Radiologie (Heidelberg, Germany)最新文献

{"title":"[Anatomy and physiology of the lymph system : What clinicians should know].","authors":"Erich Brenner","doi":"10.1007/s00117-025-01432-2","DOIUrl":"10.1007/s00117-025-01432-2","url":null,"abstract":"<p><p>The lymphatic vessels are a unidirectional, centripetal system that collects interstitial fluid from tissues and organs, directing it into the venous system. The lymphatic vessels can be categorized into four types: initial lymphatic vessels, precollectors, collectors, and lymphatic trunks. Initial lymphatic vessels comprise interconnected networks characterized by larger mash sizes compared to blood capillaries and are lined with a specialized endothelium. They have interendothelial openings that allow exchange with the surrounding tissue. These vessels also have characteristic markers such as VEGFR‑3, podoplanin, and LYVE‑1. Precollectors have smooth muscle cells that are still arranged irregularly and parietal valves that promote centripetal lymph flow. Collectors have also valves and a continuous layer of spirally arranged muscle fibers that allow the vessels to pulse and contract. This contraction causes the lymph to be transported from one lymphangion to the next. Lymphatic trunks form the next section and often flow into the thoracic duct, which opens into the venous system. Lymph nodes are situated along the course of the collectors and trunks and serve as filter centers to intercept pathogens and increase the colloid osmotic pressure of the lymph. They are organized into groups with a specific structure with cortex, medulla, and embedded B and T lymphocytes. The central lymphatic system transports lymph through segmental connections and anastomoses. The thoracic duct empties into the left venous angle and collects also other lymphatic truncs. The thoracic duct's developmental history and variations occasionally lead to anatomical anomalies.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"301-306"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694071","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":"[An uncommon cause of pulmonary infection : It's not always tuberculosis].","authors":"Christopher Kloth, Thomas Breining, Annika Beck, Camilla Westerwinter, Giuseppe Zenatti, Meinrad Beer, Daniel Vogele","doi":"10.1007/s00117-025-01426-0","DOIUrl":"10.1007/s00117-025-01426-0","url":null,"abstract":"","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"362-366"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560278","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":"[Imaging of the lymphatic vascular system-techniques].","authors":"A Henkel, Claus C Pieper","doi":"10.1007/s00117-025-01440-2","DOIUrl":"10.1007/s00117-025-01440-2","url":null,"abstract":"<p><strong>Clinical/methodical issue: </strong>Imaging of the lymphatic vascular system is comparatively difficult and logistically demanding.</p><p><strong>Standard radiological methods: </strong>The field has developed significantly in recent decades. The longest established techniques are conventional X‑ray lymphangiography and lymphoscintigraphy.</p><p><strong>Methodological innovations: </strong>In recent years, magnetic resonance (MR) and computed tomography (CT) lymphangiography have been developed using different contrast medium (CM) techniques. For interstitial lymphangiography, CM is injected intracutaneously, and absorbed and drained by the lymphatic system. For direct techniques, CM is injected directly into a lymph node or a prepared lymph vessel.</p><p><strong>Performance: </strong>Lymphangiography procedures offer high anatomical and/or temporal resolution that have method-related differences. They allow better morphological assessment of the lymph vessels compared to lymphoscintigraphy. Furthermore, MR and CT lymphangiography are less invasive than conventional x‑ray lymphangiography.</p><p><strong>Evaluation: </strong>MR lymphangiography in particular allows dynamic assessment of lymph flow through repetitive imaging, which is particularly valuable in complex situations. While MR lymphangiography is now established in centers despite the off-label use of CM, data regarding CT lymphangiography is still very limited.</p><p><strong>Practical recommendations: </strong>A number of specific lymphatic imaging techniques are available at specialized centers.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"307-315"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788973","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 lymphatic system-an interdisciplinary challenge].","authors":"Moritz Wildgruber, Wilhelm Flatz, Matthias P Fabritius, Daniel Puhr-Westerheide, Nicole Lindenblatt, Bernhard Renz, Jens Ricke, Max Seidensticker, Martin K Angele","doi":"10.1007/s00117-025-01438-w","DOIUrl":"10.1007/s00117-025-01438-w","url":null,"abstract":"<p><strong>Background: </strong>Congenital and acquired diseases as well as iatrogenic injuries to the lymphatic system pose significant differential diagnostic challenges for both diagnostic and interventional radiology. With the new diagnostic options and minimally invasive therapies, radiology has a central role in the clinical workflow of these diseases.</p><p><strong>Aim: </strong>This work is intended to provide an overview of the differential diagnostic spectrum and explain possible workflows, outlining which diagnostic procedures can be used in which sequence, and what options for minimally invasive therapies exist for the individual diseases.</p><p><strong>Methods: </strong>For this purpose, appropriate overviews of various entities and differential diagnostic workflows were compiled and options for corresponding clinical pathways are presented.</p><p><strong>Results: </strong>Injuries and diseases of the lymphatic system cover a broad differential diagnostic spectrum. The classification of the corresponding entity on the basis of patient history, clinical presentation, and imaging is crucial to effectively employ specific diagnostic procedures such as magnetic resonance (MR) lymphography or transnodal fluoroscopic lymphangiography. The latter simultaneously allows the combination with minimally invasive therapeutic approaches, including both recanalizing and embolization or sclerosing techniques. Interdisciplinary approaches and care for patients with complex illnesses in specialized centers offer advantages for care, analogous to oncology.</p><p><strong>Conclusion: </strong>New methods in both diagnostic lymphangiography and therapeutic minimally invasive interventions pose new challenges for radiology, which should be met in an interdisciplinary setting, especially in patients with complex situations.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"325-331"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722871","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":"[Transpedal x-ray lymphangiography and treatment of peripheral lymphatic leakage].","authors":"J Wagenpfeil, C M Sommer, C C Pieper","doi":"10.1007/s00117-025-01439-9","DOIUrl":"10.1007/s00117-025-01439-9","url":null,"abstract":"<p><strong>Background: </strong>Conventional x‑ray transpedal lymphangiography enables the diagnosis of a variety of lymphatic diseases through detailed visualization of the lymphatic vessels, in particular those of the lower extremities. Today, it is employed primarily to visualize peripheral lymphatic leakage such as lymphoceles. Its application in lymphoma, lymph node metastases or lymphedema nowadays-with rare exceptions-is only of historical interest.</p><p><strong>Objective: </strong>To present the basic technical principles of transpedal lymphangiography and the interventional treatment options for peripheral lymphatic leakage.</p><p><strong>Results: </strong>Transpedal x‑ray lymphangiography has a technical success rate of 75-100% when performed by an experienced interventionalist. Pathological findings are visualized in 58-95% of cases. Additionally, a therapeutic effect on postsurgical lymphatic leakage can be expected in about 50% of patients. Additional interventional procedures such as sclerotherapy and lymph vessel embolization are available for the treatment of peripheral lymphatic leaks, whereby the clinical success rates reach 80-100%. Complications are generally rare.</p><p><strong>Conclusion: </strong>Transpedal x‑ray lymphangiography is a safe and effective procedure for visualizing lymph vessel anatomy. In patients with peripheral lymphatic leaks and consecutive fistulas and/or lymphoceles, lymphangiography as well as percutaneous sclerotherapy or embolization are successful and increasingly used treatment alternatives to surgery.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"332-338"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736300","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":"Improving image quality by comparing two chest MRI sequences: free-breathing T1-weighted Star-VIBE and breath-holding T1-weighted 3D VIBE Dixon.","authors":"Zhanli Ren, Xirong Zhang, Haifeng Duan, Yu Nan","doi":"10.1007/s00117-025-01445-x","DOIUrl":"https://doi.org/10.1007/s00117-025-01445-x","url":null,"abstract":"<p><strong>Objective: </strong>To explore the feasibility of using magnetic resonance imaging (MRI) with T1-weighted free-breathing Star-VIBE sequences for improving image quality in chest examinations compared with conventional T1-weighted breath-hold VIBE (C-VIBE) sequences.</p><p><strong>Methods: </strong>The data of 20 patients with chest MRI examinations in our hospital were prospectively collected. The scanning sequences included conventional breath-hold T1-weighted VIBE sequences (echo time [TE]: 1.29 ms; repetition time [TR]: 3.97 ms) and free-breathing T1-weighted Star-VIBE sequences (TE: 1.39 ms; TR: 2.79 ms). The signal intensity (SI) and standard deviation (SD) of the ascending aorta, pulmonary artery trunk, and descending aorta were measured at the level of the main pulmonary artery. The signal-to-noise ratio (SNR = SI/SD) and coefficient of variation (CV = SD/SI) of SI were calculated. The MR image quality was subjectively scored double-blindly using a 5-point scoring system by two radiologists who had more than 10 years' experience in diagnosing chest diseases and more than 5 years' experience in MR diagnosis of chest diseases.</p><p><strong>Results: </strong>The SNR of the ascending aorta, pulmonary artery trunk, and descending aorta with free-breathing T1-weighted Star-VIBE sequences was significantly higher than that of conventional breath-hold T1-weighted VIBE sequences (p < 0.05), while the CV of SI with the former sequences was significantly lower than that of the latter sequences (p < 0.05). The subjective scores of the two radiologists regarding the image quality of the two types of sequences had excellent consistency (κ > 0.80, p < 0.05); the subjective scores for free-breathing T1-weighted Star-VIBE sequences were significantly higher than for conventional breath-hold T1-weighted VIBE sequences (p < 0.05).</p><p><strong>Conclusion: </strong>Magnetic resonance imaging with free-breathing T1-weighted Star-VIBE sequences can significantly improve image quality of chest studies compared with conventional breath-hold T1-weighted VIBE sequences.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047895","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":"Diagnostic significance and evaluation of alterations in the superior joint space for temporomandibular joint fracture detection.","authors":"Hai-Feng Zhang, Bo Feng, Ming Zhan, Hanlin Zhu","doi":"10.1007/s00117-025-01446-w","DOIUrl":"https://doi.org/10.1007/s00117-025-01446-w","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively assess the diagnostic significance of variations in the superior joint space (SJS) of the temporomandibular joint (TMJ) for the detection of TMJ fractures through spiral computed tomography (CT) scans.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of CT scans of 32 patients with clinically confirmed TMJ fractures and 30 controls without fractures. The SJS was meticulously measured using the Kamelchuk method. Statistical analyses, including the Wilcoxon signed-rank test for paired comparisons, the Mann-Whitney U test for comparisons between groups, and ROC curve analysis for evaluating diagnostic performance, were performed to rigorously quantify the diagnostic importance of SJS changes. Binary logistic regression modeling was also applied to validate the accuracy of the assessment and determine the odds ratio (OR).</p><p><strong>Results: </strong>In the fracture group, statistically significant differences were observed in the SJS of bilateral TMJs (p < 0.05), whereas no significant difference was noted in the control group. The mean SJS on the fractured side was 3.75 mm, notably greater than the bilateral mean of 3.03 mm in the control group (p < 0.001). The discrepancy in SJS between sides in the fracture group (0.82 mm) significantly surpassed that of the control group (0.19 mm, p < 0.001). Utilizing an optimal threshold SJS difference of 0.62 mm, the diagnostic sensitivity was 63.30%, specificity was 86.70%, and accuracy was 76.70%, with an OR of 21.00 (95% CI: 4.198-105.038).</p><p><strong>Conclusion: </strong>This study found that changes in the SJS caused by TMJ fractures have significant diagnostic value in fracture detection, serving as a reliable tool for early and accurate diagnosis. By utilizing early identification and diagnosis via spiral CT, the study evaluated the changes in the SJS induced by fractures, providing crucial diagnostic information for clinical practice. This discovery emphasizes the pivotal role of SJS changes in identifying TMJ fractures and offers new diagnostic methods and insights for clinical practice.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045403","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":"Assessment of variability in pulmonary fissures using multidetector computed tomography: a short review.","authors":"Berin Tuğtağ Demir, Engin Çiftçioğlu, Fatih Çankal","doi":"10.1007/s00117-025-01436-y","DOIUrl":"https://doi.org/10.1007/s00117-025-01436-y","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the variability in pulmonary fissures, focusing on their presence, absence, or incompleteness, and how these variations contribute to the formation of accessory lobes.</p><p><strong>Objective: </strong>Using multidetector computed tomography (MDCT), the study aimed to define lung morphology in terms of major, minor, and accessory fissures.</p><p><strong>Material and methods: </strong>A descriptive analysis was conducted of MDCT images from 576 lungs (288 individuals). The study group comprised 162 male (56.3%) and 126 female (43.8%) patients.</p><p><strong>Results: </strong>In the right lung, 35.1% of cases exhibited an incomplete horizontal fissure, while in the left lung, accessory horizontal fissures were complete in 8.3% and incomplete in 10.2% of cases. Accessory fissures were present in 81.59% of right lungs and 47.22% of left lungs. The most common accessory fissures were located between the medial basal-anterior basal segments (44.4%), superior and basal segments (19.4%), and anterior basal-lateral basal segments (19.4%) of the lower lobe. No significant gender or lung-side differences were noted in the occurrence of fissures (p > 0.05).</p><p><strong>Conclusion: </strong>The study revealed significant variability in the frequency of major, minor, and accessory pulmonary fissures. Understanding these variations is crucial in shedding light on unusual clinical presentations in lung pathologies and in facilitating an accurate diagnosis and surgical planning.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058006","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 use of large language models in medicine and in radiology in particular].","authors":"Alexander Herold, Christian J Herold, Elmar Kotter","doi":"10.1007/s00117-025-01433-1","DOIUrl":"10.1007/s00117-025-01433-1","url":null,"abstract":"<p><strong>Background: </strong>The integration of Large Language Models (LLMs) into radiological practice offers promising opportunities to support reporting, workflow optimization, and clinical decision-making.</p><p><strong>Objective: </strong>To provide an exemplary demonstration of an LLM's self-reflection on the use of LLMs in radiology and a critical evaluation of their possibilities and limitations.</p><p><strong>Materials and methods: </strong>In this article, an LLM (Claude AI, Version 3.5 Sonnet AI Assistant, Anthropic, PBC) reflects on its own potential and limitations within the context of radiological practice. Claude was iteratively employed to analyze and systematically present relevant topics.</p><p><strong>Results: </strong>The utilized LLM demonstrates remarkable capabilities in generating structured content and identifying radiological applications. LLMs offer promising support but need to be used responsibly for radiological applications.</p><p><strong>Conclusion: </strong>LLMs such as Claude are powerful tools whose effectiveness depends on the user's ability to critically assess the generated content. Addressing ethical and practical challenges is essential to ensure a balance between technological assistance and medical autonomy. Future developments in generative AI, including potential singularity scenarios, require thoughtful and responsible application to maximize clinical benefits and minimize risks.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"257-265"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665654","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":"[Artificial intelligence in radiology : Literature overview and reading recommendations].","authors":"Moritz C Halfmann, Peter Mildenberger, Tobias Jorg","doi":"10.1007/s00117-025-01419-z","DOIUrl":"10.1007/s00117-025-01419-z","url":null,"abstract":"<p><strong>Background: </strong>Due to the ongoing rapid advancement of artificial intelligence (AI), including large language models (LLMs), radiologists will soon face the challenge of the responsible clinical integration of these models.</p><p><strong>Objectives: </strong>The aim of this work is to provide an overview of current developments regarding LLMs, potential applications in radiology, and their (future) relevance and limitations.</p><p><strong>Materials and methods: </strong>This review analyzes publications on LLMs for specific applications in medicine and radiology. Additionally, literature related to the challenges of clinical LLM use was reviewed and summarized.</p><p><strong>Results: </strong>In addition to a general overview of current literature on radiological applications of LLMs, several particularly noteworthy studies on the subject are recommended.</p><p><strong>Conclusions: </strong>In order to facilitate the forthcoming clinical integration of LLMs, radiologists need to engage with the topic, understand various application areas, and be aware of potential limitations in order to address challenges related to patient safety, ethics, and data protection.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"266-270"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191497","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}