Radiologie (Heidelberg, Germany)最新文献

{"title":"[Efficient patient preparation in computed tomography coronary angiography].","authors":"Jonas Dörner, Florian Siedek","doi":"10.1007/s00117-024-01352-7","DOIUrl":"10.1007/s00117-024-01352-7","url":null,"abstract":"<p><strong>Background: </strong>In the coming years, a significant increase in the number of computed tomography coronary angiographies (CCTA) is expected, leading to an additional burden on existing structures.</p><p><strong>Objectives: </strong>Discussion of effective processes and patient preparation in the context of high-volume CCTA.</p><p><strong>Materials and methods: </strong>The relevance of patient education and optimized workflows in clinical practice, including pharmacological heart rate control and vasodilation.</p><p><strong>Results: </strong>To conduct resource-efficient and effective patient examinations, comprehensive and clear patient education is crucial. This can be provided to the patient during scheduling or delivered digitally, so that the patient arrives with a thorough understanding of the examination process. In addition, targeted optimization of workflows tailored to CCTA is important. For high image quality, the administration of β‑blockers is necessary in most cases. This can be done intravenously to save time. The administration of nitrates immediately before the examination is recommended by current guidelines for all patients without contraindications and is ideally applied sublingually shortly before the examination.</p><p><strong>Conclusion: </strong>The anticipated increase in CCTA will significantly strain existing structures not only in terms of reporting. Especially standardized and structured workflows pre- and periprocedurally are essential for handling a high number of examinations, while maintaining sufficient image quality in clinical practice.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"911-917"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Photon-counting detector computed tomography : Paradigm shift in cardiac CT imaging].","authors":"Dmitrij Kravchenko, Yannik Christian Layer, Milan Vecsey-Nagy, Giuseppe Tremamunno, Akos Varga-Szemes, Christopher L Schlett, Fabian Bamberg, Tilman Emrich, Muhammad Taha Hagar","doi":"10.1007/s00117-024-01380-3","DOIUrl":"10.1007/s00117-024-01380-3","url":null,"abstract":"<p><strong>Background: </strong>The introduction of photon-counting detector computed tomography (PCD-CT) heralds a new generation of cardiac imaging.</p><p><strong>Objectives: </strong>This review discusses the current scientific literature to determine the incremental value of PCD-CT in cardiac imaging.</p><p><strong>Methods: </strong>Discussion of currently available literature regarding cardiac PCD-CT from a radiological perspective.</p><p><strong>Results: </strong>Since its market introduction in 2021, numerous studies have explored the advantages of this new technology in the field of cardiac imaging, including improved image quality through superior spatial resolution, a higher contrast-to-noise ratio, reduced artifacts, and lower radiation dose.</p><p><strong>Conclusion: </strong>While preliminary studies have been promising, it remains to be seen how the advantages of PCD-CT will affect clinical guidelines for cardiac CT.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"928-934"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The challenging patient-recommendations and solutions].","authors":"Roman Johannes Gertz, Lenhard Pennig","doi":"10.1007/s00117-024-01369-y","DOIUrl":"10.1007/s00117-024-01369-y","url":null,"abstract":"<p><strong>Background: </strong>The continuous technical development of cardiac computed tomography (CT) over the last decades has led to an improvement in image quality and diagnostic accuracy, while simultaneously reducing radiation exposure. Despite these advancements, certain patient-related factors remain a challenge to conduct a high-quality diagnostic examination.</p><p><strong>Question: </strong>What factors can negatively affect the image quality of cardiac CT and how can these be addressed?</p><p><strong>Materials and methods: </strong>Analysis of the available literature on cardiac CT and identification of the quality-limiting factors, discussion, and possible solutions.</p><p><strong>Results: </strong>Tachycardia, arrhythmias, high coronary calcification, the presence of stents and coronary artery bypasses, as well as obesity and anxiety were identified as primary factors that limit image quality and diagnostic accuracy. These issues primarily arise from a lack of response or the presence of contraindications to premedication, blooming artifacts, variations in postoperative anatomy, as well as other personal factors. Suggested solutions include optimizing premedication, scanner modifications, the selection of the most suitable acquisition mode, new scanner technologies, and innovative image reconstruction methods including artificial intelligence.</p><p><strong>Conclusions: </strong>Certain factors continue to pose a major challenge for cardiac CT. Knowledge of alternative premedication, scanner modifications, as well as the use of postprocessing software and new technologies can help overcome these limitations, enabling successful and safe cardiac CTs even in challenging patients.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"935-945"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Current guidelines for chronic coronary syndrome : Role of computed tomography-coronary angiography and pretest probability for coronary artery disease].","authors":"Matthias Gutberlet, Sebastian Reinartz, Marc Dewey, Lukas Lehmkuhl","doi":"10.1007/s00117-024-01387-w","DOIUrl":"10.1007/s00117-024-01387-w","url":null,"abstract":"<p><p>Due to its high sensitivity and high negative predictive value, computed tomography angiography of the coronary arteries (CCTA) has proven to be particularly useful for ruling out obstructive coronary artery disease (CAD) in cases of suspected chronic coronary syndrome (CCS), which is why CCTA will also be included in the care of patients with statutory health insurance in Germany according to the G-BA decision of January 24, 2024. The value of CCTA is clearly confirmed in the current guidelines of the European Society of Cardiology (ESC) and the national care guideline from August 2024. However, good results from CCTA can only be achieved-in addition to appropriate qualifications of those performing the test and the necessary technical requirements-if the right patients are included, namely those with a low intermediate pretest probability for the presence of obstructive CAD. For this purpose, the pretest probability (PTP) for the presence of obstructive CAD must be determined before the indication is established. As it is not yet clear which method should be used for this purpose, this overview presents various methods for calculating the PTP for the presence of obstructive CAD. In the latest methods of the ESC Guideline 2024, cardiovascular risk factors, previous findings or the calcium score are included in the calculation in addition to age, gender and symptoms, which increases the accuracy of the prediction. The advantages and disadvantages of the various methods are explained using case studies.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"918-927"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Paragangliomas of the head and neck].","authors":"Verena Strasser, Teresa Steinbichler","doi":"10.1007/s00117-024-01395-w","DOIUrl":"10.1007/s00117-024-01395-w","url":null,"abstract":"<p><p>Paragangliomas represent a heterogeneous group of rare neuroendocrine tumors with marked variability in symptoms and disease course. Due to the close proximity to neurovascular structures, paragangliomas of the head and neck region can cause a variety of symptoms. To this day, there are no reliable prognostic factors that can predict a potentially malignant course. All patients with newly diagnosed paragangliomas should undergo an early diagnostic workup and regular follow-up examinations in specialized centers. While radical resection was previously regarded as standard treatment for paragangliomas, radiotherapy and active surveillance (watch-and-scan strategy) have become equally important over the years. Low-threshold techniques for molecular pathology analysis of the mutation-specific behavior of paragangliomas are nowadays available.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"960-970"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Computed tomography coronary angiography : What does the nonradiologist expect from the radiologist?]","authors":"Babak Salam, Ansgar Ackerschott, Alexander Isaak, Sebastian Zimmer, Julian A Luetkens","doi":"10.1007/s00117-024-01353-6","DOIUrl":"10.1007/s00117-024-01353-6","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA) has become a central tool for the primary diagnosis of stable coronary artery disease (CAD). Its integration into the service catalog of the German statutory health insurance will not only transform the way patients are examined and treated but also enhance the collaboration between nonradiologists and radiologists.</p><p><strong>Objective: </strong>This article explores the requirements nonradiologists have for CCTA and identifies ways to promote successful interdisciplinary communication.</p><p><strong>Materials and methods: </strong>The study addresses criteria for proper patient selection and preparation for CCTA. It considers the perspectives and needs of patients and various medical specialties, highlighting essential aspects of interdisciplinary communication.</p><p><strong>Results: </strong>CCTA enables precise clarification of CAD and should be used for patients with a pretest probability of chronic CAD between 15 and 50%. Clear action plans in the diagnostic report are crucial to assist general practitioners and cardiologists in treatment planning. Patients expect clear information about the procedure, possible risks, and results.</p><p><strong>Conclusion: </strong>Close collaboration between various medical disciplines is essential for the successful implementation of CCTA. Clear, structured diagnostic reports with annotated images, along with regular case discussions and feedback loops, can improve report interpretation and interdisciplinary communication. Patient-friendly reports can make diagnostic results more understandable and enhance patient adherence.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"903-910"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Plaque characterization and individualized risk assessment].","authors":"J M Brendel, K Nikolaou, B Foldyna","doi":"10.1007/s00117-024-01385-y","DOIUrl":"10.1007/s00117-024-01385-y","url":null,"abstract":"<p><strong>Clinical/methodical issue: </strong>Risk assessment and accurate plaque characterization are key to individual prognosis in coronary artery disease (CAD).</p><p><strong>Standard radiological methods: </strong>The standard of care is cardiac computed tomography (CT), including calcium scoring and coronary CT angiography (CCTA). Diagnosis is based on the CAD-RADS (Coronary Artery Disease-Reporting and Data System) classification.</p><p><strong>Methodological innovations: </strong>New developments include CT-based fractional flow reserve (CT-FFR) and plaque quantification (\"virtual histology\").</p><p><strong>Performance: </strong>A calcium score of 0 indicates an event risk of less than 1% over 10 years [7, 17]. CAD-RADS classes 1 to 5 allow risk assessment compared to patients without coronary plaques [2]. CT-FFR has high accuracy (area under the curve [AUC] 0.90; 95% confidence interval 0.87-0.94) in assessing the hemodynamic significance of stenoses compared with invasive coronary angiography [25]. Plaque quantification has shown that a necrotic core greater than 4% is associated with an almost fivefold increase in 5‑year event risk [29].</p><p><strong>Achievements: </strong>The presence of obstructive CAD (stenosis > 50%) is a strong prognostic factor. The evaluation of the hemodynamic relevance of 40-90% stenoses by CT-FFR or other functional tests is already guideline-compliant in the USA, but not yet in Germany. Quantitative approaches to measure plaque volume and composition are gaining importance in research and are expected to become relevant in clinical practice.</p><p><strong>Practical recommendations: </strong>The CAD-RADS 2.0 classification, which also provides therapy recommendations, should be used to assess the extent of CAD.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"946-955"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging of the cerebellopontine angle: comparison between constructive interference steady-state and small field-of-view technique turbo spin echo sequences.","authors":"Valerio Vitale, Alessia Varotto, Ilaria Cracco, Mariam Mansour, Loris Di Clemente, Fabio Angelo Raneri, Alberto Tecchio, Giuseppe Iannucci","doi":"10.1007/s00117-024-01334-9","DOIUrl":"10.1007/s00117-024-01334-9","url":null,"abstract":"<p><strong>Background: </strong>The aim of this work was to optimize a three-dimensional (3D) turbo-spin-echo (TSE) sequence using a small field-of-view (FOV) technique for the study of the cerebellopontine angle and to compare it with a constructive interference steady-state (CISS) sequence.</p><p><strong>Methods: </strong>A total of 30 consecutive patients underwent magnetic resonance imaging with a 3Tesla (T) scanner, including 3D CISS and the optimized 3D small FOV technique turbo spin echo (3D SFT-TSE) T2-weighted sequences for the study of the cerebellopontine angle. The 3D SFT-TSE sequence was optimized after three different steps, and a quantitative evaluation of the signal-to-noise ratio (SNR) was obtained according to the National Electrical Manufacturers Association (NEMA) method. Three neuroradiologists made a blind comparative qualitative evaluation of the images between the 3D CISS and the 3D SFT-TSE obtained after the third optimization step, based on spatial resolution, contrast resolution, and presence of artifacts and noise.</p><p><strong>Results: </strong>The calculation of SNR using the NEMA method confirmed the superiority of the third optimization step over the others. For both spatial and contrast resolution, the optimized SFT-TSE was considered better (p < 0.001) than the CISS, while image artifacts and noise were considered worse in the CISS sequence (p < 0.001). Intraobserver analysis showed that all neuroradiologists preferred the 3D SFT-TSE sequence in terms of both spatial resolution and contrast resolution and found more noise and artifact disruption in the CISS sequence.</p><p><strong>Conclusions: </strong>The use of the 2D radiofrequency pulse technique with a 3D SFT-TSE T2 sequence was significantly more efficient than the 3D CISS sequence for the study of the cerebellopontine angle and inner ear structures.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"123-130"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee pain improvement after genicular artery embolization for the management of knee osteoarthritis: an updated systematic review and meta-analysis of 21 studies.","authors":"David-Dimitris Chlorogiannis, Anastasia Vasilopoulou, Christos I Konstantinidis, Amalia Efraimia Pagona, Dimitris K Filippiadis","doi":"10.1007/s00117-024-01388-9","DOIUrl":"10.1007/s00117-024-01388-9","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis is a progressive inflammatory musculoskeletal disease with a prevalence of approximately 15-23% and limited treatment options. In recent years, transcatheter genicular artery embolization (GAE) has been proposed due to promising results concerning symptomatic knee pain relief and mobility.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the aggregated data on the safety and efficacy of GAE for pain reduction in the treatment of knee osteoarthritis.</p><p><strong>Materials and methods: </strong>A systematic search of the three major databases (MEDLINE, Embase, and CENTRAL) from inception to 27 February 2024 was conducted according to the PRISMA guidelines. Studies reporting pain reduction according to the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-Total, WOMAC-Pain, and Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain scales and adverse event rates were included. Meta-analysis was performed by estimating the mean differences and by fitting random-effect models.</p><p><strong>Results: </strong>Overall, 21 studies were included, comprising of 633 patients and 758 knees treated. The combined data analysis showed that patients who underwent GAE demonstrated mean declines in the VAS score of -38.5 points (95% confidence interval [CI]: -44.9, -32.0) at 1 month, -36.2 points (95% CI -43.0, -29.5) at 3 months, -40.3 points (95% CI: -49.0, -31.7) at 6 months, and -40.5 points (95% CI: -54.5, -26.6) at 12 months. Similarly, significant differences at all time points were also found for the WOMAC-Total, WOMAC-Pain, and KOOS-Pain scores. No difference between permanent and non-permanent embolic material was found in the subgroup analysis for all time points.</p><p><strong>Conclusion: </strong>Genicular artery embolization is safe and effective for the treatment of painful knee osteoarthritis. This result was not affected by the type of embolic material used (permanent vs. non-permanent).</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"32-46"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Red flags for child abuse : Pediatric radiological and forensic aspects].","authors":"Maria L Hahnemann, Daniel Wittschieber, Hans-Joachim Mentzel","doi":"10.1007/s00117-024-01360-7","DOIUrl":"10.1007/s00117-024-01360-7","url":null,"abstract":"<p><strong>Clinical issue: </strong>The diagnostics of physical child abuse are usually performed by a multidisciplinary team and frequently represent a clinical challenge. Radiological expertise is particularly important for the recognition of abusive injuries to the skeletal system and the central nervous system. The aim of the article is to give an overview of red flags of child abuse in radiological imaging.</p><p><strong>Imaging methods: </strong>For the diagnostics of child abuse, conventional projection radiography of the skeletal system as well as computed tomography (CT) and magnetic resonance imaging (MRI) of the head are especially relevant. There is insufficient evidence with respect to sonography.</p><p><strong>Conclusion: </strong>Radiological imaging plays a key role for recognizing physical child abuse. Radiological red flags of child abuse can be crucial for making the diagnosis.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"868-874"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}