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Non-unions remain a major complication in the treatment of long-bone fractures and affect quality of life considerably. Both early detection and treatment of non-unions are essential to secure subsequent fracture union. Sufficient vascularization plays a key role in the healing process. The aim of this prospective study was to quantify the microperfusion within non-unions by means of contrast-enhanced ultrasound (CEUS) as early as 12 wk after non-union surgery and to examine the prognostic capability of CEUS in predicting treatment failure. Among 112 patients who had undergone non-union surgery, consolidation within 36 mo was achieved in 89 patients ("responders"), whereas 23 patients showed persistent non-unions ("non-responders") and required further surgery. CEUS quantification parameters such as peak enhancement, wash-in area under the curve and wash-in perfusion index revealed significantly higher perfusion levels in "responders" compared with "non-responders" (p0.05). Receiver operator characteristic curve analysis revealed that persistent fracture non-unions could be predicted with a sensitivity/specificity of 88.7%/72.2% in lower-limb non-unions and a sensitivity/specificity of 66.7%/100.0% in upper-limb non-unions. CEUS is a suitable diagnostic tool in predicting treatment failure as early as 12 wk after non-union surgery and should be integrated into the clinical routine when deciding on revision surgery at an early stage.

Angewandte Chemie / International edition e202218850 (2023). doi:10.1002/anie.202218850 special issue: "Hot Topic: Water Splitting", Published by Wiley-VCH, Weinheim

This article presents the development, parameterization, and experimental validation of a pseudo-three-dimensional (P3D) multiphysics aging model of a 500 mAh high-energy lithium-ion pouch cell with graphite negative electrode and lithium nickel manganese cobalt oxide (NMC) positive electrode. This model includes electrochemical reactions for solid electrolyte interphase (SEI) formation at the graphite negative electrode, lithium plating, and SEI formation on plated lithium. The thermodynamics of the aging reactions are modeled depending on temperature and ion concentration and the reactions kinetics are described with an Arrhenius-type rate law. Good agreement of model predictions with galvanostatic charge/discharge measurements and electrochemical impedance spectroscopy is observed over a wide range of operating conditions. The model allows to quantify capacity loss due to cycling near beginning-of-life as function of operating conditions and the visualization of aging colormaps as function of both temperature and C-rate (0.05 to 2 C charge and discharge, −20 °C to 60 °C). The model predictions are also qualitatively verified through voltage relaxation, cell expansion and cell cycling measurements. Based on this full model, six different aging indicators for determination of the limits of fast charging are derived from post-processing simulations of a reduced, pseudo-two-dimensional isothermal model without aging mechanisms. The most successful aging indicator, compared to results from the full model, is based on combined lithium plating and SEI kinetics calculated from battery states available in the reduced model. This methodology is applicable to standard pseudo-two-dimensional models available today both commercially and as open source.

Disorders of or differences in sexual development (DSD) are defined by congenital conditions in which development of chromosomal, gonadal, or anatomic sex are atypical. Here, we report on monochorionic diamniotic twins delivered by Caesarean section in the 36th week of pregnancy. Monochorionic twins are usually monozygous and thus should have the same sexual differentiation. In this case, one twin had female external genitalia, while the other showed ambiguous genitalia. At first, a diagnosis of mixed gonadal dysgenesis was proposed because of the obvious sexual discrepancy between the supposedly monozygous twins. Cytogenetic analyses were performed to assure the sex chromosome status for both children. Male and female cells were found subsequently in both children. While hematopoietic chimerism of monochorionic dizygous twins as a result of twin-to-twin blood transfusion is a rare but already well documented phenomenon, to our knowledge this is the first case description of tetragametic chimerism that led to intersexuality.

Objectives Knowledge about cochlear duct length (CDL) may assist electrode choice in cochlear implantation (CI). However, no gold standard for clinical applicable estimation of CDL exists. The aim of this study is (1) to determine the most reliable radiological imaging method and imaging processing software for measuring CDL from clinical routine imaging and (2) to accurately predict the insertion depth of the CI electrode. Methods Twenty human temporal bones were examined using different sectional imaging techniques (high-resolution computed tomography [HRCT] and cone beam computed tomography [CBCT]). CDL was measured using three methods: length estimation using (1) a dedicated preclinical 3D reconstruction software, (2) the established A-value method, and (3) a clinically approved otosurgical planning software. Temporal bones were implanted with a 31.5-mm CI electrode and measurements were compared to a reference based on the CI electrode insertion angle measured by radiographs in Stenvers projection (CDLreference). Results A mean cochlear coverage of 74% (SD 7.4%) was found. The CDLreference showed significant differences to each other method (p < 0.001). The strongest correlation to the CDLreference was found for the otosurgical planning software-based method obtained from HRCT (CDLSW-HRCT; r = 0.87, p < 0.001) and from CBCT (CDLSW-CBCT; r = 0.76, p < 0.001). Overall, CDL was underestimated by each applied method. The inter-rater reliability was fair for the CDL estimation based on 3D reconstruction from CBCT (CDL3D-CBCT; intra-class correlation coefficient [ICC] = 0.43), good for CDL estimation based on 3D reconstruction from HRCT (CDL3D-HRCT; ICC = 0.71), poor for CDL estimation based on the A-value method from HRCT (CDLA-HRCT; ICC = 0.29), and excellent for CDL estimation based on the A-value method from CBCT (CDLA-CBCT; ICC = 0.87) as well as for the CDLSW-HRCT (ICC = 0.94), CDLSW-CBCT (ICC = 0.94) and CDLreference (ICC = 0.87). Conclusions All approaches would have led to an electrode choice of rather too short electrodes. Concerning treatment decisions based on CDL measurements, the otosurgical planning software-based method has to be recommended. The best inter-rater reliability was found for CDLA-CBCT, for CDLSW-HRCT, for CDLSW-CBCT, and for CDLreference. Key Points • Clinically applicable calculations using high-resolution CT and cone beam CT underestimate the cochlear size. • Ten percent of cochlear duct length need to be added to current calculations in order to predict the postoperative CI electrode position. • The clinically approved otosurgical planning software-based method software is the most suitable to estimate the cochlear duct length and shows an excellent inter-rater reliability.

With its standardized MRI datasets of the entire spine, the German National Cohort (GNC) has the potential to deliver standardized biometric reference values for intervertebral discs (VD), vertebral bodies (VB) and spinal canal (SC). To handle such large-scale big data, artificial intelligence (AI) tools are needed. In this manuscript, we will present an AI software tool to analyze spine MRI and generate normative standard values. 330 representative GNC MRI datasets were randomly selected in equal distribution regarding parameters of age, sex and height. By using a 3D U-Net, an AI algorithm was trained, validated and tested. Finally, the machine learning algorithm explored the full dataset (n = 10,215). VB, VD and SC were successfully segmented and analyzed by using an AI-based algorithm. A software tool was developed to analyze spine-MRI and provide age, sex, and height-matched comparative biometric data. Using an AI algorithm, the reliable segmentation of MRI datasets of the entire spine from the GNC was possible and achieved an excellent agreement with manually segmented datasets. With the analysis of the total GNC MRI dataset with almost 30,000 subjects, it will be possible to generate real normative standard values in the future.

Die vakzininduzierte zerebrale Venen- und Sinusthrombose (VI-CVST) nach Applikation der COVID-19-Vakzine ChAdOx1 nCov-19 (Vaxzevria®; AstraZeneca) ist eine seltene Impfkomplikation. Entwicklung eines diagnostischen und therapeutischen Standards. Es werden Grundlagenarbeiten und Expertenempfehlungen sowie Erfahrungen in eigenen Fallen ausgewertet. Die VI-CVST tritt i. d. R. 4–24 Tage nach der Impfung auf, vorwiegend bei unter 60-Jahrigen und bei Frauen. Meist spielt eine Immungenese durch Antikorper gegen Plattchenfaktor-4/Polyanion-Komplexe eine pathogenetische Rolle, die zu thrombotischer Thrombozytopenie und z. T. schweren klinischen, auch todlichen Verlaufen fuhrt. Leitsymptom ist der Kopfschmerz, der meist wahrend einiger Tage an Intensitat zunimmt und variabel sein kann. Auch Krampfanfalle, Sehstorungen, fokal-neurologische Symptome und Zeichen des erhohten Hirndrucks sind moglich. Bei Verdacht auf VI-CVST ist die Kontrolle von D‑Dimeren, Thrombozytenzahl und Screening auf eine heparininduzierte Thrombozytopenie (HIT2) therapeutisch richtungweisend. Bildgebende Methode der Wahl zur Bestatigung bzw. Ausschluss der VI-CVST ist die Magnetresonanztomographie (MRT) mit venoser MR-Angiographie (MRA). In MRT-T2*- und suszeptibilitatsgewichteten (SWI) Sequenzen verursacht der Thrombus ausgepragte Suszeptibilitatsartefakte (Blooming), so dass auch isolierte Thrombosen kortikaler Venen detektiert werden konnen. Mit der MRT/MRA bzw. Computertomographie (CT)/CT-Angiographie kann die Diagnose einer VI-CVST in Synopse mit den klinischen und Laborbefunden meist zuverlassig gestellt werden. Die VI-CVST erfordert die rasche labormedizinische und radiologische Diagnostik. Bei Nachweis einer Thrombozytopenie und/oder pathogener Antikorper werden spezifische Therapien zur Antikoagulation und Immunmodulation empfohlen.

The deconvolution of physicochemical processes in impedance spectra of SOCs with nickel/ceria fuel electrodes is challenging as gas diffusion strongly overlaps with the electrochemical processes at fuel and air electrode. To overcome this issue, symmetrical cells were applied and the gas diffusion process at the fuel electrode was quantified by altering the inert component (nitrogen/helium) in a ternary fuel gas mixture. An effective gas transport parameter considering microstructural and geometrical features was derived, enabling a precise quantification of polarization resistances related to gas diffusion and hydrogen electrooxidation. The obtained values were applied to parameterize an existing dc cell model. The model validation in fuel cell and electrolyzer mode showed an excellent agreement between measured and simulated current/voltage characteristics over a wide range of technically meaningful gas compositions and operating temperatures.

Introduction Shoulder pain is one of the most common complaints in orthopaedics. This study focusses on the relationship between shoulder function in subacromial impingement syndrome and imaging criteria in magnetic resonance imaging (MRI). Materials and methods This prospective clinical trial included 69 patients treated for subacromial impingement syndrome. Shoulder function (Constant Score, range of abduction, abduction force) and pain were correlated with the following MRI parameters: tendinosis of the rotator cuff, “halo-sign” around the biceps tendon, subacromial distance, critical shoulder angle, size of subacromial osteophytic spurs and maximum width of subacromial and subdeltoid bursa. Statistical analyses included Pearson’s and Spearman’s coefficients of correlation, multiple regression analysis and Student’s t-test. Results The Constant Score was correlated positively with the critical shoulder angle (r = 0.313; p = 0.009) and inversely with a “halo-sign” around the biceps tendon (rho = −0.384; p = 0.001). There was no significant correlation between spur size and shoulder function, but the size of the subacromial and subdeltoid bursae was positively correlated with the subacromial spur’s size (subacromial bursa: coronal plane: r = 0.327; p = 0.006; sagittal view: r = 0.305; p = 0.011; subdeltoid bursa coronal view: r = 0.333 p = 0.005). The width of the subdeltoid bursa in coronal plane was positively correlated with shoulder pain (r = 0.248; p = 0.004) and negatively with the range of abduction (r = −0.270; p = 0.025), as well as the mean (r = −0.332; p = 0.005) and maximum (r = −0.334; p = 0.005) abduction force. Conclusions Shoulder function and pain in subacromial impingement are best predicted by the width of the subdeltoid bursa measured in the coronal MRI plane as an indicator of bursitis as well as the presence of a “halo-sign” around the biceps tendon indicating glenohumeral joint effusion. Presence of a subacromial spur could lead to subacromial and subdeltoid bursitis, which impairs shoulder function. Shoulder function seems not to be compromised by the presence of a subacromial spur in absence of bursitis. This study was registered at the German Clinical Trials Register on 08 February 2013 (ID: DRKS00011548).

Objectives To assess imaging features of primary renal sarcomas in order to better discriminate them from non-sarcoma renal tumors. Methods Adult patients diagnosed with renal sarcomas from 1995 to 2018 were included from 11 European tertiary referral centers (Germany, Belgium, Turkey). Renal sarcomas were 1:4 compared to patients with non-sarcoma renal tumors. CT/MRI findings were assessed using 21 predefined imaging features. A random forest model was trained to predict “renal sarcoma vs. non-sarcoma renal tumors” based on demographics and imaging features. Results n = 34 renal sarcomas were included and compared to n = 136 non-sarcoma renal tumors. Renal sarcomas manifested in younger patients (median 55 vs. 67 years, p < 0.01) and were more complex (high RENAL score complexity 79.4% vs. 25.7%, p < 0.01). Renal sarcomas were larger (median diameter 108 vs. 43 mm, p < 0.01) with irregular shape and ill-defined margins, and more frequently demonstrated invasion of the renal vein or inferior vena cava, tumor necrosis, direct invasion of adjacent organs, and contact to renal artery or vein, compared to non-sarcoma renal tumors (p < 0.05, each). The random forest algorithm yielded a median AUC = 93.8% to predict renal sarcoma histology, with sensitivity, specificity, and positive predictive value of 90.4%, 76.5%, and 93.9%, respectively. Tumor diameter and RENAL score were the most relevant imaging features for renal sarcoma identification. Conclusion Renal sarcomas are rare tumors commonly manifesting as large masses in young patients. A random forest model using demographics and imaging features shows good diagnostic accuracy for discrimination of renal sarcomas from non-sarcoma renal tumors, which might aid in clinical decision-making. Key Points • Renal sarcomas commonly manifest in younger patients as large, complex renal masses. • Compared to non-sarcoma renal tumors, renal sarcomas more frequently demonstrated invasion of the renal vein or inferior vena cava, tumor necrosis, direct invasion of adjacent organs, and contact to renal artery or vein. • Using demographics and standardized imaging features, a random forest showed excellent diagnostic performance for discrimination of sarcoma vs. non-sarcoma renal tumors (AUC = 93.8%, sensitivity = 90.4%, specificity = 76.5%, and PPV = 93.9%).

Die Integration von Lean Management fordert nicht nur die stringente Anwendung entsprechender Methoden und Werkzeuge, sondern auch eine Änderung im Verhalten der Führungskräfte und Mitarbeiter. Der vorliegende Beitrag befasst sich mit dem Führungsverhalten von Managern ihren Mitarbeitern gegenüber und der Entwicklung der Mitarbeiter mithilfe von Ansätzen des Lean Managements. Durch die Ausführungen zeigt der Beitrag, dass Mitarbeiter und ihre Fähigkeiten durch eine lernfördernde Umgebung explizit gestärkt werden können.*

Ultrasound (US) is widely used as a fast and cost-efficient first-choice imaging technique without relevant side effects for a variety of diagnostic tasks. Due to technical advances, more complex and sophisticated methods such as color-coded duplex ultrasound, image fusion, contrast-enhanced ultrasound (CEUS), and ultrasound-guided interventions have become increasingly important in diagnostic algorithms.This study presents an overview of all aspects regarding the establishing of an interdisciplinary US center based on five representative examples in Germany. These aspects include topics of ultrasound education, research, economics, and administration.The goal of an interdisciplinary US center is to bundle the use of equipment, staff, rooms, and infrastructure resources (optimization of equipment availability and use of new techniques) to expand the range of examinations, to promote resident training, and to boost continuing medical education of residents. This should result in better patient care and has additionally improved patient care while considering the added value for the participating institutions involved. Interdisciplinary US centers allow a reduction of the number of US devices needed in a hospital and more efficient use of available equipment through bedside time optimization by central organization within interdisciplinary management. The focused application of special US techniques such as CEUS or image fusion for complex, difficult interventions as well as the training and education of younger colleagues in using these techniques is centrally organized by experts and can be improved through the multidisciplinary experience available.Organizational structures, sharing of materials, and standardization of diagnostic reports facilitate and accelerate cooperation with the referring specialty.· Interdisciplinary US centers foster clinical collaboration, research, and jointly organized, standardized training.. · Economic aspects include optimization of available equipment, use of the latest US techniques, and centralization of organizational structures.. · Common terminology and standardized reporting increase the satisfaction of referring doctors.· Clevert DA, Jung EM, Weber M et al. Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology. Fortschr Röntgenstr 2022; 194: 1322 - 1332.Die Sonografie (Ultraschall/US) wird als schnell verfügbare und kosteneffiziente Bildgebung der ersten Wahl ohne relevante Nebenwirkungen für eine Vielzahl von Fragestellungen genutzt. Durch den technischen Fortschritt gewannen komplexere Methoden wie die Farbduplexsonografie, Bildfusion und Kontrastmittelsonografie (CEUS) sowie interventionelle Verfahren unter sonografischer Bildführung zunehmend an Bedeutung im diagnostischen Algorithmus.In diesem Überblick sind sämtliche Aspekte im Aufbau eines interdisziplinären US-Zentrums anhand von 5 Beispielen in Deutschland dargestellt. Diese umfassen Themen der Ausbildung, Forschung, Ökonomie und Administration.Ziel eines interdisziplinären US-Zentrums ist es, apparative, personelle, räumliche und infrastrukturelle Ressourcen zu bündeln (Optimierung der Geräteverfügbarkeit und Nutzung neuer Techniken), das Untersuchungsspektrum zu erweitern und die ärztliche Fort- und Weiterbildung zu verbessern. Damit sollte zusätzlich eine bessere und schnellere Patientenversorgung unter Beachtung der Wertschöpfung für die beteiligten Einrichtungen gewährleistet sein. Durch Bündelung in Ultraschallzentren gelingen eine Reduzierung der Geräteanzahl und eine Zeitoptimierung der Nutzung von vorhandenen Systemen und Equipment. In Ultraschallzentren ist die fokussierte Anwendung spezieller US-Techniken wie CEUS und Bildfusion für schwierige Interventionen sowie die Ausbildung und das Heranführen jüngerer Kollegen an diese Techniken zentral besser verfügbar.Durch die Etablierung interdisziplinärer Ultraschall-Zentren mit zentralen Organisationsstrukturen, gemeinsamer Nutzung von Materialien und Vereinheitlichung der Befundung werden die Effektivität und Effizienz der Ultraschalldiagnostik verbessert.· Interdisziplinäre US-Zentren fördern klinische Zusammenarbeit, Forschung und gemeinsam organisierte, standardisierte Ausbildung.. · Wirtschaftliche Aspekte umfassen die Optimierung der Geräteverfügbarkeit, Nutzung neuester Techniken und Konzentration von Organisationsstrukturen.. · Einheitliche Terminologie und standardisierte Befunderstellung erhöhen die Zufriedenheit der überweisenden Kliniken..· Clevert DA, Jung EM, Weber M et al. Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology. Fortschr Röntgenstr 2022; 194: 1322 – 1332.

Transjugular intrahepatic portosystemic shunt (TIPS) placement is an effective intervention for recurrent tense ascites. Some studies show an increased risk of acute on chronic liver failure (ACLF) associated with TIPS placement. It is not clear whether ACLF in this context is a consequence of TIPS or of the pre-existing liver disease.To better understand the risks of TIPS in this challenging setting and to compare them with those of conservative therapy.Two hundred and fourteen patients undergoing their first TIPS placement for recurrent tense ascites at our tertiary-care center between 2007 and 2017 were identified (TIPS group). Three hundred and ninety-eight patients of the same time interval with liver cirrhosis and recurrent tense ascites not undergoing TIPS placement (No TIPS group) were analyzed as a control group. TIPS indication, diagnosis of recurrent ascites, further diagnoses and clinical findings were obtained from a database search and patient records. The in-hospital mortality and ACLF incidence of both groups were compared using 1:1 propensity score matching and multivariate logistic regressions.After propensity score matching, the TIPS and No TIPS groups were comparable in terms of laboratory values and ACLF incidence at hospital admission. There was no detectable difference in mortality (TIPS: 11/214, No TIPS 13/214). During the hospital stay, ACLF occurred more frequently in the TIPS group than in the No TIPS group (TIPS: 70/214, No TIPS: 57/214,TIPS placement for recurrent tense ascites is associated with an increased rate of ACLF in patients with severely impaired liver function but does not result in higher in-hospital mortality.

COVID-19 is a new viral disease that is associated with inflammatory pulmonary changes which can be detected in computed tomography (CT). So far postmortem CT (PMCT) has not been used as a screening instrument for the evaluation of deaths with and without autopsy. In this respect, its validity has to be proved in comparison to clinical-radiological experiences.Postmortem CT METHODICAL INNOVATIONS: So far, PMCT can be regarded as a methodological innovation that has not yet been sufficiently evaluated for pneumonia.CT in clinical routine has a high sensitivity for pneumonia. However, to what extent postmortem artifacts are relevant to PMCT still has to be determined.There is still no standard procedure for the postmortem radiological diagnosis of COVID-19 disease. Despite postmortem artifacts, PMCT can provide valuable information about the presence of pneumonia with interstitial character, especially without autopsy.PMCT is particularly useful in the assessment of suspected cases of COVID-19 pneumonia for morphological assessment in the context of monitoring deaths in the current pandemic situation.

Este trabalho tem por objetivo discutir as intersecções com relação à influência que o ambiente proporciona aos usuários do serviço de saúde mental. Para isso, a retomada histórica de como a medicina se apropriou do hospital, passando pela instituição dos manicômios, até a reforma psiquiátrica realizada no Brasil, recebe o enfoque para debater a influência do ambiente/espaço físico no trabalho com o usuário. Com isso, a abordagem das construções teóricas que se dão na relação do ambiente com o sujeito torna-se outro tópico necessário para que se traga a importância dessa relação na saúde mental. Os conceitos são buscados na interdisciplinaridade, atrelando as questões da saúde mental do sujeito com o modo como o ambiente influencia nela. Concluise que há uma fundamental importância em pensar o ambiente/espaço físico nas instituições da rede de atenção em saúde mental.

Today technical electrodes in batteries and fuel cells rely on complex multiphase microstructures that facilitate electronic, ionic and, in case of fuel cells, diffusive gas transport to the active reaction sites distributed in the electrode volume. The impedance of such electrodes can be described by the well-established transmission line model (TLM) approach. In a TLM, transport, charge transfer phenomena and capacitive effects are coupled considering microstructural features of the electrode. Its application for impedance data analysis of technical cells is challenging as the TLM impedance extends over a wide frequency range and quite often a strong overlapping with other contributions takes place. In this paper the application of the distribution of relaxation times (DRT) to the analysis of technical electrodes in batteries and fuel cells is elucidated. Different examples how to apply the DRT to analyze impedance spectra of solid oxide-, polymer electrolyte- and lithium ion-cells will be discussed. It will be shown that the TLM is usually represented by multiple peaks in the DRT, which might be strongly affected if contributions of different electrode layers overlap in the spectra. Related error sources and countermeasures are illustrated. Approaches how the DRT can be applied for the analysis of measured spectra and how it is able to support CNLS-fitting are presented.

Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.

To examine the relationship between superficial lesions (such as bruises, hematomas, deep abrasions, and soft tissue emphysema) and internal post-traumatic injuries, assessed using whole-body computed tomography (WBCT), and to determine if these are valid markers for internal injuries. 250 patients who underwent WBCT emergency scans for suspected polytrauma were retrospectively analyzed after institutional review board approval of the study. The scans were carried out on patients who met the criteria for standard operating procedures for WBCT emergency scans. WBCT covering the entire head, neck, chest, and abdomen (including pelvis and proximal lower extremities) and at least one phase with intravenous contrast agent were included in the study. Initial analyses of immediate WBCT scans was carried out by a consultant radiologist and a radiological resident. The first reading focused on internal damage that needed immediate therapy. The second reading focused on a detailed analysis of the skin and subcutaneous tissue and their relation to internal injuries without the time pressure of an emergency setting, carried out by another experienced radiologist. All skin lesions and the degree of penetration and a comparison between the two readings were reported in tables. Superficial lesion of the chest was detected in 19 patients, 17 of them had an internal injury of the thorax while only two patients, with hematoma of the chest wall, had no internal injuries. Skin and subcutaneous lesions of the chest had the strongest association with an internal injury. Skin lesions of the abdominal wall were observed in 30 patients. In only 11 cases, these lesions were correlated with internal injuries, such as fractures or active bleeding. 52 skin and subgaleal lesions of the scalp were observed. In 20 of these patients, an intracranial or internal injury was detected. In 3 patients, skin abrasions of the neck were present and in only one of them, this finding was associated with an internal injury. Trauma patients whose history and clinical presentation meet the standard operating procedures for WBCT emergency scans and who present with a cutaneous lesion, especially at the neurocranium or chest wall, should be observed for internal injuries by WBCT. · Presence or lack of a superficial injury of the abdominal wall is not a reliable predictive indication of any internal abdominal injury.. · Superficial lesions of the chest and the neurocranium require a CT scan.. · Superficial injuries of the chest wall had the strongest association with internal injuries..· Klempka A, Fischer C, Kauczor H et al. Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Trauma. Fortschr Röntgenstr 2021; 193: 177 - 185.ZIEL: Korrelationsbestimmung zwischen kutanen und subkutanen Läsionen wie Prellung, Hämatom, Schürfwunde, Hautemphysem mit inneren posttraumatischen Verletzungen zur Evaluierung des klinischen Entscheidungsprozesses bei der Indikationsstellung zur Polytrauma-Ganzkörper-CT. 250 Patienten, die Polytrauma-Ganzkörper-CTs erhielten, wurden nach Genehmigung dieser Studie seitens der Ethikkommission retrospektiv evaluiert. Die CTs wurden durchgeführt, sofern die Patienten die Kriterien für die entsprechende SOP an unserer Institution erfüllten. CTs des Neurokraniums, Hals, Thorax und Abdomens, inkl. Becken und proximalen Oberschenkeln sowie mindestens eine kontrastmittelgestützte Phase enthaltend, wurden in die Studie einbezogen. Die erste Analyse der CTs wurde unmittelbar nach der Durchführung von einem radiologischen Oberarzt sowie einem Assistenzarzt vorgenommen. Bei der ersten Prüfung standen die sofort zu therapierenden inneren Verletzungen im Vordergrund. Die zweite Analyse im Hinblick auf eine detaillierte Analyse der Hautoberfläche wurde separat von einem fachärztlichen Radiologen durchgeführt. Alle Hautläsionen wurden in einer Tabelle festgehalten, die sowohl das betroffene Körperteil als auch den Grad der Verletzung zeigt. Eine oberflächliche Läsion der Thoraxwand wurde bei 19 Patienten festgestellt, von denen 17 eine innere Thoraxverletzung hatten. Nur 2 Patienten mit einem Thoraxwandhämatom wiesen keine innere Verletzung auf. Kutane und subkutane Läsionen der Thoraxwand traten am häufigsten auf in Verbindung mit inneren Verletzungen. Hautläsionen der Abdominalwand wurden bei 30 Patienten beobachtet. Nur in 11 Fällen waren diese Läsionen mit inneren Verletzungen verbunden, wie zum Beispiel Frakturen oder aktiven Blutungen. 52 kutane, subkutane und subgaleale Läsionen des Schädels wurden beobachtet. Bei 20 dieser Patienten wurde eine intrakranielle oder innere Verletzung festgestellt. Bei 3 Patienten gab es Hautabschürfungen am Hals und nur in einem Fall war dies mit einer inneren Verletzung verbunden. Bei Patienten, deren Unfallhistorie sowie klinische Situation die Kriterien für die Polytrauma-Ganzkörper-CT SOP erfüllten und bei denen kutane und subkutane Läsionen, insbesondere am Neurokranium oder Thorax, vorlagen, kam es häufiger zu inneren Läsionen. · Das Vorhandensein oder Fehlen einer oberflächlichen Verletzung der Abdominalwand ist kein verlässlicher Vorhersagefaktor für eine innere Bauchverletzung.. · Wenn eine oberflächliche Verletzung der Brust oder des Neurokraniums feststellbar wäre, sollte ein CT-Scan durchgeführt werden.. · Oberflächliche Verletzungen der Thoraxwand waren am stärksten mit inneren Verletzungen assoziiert..

Transitional fractures are special forms of epiphyseal injuries in adolescents in whom the growth plate is already partially closed. Due to the partial ossification specific stereotypical fracture patterns can develop, which can be differentiated into twoplane, triplane I and triplane II fractures, depending on the involvement of the metaphysis and the number of fragments. At the beginning of the diagnostics conventional projection radiography in two planes is used; however, due to the complex fracture patterns computed tomography (CT) is often indicated, also for preoperative planning. The treatment depends on the extent of the fracture dislocation, which should be an integral part of the radiological findings, as dislocation of fragments less than 2 mm in size are usually treated conservatively. Prognostically relevant is above all the reconstruction of the joint surfaces, as early arthrosis can be a threat if the incongruity remains-relevant growth disturbances in the case of growth joint closure that has already begun are usually no longer expected.

Three-dimensional (3D) imaging has been available for nearly four decades and is regarded as state of the art for visualization of anatomy and pathology and for procedure planning in many clinical fields. Together with 3D image reconstructions in the form of rendered virtual 3D models, it has helped to better perceive complex anatomic and pathologic relations, improved preprocedural measuring and sizing of implants, and nowadays enables even photorealistic quality. However, presentation on 2D displays limits the 3D experience. Novel 3D printing technologies can transfer virtual anatomic models into true 3D space and produce both patient-specific models and medical devices constructed by computer-aided design. Individualized anatomic models hold great potential for medical and patient education, research, device development and testing, procedure training, preoperative planning, and fabrication of individualized instruments and implants. Hand in hand with 3D imaging, medical 3D printing has started to revolutionize medicine in certain fields and new applications are developed and introduced regularly. The demand for medical 3D printing will likely continue to rise, as it is a promising tool for plastic preparation of medical interventions. However, there is ongoing debate on the appropriateness of medical 3D printing and further research on its efficiency is needed. As experts in 3D imaging, radiologists are not only capable of advising on adequate imaging parameters, but should also become adept in 3D printing to participate in on-site 3D printing facilities and randomized controlled trials on the topic, thus contributing to improving patient outcomes via personalized medicine through patient-specific preparation of medical interventions.Die dreidimensionale (3D) Bildgebung steht seit fast vier Jahrzehnten zur Verfügung und gilt als State of the Art für die Visualisierung von Anatomie und Pathologie sowie für die Therapieplanung in vielen klinischen Bereichen. Zusammen mit 3D-Bildrekonstruktionen in Form von gerenderten virtuellen 3D-Modellen hat sie dazu beigetragen, komplexe anatomische und pathologische Zusammenhänge besser zu verstehen und die präprozedurale Vermessung und Größenbestimmung von Implantaten zu verbessern. Heute kann dabei sogar fotorealistische Bildqualität erreicht werden. Die Betrachtung auf 2D-Displays schränkt jedoch die 3D-Perzeption ein. Neuartige 3D-Drucktechnologien können virtuelle anatomische Modelle in den echten 3D-Raum übertragen und erlauben die Herstellung sowohl patientenspezifischer Modelle als auch mittels CAD („computer-aided design“) konstruierter medizinischer Geräte. Individualisierte anatomische Modelle bergen ein großes Potenzial für die medizinische Lehre und Forschung, Patientenaufklärung, Geräteentwicklung und -prüfung, für Operationskurse, präoperative Planung und Herstellung individualisierter Instrumente und Implantate. Zusammen mit der 3D-Bildgebung hat der medizinische 3D-Druck begonnen, die Medizin in bestimmten Bereichen zu revolutionieren, und es werden regelmäßig neue Anwendungen entwickelt und eingeführt. Die Nachfrage nach medizinischem 3D-Druck als ein vielversprechendes Werkzeug für die plastische Vorbereitung von medizinischen Eingriffen wird wahrscheinlich noch steigen. Andererseits wird in der wissenschaftlichen Debatte kritisch hinterfragt, wann medizinischer 3D-Druck angemessen ist, und zur Beurteilung der Effizienz des Verfahrens sind weitere Studien erforderlich. Als Experten auf dem Gebiet der 3D-Bildgebung können Radiologen nicht nur zu adäquaten Bildgebungsparametern beraten und optimale 3D-Bilddaten liefern. Vielmehr sollten sie sich auch selbst mit dem 3D-Druck vertraut machen, um als Partner an lokalen 3D-Druck-Enrichtungen und an randomisierten kontrollierten Studien zu diesem Thema teilzunehmen und so dazu beizutragen, die personalisierte Medizin mittels patientenspezifischer Vorbereitung medizinischer Eingriffe voranzubringen.

Objectives The healing process of tendons after surgical treatment of tendon ruptures mainly depends on the perfusion of the tendon and its surrounding tissue. Dynamic contrast-enhanced ultrasound (DCE-US) and dynamic contrast-enhanced MRI (DCE-MRI) can provide additional information about the local microperfusion. In this pilot study, the feasibility of these techniques to assess the vascularization during tendon regeneration was evaluated. Methods Between 2013 and 2015, 23 patients with surgical treatment of traumatic rupture of quadriceps, patellar, and Achilles tendons were involved. All patients received clinical follow-up examinations at 6, 12, and at least 52 weeks postoperatively. Dynamic contrast-enhanced US and DCE-MRI examinations were performed 6 and 12 weeks postoperatively. Dynamic contrast-enhanced US perfusion was quantified by the parameters peak enhancement, wash-in area under the curve, rise time, and initial area under the curve. Correlations between these parameters were examined via the Spearman rank correlation. The clinical and functional outcomes were assessed via the Lysholm Knee Score and Knee and Osteoarthritis Outcome Score at 12 and 52 weeks postoperatively. Results Fourteen patients with quadriceps (n = 8), patellar (n = 4) and Achilles (n = 2) tendon ruptures with complete follow-up were available. The microperfusion could be successful assessed. We could detect a strong correlation of DCE-US (peak enhancement) parameters with DCE-MRI (initial area under the curve) parameters after 6 and 12 weeks. Conclusions In this pilot study, DCE-US was able to visualize the microperfusion of healing tendons with a strong correlation with DCE-MRI. Our initial results are in favor of DCE-US as a potential quantitative imaging tool for evaluating the vascularization in tendon regeneration as a complementary method.

To determine MRI characteristics and the clinical presentation of intraarticular osteoid osteomas (OO) before and after treatment with CT-guided radiofrequency ablation (RFA) compared with extraarticular osteoid osteomas. In a retrospective study, n = 21 patients with an intraarticular OO were matched with a control group of n = 21 patients with an extraarticular OO at a comparable anatomical position. All patients underwent CT-guided RFA and preinterventional MRI. In n = 31 cases, follow-up MR imaging was available. MR images were analyzed for morphologic features: effusion and synovitis, bone marrow edema (BME), soft tissue edema, periosteal reaction as well as T1 / T2 signal and contrast enhancement of the nidus. Recorded clinical parameters included the initial diagnosis, the course of pain symptoms after RFA and the incidence of complications. The nidus was detectable in all patients on MRI. BME had the highest sensitivity in both intra- and extraarticular OO (100 %). Effusion and synovitis were only observed in the intraarticular OO group (n = 21) with a perfect sensitivity and specificity (100 %) and a high negative predictive value (85 %). Soft tissue edema was significantly more present in patients with intraarticular OO (p = 0.0143). No significant differences were present regarding periosteal reaction, T1/T2 signal and contrast enhancement of the nidus (p 0.05). BME, contrast enhancement, soft tissue edema, periosteal reaction, effusion and synovitis, if preexisting, always decreased after RFA. In 66.7 % of patients with intraarticular OO, a false initial diagnosis was made (extraarticular: 19 %). All patients were free of pain after intervention. Complications following the RFA procedure did not occur. MRI demonstrates the nidus and thus the OO in all cases regardless of the location. The characteristic MRI morphology of an intraarticular OO includes synovitis and joint effusion, which are always present and differentiate with perfect sensitivity/specificity from an extraarticular OO. In both intra- and extraarticular OOs pathologic MRI changes at least decreased or completely normalized and the clinical results after RFA were excellent. · MRI is excellently suited for the diagnosis of intra- and extraarticular OOs.. · Joint effusion and synovitis distinguish both forms with perfect sensitivity and specificity.. · All MRI changes, which indicate activity, decreased after successful RFA.. · The clinical results after RFA are excellent in both forms..· Germann T, Weber M, Lehner B et al. Intraarticular Osteoid Osteoma: MRI Characteristics and Clinical Presentation Before and After Radiofrequency Ablation Compared to Extraarticular Osteoid Osteoma. Fortschr Röntgenstr 2020; 192: 1190 - 1198.ZIEL: Untersucht wurden MRT-Charakteristik und klinisches Erscheinungsbild von intraartikulären Osteoidosteomen (OO) vor und nach der Behandlung mit Radiofrequenzablation (RFA) im Vergleich zu extraartikulären OO. In einer retrospektiven Studie wurden n = 21 Patienten mit intraartikulärem OO einer gleichgroßen Kontrollgruppe von n = 21 Patienten mit extraartikulärem OO an vergleichbarer anatomischer Position gegenübergestellt. Alle Patienten erhielten eine CT-gesteuerte RFA sowie eine präinterventionelle MRT. Bei n = 31 Patienten lag eine Verlaufsbildgebung vor. Die MRT-Bilder wurden hinsichtlich morphologischer Merkmale analysiert: Erguss und Synovitis, Knochenödem, Weichteilödem, Periostreaktion sowie T1-/T2-Signal und Kontrastmittel (KM)-Aufnahme des Nidus. Erfasste klinische Parameter waren unter anderem die initiale Verdachtsdiagnose, der Verlauf der Schmerzsymptomatik nach RFA und das Auftreten von Komplikationen. Der Nidus war bei allen Patienten in der MRT erkennbar. Das Knochenödem wies die höchste Sensitivität sowohl beim intra- als auch beim extraartikulären OO auf (100 %). Erguss und Synovitis wurden nur in der Gruppe der intraartikulären OO (n = 21) beobachtet mit einer perfekten Sensitivität und Spezifität (100 %) und einem hohen negativen Vorhersagewert (85 %). Bei Patienten mit intraartikulärem OO war ein Weichteilödem signifikant häufiger vorhanden (p = 0,0143). Periostreaktion, T1-/T2-Signal und KM-Aufnahme des Nidus zeigten keine signifikanten Unterschiede (p 0,05). Knochenödem, KM-Aufnahme, Weichteilödem, Periostreaktion, Erguss und Synovitis waren, sofern vorbestehend, immer rückläufig nach RFA. Bei 66,7 % der Patienten mit intraartikulärem OO wurde initial eine falsche Verdachtsdiagnose gestellt (extraartikulär: 19 %). Alle Patienten waren nach dem Eingriff schmerzfrei. Komplikationen traten nicht auf. Die MRT zeigt den Nidus und damit das OO in allen Fällen unabhängig von der Lokalisation. Die charakteristische MRT-Morphologie des intraartikulären OO umfasst die Synovitis und den Gelenkerguss, die immer vorliegen und mit perfekter Sensitivität/Spezifität von einem extraartikulären OO differenzieren. Sowohl beim intra- als auch beim extraartikulären OO waren die pathologischen MRT-Veränderungen mindestens abnehmend oder vollständig normalisiert und die klinischen Ergebnisse nach RFA waren ausgezeichnet. · Die MRT ist hervorragend geeignet, intra- und extraartikuläre OO zu diagnostizieren.. · Gelenkerguss und Synovitis unterscheiden beide Formen mit perfekter Sensitivität und Spezifität.. · Alle MRT-Veränderungen, die eine Aktivität anzeigen, sind nach erfolgreicher RFA rückläufig.. · Die klinischen Ergebnisse nach RFA sind bei beiden Formen exzellent..· Germann T, Weber M, Lehner B et al. Intraarticular Osteoid Osteoma: MRI Characteristics and Clinical Presentation Before and After Radiofrequency Ablation Compared to Extraarticular Osteoid Osteoma. Fortschr Röntgenstr 2020; 192: 1190 – 1199.

ZusammenfassungSeit Einführung der PET/CT im Jahr 2001 bzw. der PET/MRT im Jahr 2010 ist die PET als Hybridbildgebung und Instrument einer bildgesteuerten Präzisionsmedizin zunehmend zu einem Versorgungsstandard in der Onkologie geworden. Die zentrale Schnittstelle in der Kommunikation zwischen den zuweisenden onkologisch tätigen Ärzten und dem Nuklearmediziner und Radiologen stellt der schriftliche Befund dar, der das Patientenmanagement und Outcome beeinflusst, aber auch juristisch-relevante Dokumentation der erbrachten Leistung und ärztlichen Beurteilung der erhobenen Befunde ist. Eine qualitativ hochwertige, auf die klinische Frage fokussierte Hybridbildgebung sollte im weiteren Fortgang mit einem gleichermaßen qualitativ hochwertigen, strukturierten schriftlichen Befund verbunden sein, der die klinische Frage zur Zufriedenheit des zuweisenden Arztes beantwortet. Im vorliegenden Manuskript werden daher Konsensempfehlungen zur Befundstruktur, zu Befundinhalten und zur konklusiven Beurteilung einer onkologischen Hybridbildgebung gegeben. Darüber hinaus werden beispielhafte Vorlagen für ebensolche Befunde dargestellt. Die hier dargelegten Empfehlungen zur strukturierten Befunderstellung sollen eine weitere Standardisierung und Harmonisierung onkologischer Befunde im Kontext einer Hybridbildgebung fördern und so die Kommunikation mit den zuweisenden Ärzten vereinfachen und die Akzeptanz und Wertschätzung der onkologischen Hybridbildgebung weiter unterstützen.

O trabalho teve objetivo de avaliar o desempenho produtivo e caracteristicas qualitativas da carcaca e da carne de bovinos de corte confinados com dieta controle e dieta soro de leite, em delineamento experimental inteiramente casualizado, 2 dietas e 3 repeticoes. Foram utilizados 24 novilhos, de racas taurinas e suas cruzas, com peso vivo inicial de 319,3±11,4 kg e idade de 11 meses, alimentados por 124 dias. As dietas apresentaram relacao volumoso:concentrado de 40:60, contendo 13% de PB e 68% de NDT, compostas por silagem de milho e concentrado. Na dieta soro, foram incluidos 14,78% da MS da dieta de soro de leite. Os resultados apresentaram semelhancas (p>0,05) de 1,42 kg/dia no ganho de peso medio diario, pesos de abate (497±19,94 e 504±21,36 kg), peso das carcacas quente (279,15±12,54 e 287,77±13,16 Kg), rendimento de carcaca quente (56,02±0,50 e 56,89 ±0,50%), espessura de gordura subcutânea (5,25±0,92 e 6,50±1,35 mm), temperatura das carcacas (7,17±0,27 e 7,08±0,29 °C), marmoreio (8,42±0,99 e 7,58±0,62), e valores na cor da carne (L*38,77±0,82 e 38,43±0,69; a* 21,09±0,58 e 20,02±0,58; b* 12,44±0,35 e 11,45±0,44). Diferencas (p

Understanding cell performance is essential for selecting cell components and the processing parameters for solid oxide fuel cells. The scale of relevant microstructural features in electrodes, electrolyte and supporting substrate covers several orders of magnitude. This contribution will demonstrate how advanced correlative multi-scale tomography can be used to identify those parameters: ranging from millimeter to nanometer scale. We employ optical microscopy, X-ray computed tomography (μ-CT), focused ion beam-scanning electron microscopy tomography and energy-dispersive X-ray spectroscopy–scanning transmission electron microscopy. Additional investigations by selected area electron diffraction allow a determination of the underlying crystal structures. An SOFC design based on the co-sintering of an inert substrate with various functional layers on top is used as a blueprint, allowing further methodological development. The effect of interdiffusion between phases and development of secondary phases on microstructure and chemical composition will be shown. Furthermore, porosity and tortuosity extracted individually from all porous layers will allow modeling of gas diffusion loss contributions within the co-fired cell structure. This exemplifies how correlative tomography helps to understand specific contributions to overall cell performance.

Benigne Knochentumoren werden haufig als Zufallsbefund entdeckt, wohingegen sich maligne Tumoren und Metastasen klinisch oft durch Schmerzen oder eine Schwellung bemerkbar machen. Die radiologische Erstdiagnostik (konventionelles Rontgen, Magnetresonanz- [MRT] und Computertomographie [CT]) spielt eine bedeutende Rolle in der Einschatzung der Dignitat und der weiteren Behandlungsplanung. Die Nachsorge von Knochentumoren dient dem Erkennen von Rezidiven und Fernmetastasen sowie der Detektion von Komplikationen, z. B. nach eingebrachter Prothese. Eingebrachtes Metall sowie posttherapeutische Veranderungen konnen die Nachsorge durch Artefakte und therapieassoziierte Gewebeveranderungen erschweren. Neben den Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), der European Organisation for Research and Treatment of Cancer (EORTC) und der European Society of Musculoskeletal Radiology (ESSR) konnen Studienprotokolle als Orientierung fur die Nachsorge einzelner primar maligner Knochentumoren verwendet werden.

Frakturen des Kopfes und der Halswirbelsaule (HWS) sind haufige Traumafolgen. Die rechtzeitige Diagnose ist von entscheidender Bedeutung fur eine adaquate Therapie und die Verhinderung neurologischer Komplikationen. Die verschiedenen bildgebenden Verfahren zur Diagnostik von Kalotten- und Halswirbelsaulenfrakturen werden beurteilt. Die Bildgebung wird im Kontext mit der aktuellen Literatur diskutiert. In diesem Beitrag werden haufige Frakturen der Kalotte und der Halswirbelsaule sowie deren Indikationen und Klassifikationen beschrieben. Frakturen des Kopfes konnen die Kalotte, die Schadelbasis und das Felsenbein betreffen. Verletzungen der Dura fuhren zu einem offenen Schadel-Hirn-Trauma. Frakturen der Halswirbelsaule konnen in subaxiale und in Frakturen des kraniozervikalen Ubergangs unterteilt werden. Untersuchungsmodalitat der Wahl bei Frakturen des Kopfes oder der Halswirbelsaule ist die Computertomographie (CT). Bei Frakturen des Kopfes mussen ein offenes und geschlossenes Schadel-Hirn-Trauma unterschieden und begleitende intrakranielle Traumafolgen erfasst werden. Bei Felsenbeinfrakturen ist immer auf die Mittel- und Innenohrstrukturen zu achten. Bei Frakturen der Halswirbelsaule ist entscheidend, ob es sich um eine stabile oder instabile Fraktur handelt und ob eine begleitende Verletzung des Myelons vorliegt.

Kurzfassung Im Kontext der industriellen Produktion gewinnt die kollaborierende Zusammenarbeit zwischen Mensch und Roboter zunehmend an Bedeutung. Die Implementierungsphasen erfordern die Analyse differenter Bereiche sowie eine strukturierte Vorgehensweise. Im Kontext der Implementierung richtet dieser Beitrag seinen Schwerpunkt auf die Darstellung von Herausforderungen sowie einem strukturierten und praxisnahen Vorgehen zur Auswahl von geeigneten Arbeitsplätzen.

Pathologische Frakturen entstehen ohne adaquates Trauma auf Basis einer lokalen benignen oder malignen Knochenschadigung. Neben Knochenzysten und dem Plasmozytom/multiplen Myelom gehoren Knochenmetastasen zu den haufigsten Ursachen pathologischer Frakturen, deren Inzidenz bei einer alternden Bevolkerung und der Verbesserung der medizinischen Versorgung zunimmt. Die Unterscheidung von pathologischen Frakturen und Stressfrakturen, v. a. osteoporotischen Insuffizienzfrakturen, ist fur die Bestimmung des folgenden Procederes essenziell. Dieser Artikel soll einen Uberblick uber die bildgebenden Unterscheidungsmerkmale sowie eine Einordnung der Bildgebung in der klinischen Aufarbeitung bei Verdacht auf pathologische Frakturen geben. Daruber hinaus werden die Mirels-Klassifikation und die SINS-Klassifikation (Spinal Instability Neoplastic Score) zur Abschatzung des Frakturrisikos fokal neoplastischer Knochenlasionen erlautert. Es wurde eine PubMed-Literaturrecherche zu den folgenden Stichworten durchgefuhrt: „pathologic fracture“, „fatigue fracture“, „insufficiency fracture“, „treatment of pathologic fractures“, „imaging of pathologic fractures“, „fracture risk“, „bone metastases“, „MRI of pathologic fractures“, „CT of pathologic fractures“, „differentiation of pathologic and insufficiency fractures“, „Mirels’ score“, „SINS“ und „spinal instability neoplastic score“. Definitionen fur pathologische Frakturen und deren Abgrenzung zu anderen Frakturformen werden erklart, die Rolle der Bildgebung bei der Aufarbeitung pathologischer Frakturen erlautert, bildgebende Unterscheidungsmerkmale von pathologischen Frakturen und Ermudungs‑/Insuffizienzfrakturen genannt sowie Scoring-Systeme zur Beurteilung des Frakturrisikos vorgestellt.