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Diverticular disease frequently leads to emergency admissions. Clinical parameters are not sufficiently accurate to determine the extent of acute colonic diverticulitis, thus a quick, reproducible and valid diagnostic imaging procedure is required.In the following, the imaging methods commonly used for the diagnostic work-up and staging of diverticulitis are presented and classified in the context of the data situation and clinical reality.Multidetector computed tomography (MDCT) is the current diagnostic gold standard for the imaging evaluation of diverticulitis and the basis for guideline-conform treatment decisions according to the classification of diverticular disease (CDD).The role of magnetic resonance imaging (MRI) in the evaluation of diverticulitis will have to be investigated but a more profound integration of this method can already be predicted. Point-of-care ultrasound for initial diagnosis and follow-up assessment will become more important, analogous to FAST in trauma patients.HINTERGRUND: Die Divertikelkrankheit führt häufig zu Akuteinweisungen in die Notaufnahme. Klinische Parameter sind für die Erfassung des Ausprägungsgrades der Entzündung zu ungenau, sodass eine schnelle, reproduzierbare und valide bildgebende Diagnostik unter Einsatz eines Verfahrens anzustreben ist.Die heute für die Abklärung und Stadieneinteilung der Divertikulitis gebräuchlichen bildgebenden Methoden werden vorgestellt und im Kontext der Datenlage und klinischen Realität eingeordnet.Die Multidetektorcomputertomographie ist der diagnostische Goldstandard für die bildgebende Evaluation der Divertikulitis und Grundlage der leitlinienkonformen Therapieentscheidung auf dem Boden der Classification of Diverticular Disease.Der Stellenwert der Magnetresonanztomographie bei der Fragestellung wird zu überprüfen sein, es kann jedoch bereits heute eine intensivere Einbindung der Methode prognostiziert werden. Die Sonographie wird sich, analog zu FAST bei Traumapatienten, stärker im Rahmen einer symptombezogenen Point-of-care-Eingangsdiagnostik und in der Verlaufsbeurteilung etablieren.

The assessment of traumatic lesions to the chest and thoracic spine can pose a challenge for the emergency radiologist. Collaboration with the treating clinicians and knowledge of the patients' history and the trauma mechanism are essential.In case of minor trauma, digital radiography may be sufficient for diagnosis. For the diagnostic work-up of polytrauma patients, multidetector computed tomography (MDCT) is the most important modality due to its broad availability and higher sensitivity. The chest has to be completely contained within the scan volume to be able to adequately analyze the bony structures and thoracic spine. Reconstruction in three planes and multiplanar reconstruction are prerequisite for a correct diagnosis and further therapy planning.Magnetic resonance imaging (MRI) serves as a third level diagnostic modality in special cases. MRI can demonstrate bone marrow edema of vertebral bodies or other bones. In addition, the myelon and the epidural space are best assessed with MRI.In this article, the most relevant knowledge for the diagnostic work-up of traumatic lesions of the bony chest and the thoracic spine is summarized.

Fragestellung: Cinematic Rendering (CR) ist ein neuartiges 3D-Rekonstruktionsverfahren, das axiale CT-Datensätze mithilfe eines einzigartigen Lichtmodells in fotorealistische 3D-Bilder konvertieren kann. Das Ziel dieser Studie war es, CR-Bilder von Frakturen des Ellenbogens mit Bildern der konventionellen[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

In patients with multiple trauma, abdominal involvement is a particularly relevant injury pattern. Depending on the intensity and manner of injury, heterogeneous but often typical organ manifestations result. Knowledge of these injury patterns is essential for targeted diagnostics and treatment.This review provides a presentation of typical forms of abdominal injury with appropriate radiological techniques and where applicable treatment.Experiences and case examples from a supraregional trauma center are presented and discussed with the results of a Medline literature search and relevant parts of the german S3 guidelines on polytrauma.Traumatic abdominal injuries are subdivided into blunt and penetrating injuries. Among these groups, blunt trauma with splenic injury being most frequent followed by liver and kidney involvement. In penetrating abdominal injuries hollow visceral organs are most frequently affected. For diagnosis, ultrasound and with escalating injury severity, multidetector computed tomography (MDCT) are the most important methods. For years there has been an ongoing trend towards conservative management and interventional hemorrhage control. This is driven by improvements in imaging that enable a more precise classification and indications for subsequent treatment.Progress in radiology has led to an increasingly more important role for radiology in the management of traumatic abdominal injury. Therefore, it is crucial for the radiologist to gain interdisciplinary knowledge of the relevant trauma mechanisms and injury patterns of the severely injured patient in order to provide a treatment process that provides the optimal outcome.

Multislice computed tomography (MSCT) is the current standard in the work-up of hematuria. The examination protocol should be as accurate as possible while avoiding unnecessary exposure to ionizing radiation.To present opportunities to reduce the overall radiation dose by tailoring examination protocols to the clinical requirements.A four-phase MSCT protocol is an accurate tool to diagnose the cause of unclear hematuria in the majority of cases. In patients younger than 30 years and in patients younger than 40 years presenting only with microhematuria, the use a noncontrast low-dose scan is adequate. In addition, patients younger than 50 years may not require precontrast and a late-phase CT scans. Another opportunity to omit acquisitions is a combination of different phases by using the so-called split bolus injection protocol, where the administration of contrast is performed 10 min before the scan and the portal-venous phase and the late phase are combined. If dual energy is available, the precontrast scan can be calculated from the enhanced series. For the evaluation of a renal cyst, a two-phase CT protocol is sufficient to obtain diagnostic information.

Background: Anxiety has been identified as a cardiac risk factor. However, less is known about the impact of generalized anxiety disorder (GAD) on prehospital delay during an acute myocardial infarction (AMI). This study assessed the impact of GAD on prehospital delay and delay related cognition and behavior. Methods: Data were from the cross-sectional Munich examination of delay in patients experiencing acute myocardial infarction (MEDEA) study with a total of 619 ST-elevated myocardial infarction (STEMI) patients. Data on socio-demographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed with the Generalized Anxiety Disorder scale (GAD-7). A GAD-7 score greater than or equal to 10 indicates general anxiety disorder. Results: A total of 11.47% (n = 71) MI patients suffered from GAD. GAD was associated with decreased odds of delay compared to patients without GAD (OR 0.58, 95% CI 0.35–0.96), which was more significant in women (112 vs. 238 min, p = 0.02) than in men (150 vs. 198 min, p = 0.38). GAD was highly correlated with acute anxiety (p = 0.004) and fear of death (p = 0.005). Nevertheless, the effect remained significant after controlling for these two covariates. GAD patients were more likely to perceive a higher cardiovascular risk (OR 2.56, 95% CI 1.37–4.76) in 6 months before MI, which leads to the higher likelihood of making self-decision to go to the hospital (OR 2.68, 95% CI 1.48–4.85) in the acute phase. However, GAD was also highly associated with impaired psychological well-being, stress and fatigue (p < 0.0001). Conclusions: In AMI patients, GAD was independently associated with less prehospital delay, but led to an impaired psychological state.

The adequate treatment of severely injured patients is challenging and can only be successfully executed when it starts at the accident site and is continued in all treatment phases including the early rehabilitation phase. Treatment should be performed by an interdisciplinary team guided by a trauma surgeon in order to adequately manage the severe injuries some of which are life-threatening. Treatment of polytrauma patients is a key task of certified trauma centers and must follow standardized guidelines. For a successful therapy of severely injured patients lifetime training at regular intervals in well-established polytrauma concepts is a mandatory requirement.Die qualitativ hochwertige Therapie schwerverletzter Patienten ist anspruchsvoll und nur dann erfolgversprechend, wenn sie am Unfallort beginnt und in der Primär-, Postprimär- und Intensivbehandlung bis zur frühzeitig beginnenden multimodalen Rehabilitation interdisziplinär und interprofessionell durchgeführt wird, um die zum Teil lebensbedrohlichen Verletzungen behandeln zu können.

Renal cell carcinoma in combination with a supradiaphragmatic tumor thrombus is a rare tumor entity. Radical surgery including nephrectomy and thrombectomy is still considered standard treatment. The extent of the tumor thrombus should be preoperatively evaluated by MRI and TEE. An interdisciplinary team is important for surgery planning and realization. Despite the known risks of an operation, a longer overall survival is achieved.

The increased use of highly developed imaging procedures, such as multidetector-row computed tomography and magnetic resonance imaging has led to a substantial increase of asymptomatic and unexpected findings.Abdominal CT investigations are particularly affected with a large number of incidental findings. This valuable diagnostic procedure also entails the risk of complex and cost-intensive subsequent investigations with partly invasive procedures.For this reason radiologists are more often confronted with the difficult task of correctly assessing these lesions, to decide on the need for additional investigations and to inform the patient in detail about the clinical relevance.The aims of this article are to describe the most common abdominal incidentalomas, to assist with the interpretation and differential diagnosis and to give recommendations for further management.

The clinical relevance of scaphoid bone fractures is reflected by their high incidence, accounting for approximately 60 % among carpal fractures and for 2-3 % of all fractures. With adequate therapy most scaphoid bone fractures heal completely without complications. Insufficient immobilization or undiagnosed fractures increase the risk of nonunion and the development of pseudarthrosis.X-ray examination enables initial diagnosis of scaphoid fracture in 70-80 % of cases. Positive clinical symptoms by negative x‑ray results require further diagnostics by multi-slice spiral CT (MSCT) or MRI to exclude or confirm a fracture. In addition to the diagnosis and description of fractures MSCT is helpful for determining the stage of nonunion. Contrast enhanced MRI is the best method to assess the vitality of scaphoid fragments.

Pulmonary complications are frequent in patients with collagen vascular diseases (CVD). Frequent causes are a direct manifestation of the underlying disease, side effects of specific medications and lung infections.The standard radiological procedure for the work-up of pulmonary pathologies in patients with CVD is multidetector computed tomography (MDCT) with thin-slice high-resolution reconstruction.The accuracy of thin-slice CT for the identification of particular disease patterns is very high. The pattern of usual interstitial pneumonia (UIP) representing the direct pulmonary manifestation of rheumatoid arthritis (RA) can be identified with a sensitivity of 45 % and a specificity of 96 %.Both direct pulmonary manifestations, drug-induced toxicity and certain infections can have a similar appearance in thin-slice MDCT in various forms of CVD. Knowledge of the patterns and causes contributes to the diagnostic certainty.At first diagnosis of a CVD and associated pulmonary symptoms thin-slice MDCT is recommended. Clinical, lung function and imaging follow-up examinations should be performed every 6-12 months depending on the results of the MDCT. In every case the individual CT morphological patterns of pulmonary involvement must be identified. The combination of information on the anamnesis, clinical and imaging results is a prerequisite for an appropriate disease management.

The currently established standard for planning liver surgery is multistage contrast media-enhanced multidetector computed tomography (CM-CT), which as a rule enables an appropriate resection planning, e.g. a precise identification and localization of primary and secondary liver tumors as well as the anatomical relation to extrahepatic and/or intrahepatic vascular and biliary structures. Furthermore, CM-CT enables the measurement of tumor volume, total liver volume and residual liver volume after resection. Under the condition of normal liver function a residual liver volume of 25 % is nowadays considered sufficient and safe. Recent studies in patients with liver metastases of colorectal cancer showed a clear staging advantage of contrast media-enhanced magnetic resonance imaging (CM-MRI) versus CM-CT. In addition, most recent data showed that the use of liver-specific MRI contrast media further increases the sensitivity and specificity of detection of liver metastases. This imaging technology seems to lead closer to the ideal "one stop shopping" diagnostic tool in preoperative planning of liver resection.

Cross-sectional imaging modalities including multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are the diagnostic standard in detection, characterization, and staging of renal masses due to their high sensitivity and specificity. Currently, most renal masses are incidentally diagnosed by imaging for other medical reasons. Recent developments have improved image acquisition with high resolution, while simultaneously reducing radiation dose. CT imaging is the most accessible cross-sectional imaging method and is, therefore, the standard technique. MRI is indicated in patients who are allergic to intravenous CT contrast medium, in patients with renal insufficiency, or in younger patients. Further characterization of renal masses is possible with functional imaging including dual energy CT, perfusion CT, or diffusion-weighted MRI. Contrast-enhanced ultrasound allows detection of even subtle enhancement in hypovascular lesions with high sensitivity and can add valuable information to CT and MRI studies.

Pulmonary embolism is a potentially fatal disorder and frequently seen in critical care and emergency medicine. Due to a high mortality rate within the first few hours, the accurate initiation of rational diagnostic pathways in patients with suspected pulmonary embolism and timely consecutive treatment is essential. In this review, the current European guidelines on the diagnosis and therapy of acute pulmonary embolism are presented. Special focus is put on a structured patient management based on the individual risk of early mortality. In particular risk assessment and new risk-adjusted treatment recommendations are presented and discussed in this article.

Diabetic bone diseases are more than just osteoporosis in patients with diabetes mellitus (DM): a relatively high bone mineral density is paired with a paradoxically high risk of fragility fractures. Diabetics exhibit low bone turnover, osteocyte dysfunction, relative hypoparathyroidism and an accumulation of advanced glycation end products in the bone matrix. Besides typical insufficiency fractures, diabetics show a high risk for peripheral fractures of the lower extremities (e.g. metatarsal fractures). The correct interdisciplinary assessment of fracture risks in patients with DM is therefore a clinical challenge.There are two state of the art imaging methods for the quantification of fracture risks: dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). Radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are suitable for the detection of insufficiency fractures.Novel research imaging techniques, such as high-resolution peripheral quantitative computed tomography (HR-pQCT) provide non-invasive insights into bone microarchitecture of the peripheral skeleton. Using MR spectroscopy, bone marrow composition can be studied. Both methods have been shown to be capable of discriminating between type 2 diabetic patients with and without prevalent fragility fractures and thus bear the potential of improving the current standard of care. Currently both methods remain limited to clinical research applications.DXA and HR-pQCT are valid tools for the quantification of bone mineral density and assessment of fracture risk in patients with DM, especially if interpreted in the context of clinical risk factors. Radiography, CT and MRI are suitable for the detection of insufficiency fractures.

During the last decade, DVT (digital volume tomography) imaging has become a widely used standard technique in head and neck imaging. Lower radiation exposure compared to conventional computed tomography (MDCT) has been described. Recently, DVT has been developed as an extremity scanner and as such represents a new imaging technique for hand surgery. We here describe the first 24 months experience with this new imaging modality in hand and wrist imaging by presenting representative cases and by describing the technical background. Furthermore, the method's advantages and disadvantages are discussed with reference to the given literature.

We report a case of a 77-year old female patient with abdominal pain in the upper right part. In the computertomography we had the suspicion of a rare small bowel diverticulitis which was confirmed in laparoscopic and histopathologic diagnostics. After surgical excision the patient was free of symptoms.Wir berichten über eine 77-jährige Patientin, die sich mit Oberbauchschmerzen rechts vorstellte. Computertomographisch wurde der Verdacht einer seltenen Dünndarmdivertikulitis im Jejunum gestellt, die laparoskopisch und histopathologisch im Exzidat bestätigt wurde. Postoperativ war die Patientin anhaltend beschwerdefrei.

In the challenging evaluation of upper urinary tract malignancies multidetector computed tomography (CT) has become the standard imaging method. Cross sectional imaging not only allows the detection and visualization of the tumor itself but also provides nodal and metastasis staging in one examination (one-stop-shop). The majority of urothelial carcinomas are located in the urinary bladder. In this case, CT and more recently magnetic resonance imaging (MRI) can also deliver decisive information regarding TNM classification. A combination of clinical, histological, morphological and functional parameters allows both risk stratification and a targeted therapy based on the individual tumor stage.