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Background/aim Angiosarcoma of primary gynecologic origin is an extremely rare and highly malignant tumor of endothelial origin with a 5-year survival rate of less than 35%. To date, only 61 cases have been described in the literature. The aim of this study was to present more cases and discuss potential therapy options. Case report The following case series presents three cases of gynecologic angiosarcomas that were under therapy at the Charite - University medicine of Berlin from June 2014 to February 2018. Results Two of the cases deal with primary angiosarcomas of the uterus whereas the third case was diagnosed after the suspicion of a recurrence of a poorly differentiated squamous cell carcinoma of the cervix uteri. In case one a 75-year old patient with initial postmenopausal bleeding and a tumor mass of the uterus is described. After surgery a hemangiosarcoma of the uterus was confirmed. After two months the patient presented with a presacral peritoneal sarcomatosis. Chemotherapy of weekly paclitaxel was administered. Case two deals with a patient presenting with abdominal pain. A uterine sarcoma with infiltration of the parametry and angiosarcomatosis peritonei was diagnosed during an emergency laparotomy because of spontaneous peritoneal bleeding. Moreover, osseous metastasis was found. The patient underwent weekly paclitaxel. Due to tumor progression, chemotherapy was changed to doxorubicin and olaratumab and radiotherapy was induced. The patient died 33 months after initial diagnosis. Case three describes a 34-year old patient with suspected local recurrence of cervical cancer with infiltration of the bladder. During TURB an angiosarcoma was found. Following laparoscopy revealed peritoneal metastasis. The patient underwent weekly paclitaxel followed by a paclitaxel and pazopanib maintainance therapy which showed a regression. Due to progression afterwards, chemotherapy was changed to gemcitabine and docetaxel and gemcitabine monotherapy. The patient died 33 months after initial diagnosis. Conclusion Even though there is no evidence on standard treatment of this extremely rare and aggressive tumor entity of the female genital tract the patients showed the longest stability of disease during chemotherapy with weekly paclitaxel.

To assess the reproducibility of the renal resistive index (RRI) in a routine clinical setting. 22 patients with a kidney allograft and 19 physicians participated in our prospective study. Within 2 hours each patient was examined by 5 different physicians using 2 out of 3 different, randomly allocated ultrasound machines. Each investigator determined the hilar and parenchymal RRI of the allograft. The reproducibility and reproducibility limit of the RRI were assessed as well as Cronbach's alpha and the intraclass correlation coefficient (ICC). The deviation of the RRI from the mean RRI over the 5 measurements was used as an indicator of reproducibility. The impact of the ultrasound machine, examiner's level of experience, and kidney function impairment (GFR 45 ml/min) was assessed with the Kruskal-Wallis test. The bivariate linear correlation of the minimal transplant distance from the body surface with the variance of the parenchymal RRI was analyzed. A reproducibility of 0.045 with a reproducibility limit of 0.124 was found for the parenchymal RRI. The ICC between RRIs was good with 0.852 for the parenchymal RRI and 0.868 for the hilar RRI. The type of ultrasound machine used was found to have a significant impact on the deviation of the parenchymal RRI (Kruskal-Wallis-Test, p = 0.003). Variance in serial parenchymal RRI measurements correlated significantly with the depth of the kidney transplant (p = 0.001). While the RRI is generally sufficiently reproducible, the type of ultrasound machine used and the depth of the kidney transplant within the recipient's body have a significant impact on reproducibility. · The renal resistive index (RRI) in allografts is reproducible.. · The type of ultrasound machine has an impact on the measured RRI.. · RRI reproducibility decreases with the depth of the renal allograft in the recipient..· Theilig DC, Münzfeld H, Auer TA et al. The Renal Resistive Index in Allografts: Is Sonographic Assessment Sufficiently Reproducible in a Routine Clinical Setting?. Fortschr Röntgenstr 2020; 192: 561 - 566.ZIEL: Die Überprüfung der Reproduzierbarkeit des renalen Widerstandsindex (RRI) in der Alltagssituation. An der prospektiven Studie nahmen 22 Patienten mit Nierentransplantat und 19 Untersucher teil. Jeder Patient wurde innerhalb von 2 Stunden von 5 verschiedenen Untersuchern mit insgesamt 2 von 3 verschiedenen Ultraschallgeräten untersucht, wobei jeweils hilärer und parenchymatöser RRI bestimmt wurden. Die Reproduzierbarkeit, deren Grenzwerte, der Cronbachs Alpha und die Intraklassenkorrelation (ICC) wurden ermittelt. Das Ausmaß der Abweichung vom Mittelwert der 5 Messungen wurde als Indikator für die Reproduzierbarkeit herangezogen. Mittels Kruskal-Wallis-Test wurde der Einfluss von Ultraschallgerät, Erfahrungsgrad des Untersuchers und Nierenfunktionseinschränkung (GFR 45 ml/min) ermittelt. Die bivariate lineare Korrelation der Abhängigkeit der Varianz der RRI-Messungen von der Tiefe des Nierentransplantats im Patienten wurde eruiert. Die statistische Auswertung ergab eine Reproduzierbarkeit des parenchymalen RRI von 0,045 bei einer Grenze von 0,124. Der ICC zwischen den parenchymalen und hilären RRIs lag bei 0,852 bzw. 0,868. Der Kruskal-Wallis-Test zeigte einen signifikanten Unterschied in der Reproduzierbarkeit bei unterschiedlichen Ultraschallgeräten (p = 0,003). Die Korrelation der Varianz der RRIs mit der Tiefe des Nierentransplantats im Patienten war ebenfalls signifikant (p = 0,001). Die Reproduzierbarkeit des RRI ist prinzipiell auch in der Alltagssituation gegeben, nimmt aber mit der Tiefe des Transplantats im Patienten und durch die Benutzung unterschiedlicher Ultraschallgeräte ab. · Der renale Widerstandsindex (RRI) in Nierentransplantaten ist ausreichend reproduzierbar.. · Der gemessene RRI wird vom verwendeten Ultraschallgerät beeinflusst.. · Die Reproduzierbarkeit des RRI nimmt mit der Transplantattiefe im Empfänger ab..

Lan Song,1,* Jonas A Leppig,2,* Ralf H Hubner,3 Bianca C Lassen-Schmidt,4 Konrad Neumann,5 Dorothea C Theilig,2 Felix W Feldhaus,2 Ute L Fahlenkamp,2 Bernd Hamm,2 Wei Song,1 Zhengyu Jin,1 Felix Doellinger2 1Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany; 3Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany; 4Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany; 5Institute of Biometrics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany*These authors contributed equally to this workCorrespondence: Zhengyu JinDepartment of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, People’s Republic of ChinaTel +86 10 69 155 439Fax +86 10 69 155 058Email jinzy@pumch.cnPurpose: The aim of this retrospective study was to evaluate correlations between parameters of quantitative computed tomography (QCT) analysis, especially the 15th percentile of lung attenuation (P15), and parameters of clinical tests in a large group of patients with pulmonary emphysema.Patients and Methods: One hundred and seventy-two patients with pulmonary emphysema and chronic obstructive pulmonary disease (COPD) global initiative for chronic obstructive lung disease (GOLD) stage 3 or 4 were assessed by nonenhanced thin-section CT scans in full inspiratory and expiratory breath-hold, pulmonary function test (PFT), a 6-minute walk test (6MWT), and quality of life questionnaires (SGRQ and CAT). QCT parameters included total lung volume (TLV), total emphysema score (TES), and P15, all measured at inspiration (IN) and expiration (EX). Differences between inspiration and expiration were calculated for TLV (TLVDiff), TES (TESDiff), and P15 (P15Diff). Spearman correlation analysis was performed.Results: CT-measured lung volume in inspiration (TLVIN) correlated strongly with spirometry-measured total lung capacity (TLC) (r=0.81, p< 0.001) and moderately to strongly with residual volume (RV), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1)/FVC (r=0.60, 0.56, and − 0.49, each p< 0.001). Lung volume in expiration (TLVEX) correlated moderately to strongly with TLC, RV and FEV1/FVC ratio (r=0.75, 0.66, and − 0.43, each p< 0.001). TES and P15 showed stronger correlations with the carbon monoxide transfer coefficient (KCO%) (r= − 0.42, 0.44, both p< 0.001), when measured during expiration. P15Diff correlated moderately with KCO% and carbon monoxide diffusing capacity (DLCO%) (r= 0.41, 0.40, both p< 0.001). The 6MWT and most QCT parameters showed significant differences between COPD GOLD 3 and 4 groups.Conclusion: Our results suggest that QCT can help predict the severity of lung function decrease in patients with pulmonary emphysema and COPD GOLD 3 or 4. Some QCT parameters, including P15EX and P15Diff, correlated moderately to strongly with parameters of pulmonary function tests.Keywords: chronic obstructive pulmonary disease, pulmonary emphysema, quantitative CT, pulmonary function test

BACKGROUND/AIM Thermal-ablative therapies are limited to tumors of 3-4 cm diameter. The purpose of this study was to evaluate the local tumor control (LTC) of CT-guided High-Dose-Rate-Brachytherapy (CT-HDRBT) for ablation of cholangiocarcinomas (CCA) ≥4 cm compared to smaller tumors. PATIENTS AND METHODS Sixty-one patients (tumors: 142, interventions: 91) were treated from March 2008 to January 2017. LTC, progression-free survival (PFS) and overall survival (OS) after first CT-HDRBT were identified for two subgroups (A