DOIUrl":"https://doi.org/10.1007/s00117-021-00934-z","url":null,"abstract":"<p><strong>Background: </strong>Bone marrow consists of connective tissue and stem cells, which generate blood cells. This includes erythropoiesis, leukopoiesis and thrombopoiesis. Thus, hematologic disorders first affect the bone marrow and secondarily the blood.</p><p><strong>Methods: </strong>Bone marrow changes can be sensitively detected using magnetic resonance imaging (MRI) and often represent the initial manifestation of the underlying disease. With longer duration of disease, changes can also be found on X‑ray or computed tomography (CT).</p><p><strong>Results: </strong>The findings on MRI and X‑ray/CT are often nonspecific and can only be interpreted in the context of clinical information.</p><p><strong>Conclusion: </strong>In the following article, we provide a brief overview of the clinical manifestations and imaging changes to be expected in leukemia, anemia, and chronic myeloproliferative disorders.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39745693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Skeletal changes in plasma cell dyscrasias].","authors":"Tim Frederik Weber,&nbsp;Theresa Mokry","doi":"10.1007/s00117-021-00932-1","DOIUrl":"https://doi.org/10.1007/s00117-021-00932-1","url":null,"abstract":"<p><strong>Background: </strong>Plasma cell dyscrasias are a spectrum of diseases characterized by clonal plasma cell proliferation. Important entities within this group are monoclonal gammopathy of unknown significance, smoldering multiple myeloma, and symptomatic multiple myeloma.</p><p><strong>Purpose: </strong>The goal of this review is to illustrate plasma cell dyscrasia imaging findings of bone and bone marrow as seen on whole-body computed tomography (CT) and magnetic resonance imaging (MRI) and to discuss the relevance of imaging for management of patients with plasma cell dyscrasias.</p><p><strong>Materials and methods: </strong>Selective literature search with analysis of dedicated original research articles and reviews and discussion of clinical guidelines.</p><p><strong>Results: </strong>Diagnostic classification of plasma cell dyscrasias is based on the SLiM-CRAB criteria. CT primarily represents imaging of mineralized bone to show osseous end organ damage by detecting osteodestruction. MRI is primarily used for bone marrow imaging to detect diffuse or focal bone marrow infiltration, even in the absence of bone destruction. Different patterns of bone marrow infiltration can be distinguished. Treatment response is associated with characteristic imaging signs of lesion regression.</p><p><strong>Conclusion: </strong>Imaging plays a prominent role in treatment stratification of patients with plasma cell dyscrasia at first diagnosis and during follow-up.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39801511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-enhanced ultrasound perfusion imaging of organs.","authors":"Ernst-Michael Jung, Marc-André Weber, Isabel Wiesinger","doi":"10.1007/s00117-021-00891-7","DOIUrl":"10.1007/s00117-021-00891-7","url":null,"abstract":"<p><p>In multimodal radiologic imaging, contrast-enhanced ultrasound (CEUS) is increasingly used. One of the advantages of CEUS is the possibility of repeated application of contrast media without decreasing renal function or affecting the thyroid gland. Small solid liver lesions can be diagnosed and detected with high accuracy. Moreover, solid lesions in other abdominal organs can also be characterized. Frequent applications for solid lesions in the near field concern thyroid tumors and lymph nodes. For prostate diagnostics, CEUS can be used with an endorectal probe and perfusion imaging. This review explains how the additional (semi-)quantitative perfusion analysis, especially time-intensity curve (TIC) analyses, and wash-in/wash-out kinetics of integrated or external perfusion software programs facilitate new options in dynamic assessment of microvascularization during tumor follow-up care and even minimally invasive tumor therapy.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39301671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Sclerosing hyperostotic bone disorders].","authors":"Daniela Kildal,&nbsp;Rainer Braunschweig,&nbsp;Matthias Schaal,&nbsp;Martin Mack","doi":"10.1007/s00117-021-00930-3","DOIUrl":"https://doi.org/10.1007/s00117-021-00930-3","url":null,"abstract":"<p><strong>Clinical/methodical issue: </strong>Diagnosis of sclerosing and hyperostotic bone disorders (SHS) is challenging. The correct and early identification of SHS can have therapeutic, prognostic and, in case of genetic SHS with regard to the risk of inheritance, advisory consequences.</p><p><strong>Standard radiological methods: </strong>For diagnosis, radiographic examinations and supplementary computed tomography (CT) and magnetic resonance imaging (MRI) are used. These are of indicative nature. Definitive diagnosis is usually made by genetic differentiation.</p><p><strong>Methodical innovations: </strong>In combination with the age of the affected person and the location of the osseous changes the characteristic image criteria are important. These are summarized in groups in this overview.</p><p><strong>Practical recommendations: </strong>Projection radiography in two planes is the imaging modality of choice. CT and MR can detect additional differential diagnostic criteria and should be indicated when needed.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39843288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MR-guided radiotherapy of moving targets.","authors":"C Katharina Spindeldreier,&nbsp;Sebastian Klüter,&nbsp;Philipp Hoegen,&nbsp;Carolin Buchele,&nbsp;Carolin Rippke,&nbsp;Eric Tonndorf-Martini,&nbsp;Jürgen Debus,&nbsp;Juliane Hörner-Rieber","doi":"10.1007/s00117-020-00781-4","DOIUrl":"https://doi.org/10.1007/s00117-020-00781-4","url":null,"abstract":"<p><strong>Introduction: </strong>Hybrid magnetic resonance (MR) linear accelerators (MR-Linacs) for radiotherapy allow for the visualization and tracking of moving target volumes during the entire treatment. This makes gated treatments possible, decreasing the irradiated volumes and thus sparing healthy tissue from unnecessary radiation dose. Conventionally, tumors that are subject to respiration motion are treated by irradiating the entire area of potential target presence (internal target volume, ITV). This study presents three patient cases (lung, adrenal gland, and liver tumors) treated with gated MR-guided radiotherapy and compares the treatment plans retrospectively with conventional ITV plans.</p><p><strong>Materials and methods: </strong>The gross tumor volume was delineated on MR and computed tomography (CT) images of the patients, and MR-Linac treatment plans were generated using additional clinical and planning target volume margins. The motion of the gross tumor volume was evaluated on two-dimensional cine-MRI images during the entire MR-Linac treatment. Based on the motion analysis, standard ITV-based plans were retrospectively created and compared by means of irradiated target volumes and dose-volume parameters.</p><p><strong>Results: </strong>For the MR-Linac plans, the irradiated treatment volumes were reduced by an average of 62% across the three cases, and for one case the ITV-based target volume would have overlapped with a critical organ. Target volume coverage was much better and the lung and adrenal MR-Linac plans revealed superior sparing of the organs at risks thanks to gated treatments.</p><p><strong>Conclusion: </strong>Dosimetrically beneficial treatment plans with promising clinical outcomes can be applied when using gated MR-guided radiotherapy. Future studies will reveal which patients will benefit most from this technique. To utilize the full potential of online adaptive, individualized MR-guided therapy, the close collaboration of radio-oncology and radiology is needed.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00117-020-00781-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38776359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photon-counting detectors in computed tomography: from quantum physics to clinical practice.","authors":"E Wehrse,&nbsp;L Klein,&nbsp;L T Rotkopf,&nbsp;W L Wagner,&nbsp;M Uhrig,&nbsp;C P Heußel,&nbsp;C H Ziener,&nbsp;S Delorme,&nbsp;S Heinze,&nbsp;M Kachelrieß,&nbsp;H-P Schlemmer,&nbsp;S Sawall","doi":"10.1007/s00117-021-00812-8","DOIUrl":"https://doi.org/10.1007/s00117-021-00812-8","url":null,"abstract":"<p><p>Over the last decade, a fundamentally new type of computed tomography (CT) detectors has proved its superior capabilities in both physical and preclinical evaluations and is now approaching the stage of clinical practice. These detectors are able to discriminate single photons and quantify their energy and are hence called photon-counting detectors. Among the promising benefits of this technology are improved radiation dose efficiency, increased contrast-to-noise ratio, reduced metal artifacts, improved spatial resolution, simultaneous multi-energy acquisitions, and the prospect of multi-phase imaging within a single acquisition using multiple contrast agents. Taking the conventional energy-integrating detectors as a reference, the authors demonstrate the technical principles of this new technology and provide phantom and patient images acquired by a whole-body photon-counting CT. These images serve as a basis for discussing the potential future of clinical CT.</p>","PeriodicalId":54513,"journal":{"name":"Radiologe","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00117-021-00812-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25378787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}