Radiologie (Heidelberg, Germany)最新文献

{"title":"[Therapeutic concepts in treatment of lymphedema].","authors":"Christian Dirk Taeger, Claus Christian Pieper, Daniel Schiltz","doi":"10.1007/s00117-025-01441-1","DOIUrl":"https://doi.org/10.1007/s00117-025-01441-1","url":null,"abstract":"<p><strong>Background: </strong>Lymphoedema is a chronically progressive disease which, if left untreated, can lead to a massive reduction in quality of life and secondary diseases such as recurrent erysipelas. For a long time, purely conservative therapy was considered the only treatment option for primary or secondary chronic lymphedema of the upper or lower extremities. Only in very pronounced late forms were resection procedures such as liposuction or tissue removal considered as further treatment options. A series of modern reconstructive therapy procedures are now available thanks to the-in some cases rapid-further development of diagnostic and microsurgical procedures, which in many cases can significantly alleviate the severity of the disease in the hands of experienced microsurgeons.</p><p><strong>Aim: </strong>The aim of this article is to present the modern treatment options for lymphedema according to the current state of scientific knowledge in a practice-oriented manner and to provide guidelines for the optimal treatment of affected patients.</p><p><strong>Conclusion: </strong>In addition to indispensable conservative therapy, modern microsurgical procedures can lead to successful and lasting symptom relief in mandy cases and should be considered at an early stage. Preoperative diagnostics are essential for choosing the right treatment and its success.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":"65 5","pages":"347-353"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051833","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":"[Lymphatic vessel imaging-Indications and clinical applications].","authors":"Claus C Pieper","doi":"10.1007/s00117-025-01451-z","DOIUrl":"https://doi.org/10.1007/s00117-025-01451-z","url":null,"abstract":"<p><strong>Background: </strong>The armamentarium of lymphatic imaging techniques and treatment concepts available at specialized centers has significantly increased in recent years. The rarity and complexity of lymphatic vascular diseases presents the particular challenge of implementing these methods in a meaningful and targeted manner in patient care; however, there are currently no generally accepted diagnostic guidelines.</p><p><strong>Objective: </strong>Which lymphatic imaging technique is useful in which clinical situations?</p><p><strong>Material and methods: </strong>This article provides an overview of clinical and technical considerations that are relevant for a targeted evaluation of indications for lymphatic imaging in a multidisciplinary diagnostic and therapeutic approach.</p><p><strong>Results: </strong>The lymphatic vascular system can be affected by a wide range of primary and secondary pathologies, which often lead to relatively uniform clinical presentations (especially localized swellings, chylolymphatic effusions). In general, dedicated imaging should be discussed if a lymphatic vascular disease is suspected based on such a typical presentation. The choice of imaging strategy is then individually determined by the urgency of treatment, suspected localization and etiology of the pathology, comorbidities, specific properties of the imaging techniques, the treatment strategy pursued and local availability. When interpreting imaging and planning treatment, in addition to the large spectrum of different pathologies, the individual variability of the lymphatic system must also be taken into account.</p><p><strong>Conclusion: </strong>An individual pretherapeutic assessment of lymphatic flow should nowadays be mandatory in order to be able to optimize the therapeutic approach for each patient with a suspected lymphatic vascular disease. Interdisciplinary patient care is of decisive importance.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":"65 5","pages":"316-324"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014069","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":"[Importance of peptide receptor radionuclide therapy for the management of neuroendocrine tumours].","authors":"I Ciuciulkaite, K Herrmann, H Lahner","doi":"10.1007/s00117-025-01452-y","DOIUrl":"https://doi.org/10.1007/s00117-025-01452-y","url":null,"abstract":"<p><p>Neuroendocrine tumours (NETs) are rare, heterogeneous neoplasms that often express somatostatin receptors (SSTRs). This allows targeted peptide receptor radionuclide therapy (PRRT) for NETs. PRRT is currently indicated as second- or third-line therapy for metastatic or unresectable, progressive, SSTR-positive NETs of grade (G) 1 or 2. Adequate bone marrow reserves as well as renal and hepatic function are required for PRRT. The most commonly used radiopharmaceutical for PRRT is ¹⁷⁷Lu-DOTA-TATE. PRRT prolongs progression-free and overall survival, reduces or stabilises tumour burden, and improves tumour symptoms and quality of life. Adverse events associated with PRRT are mostly mild and transient. Haemato- and nephrotoxicity are the most common toxicities following PRRT. The NETTER‑2 and COMPOSE trials are investigating PRRT with ¹⁷⁷Lu-DOTA-TATE/-TOC in G2 and G3 gastroenteropancreatic NETs.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":"65 5","pages":"371-380"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055213","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":"[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}