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Fokale Epilepsien machen etwa 40 % der Epilepsiesyndrome aus. Es handelt sich haufig um Erkrankungen, bei denen die Epilepsie Folge einer erworbenen Schadigung des Hirnparenchyms ist – beispielhaft seien hier die Hippocampussklerose und glioneuronale Tumoren genannt. In dieser Ubersichtsarbeit werden im Unterschied zu erworbenen Schadigungen exemplarisch fokale Epilepsien mit einem genetischen Hintergrund und einem Eintrag in der OMIM (Online Mendelian Inheritance in Man) Datenbank dargestellt, wobei der genetische Hintergrund infolge der Befunde der Bildgebung aufgeklart wurde.

Definition of gross tumor volume (GTV) in hepatocellular carcinoma (HCC) requires dedicated imaging in multiple contrast medium phases. The aim of this study was to evaluate the interobserver agreement (IOA) in gross tumor delineation of HCC in a multicenter panel. The analysis was performed within the “Stereotactic Radiotherapy” working group of the German Society for Radiation Oncology (DEGRO). The GTVs of three anonymized HCC cases were delineated by 16 physicians from nine centers using multiphasic CT scans. In the first case the tumor was well defined. The second patient had multifocal HCC (one conglomerate and one peripheral tumor) and was previously treated with transarterial chemoembolization (TACE). The peripheral lesion was adjacent to the previous TACE site. The last patient had an extensive HCC with a portal vein thrombosis (PVT) and an inhomogeneous liver parenchyma due to cirrhosis. The IOA was evaluated according to Landis and Koch. The IOA for the first case was excellent (kappa: 0.85); for the second case moderate (kappa: 0.48) for the peripheral tumor and substantial (kappa: 0.73) for the conglomerate. In the case of the peripheral tumor the inconsistency is most likely explained by the necrotic tumor cavity after TACE caudal to the viable tumor. In the last case the IOA was fair, with a kappa of 0.34, with significant heterogeneity concerning the borders of the tumor and the PVT. The IOA was very good among the cases were the tumor was well defined. In complex cases, where the tumor did not show the typical characteristics, or in cases with Lipiodol (Guerbet, Paris, France) deposits, IOA agreement was compromised.