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Background: The aim of this study was to compare microwave ablation (MWA) with and without prior placement of an intra-arterial catheter for the purpose of application of contrast medium (CM)., Methods: 148 patients (45 female, 65.1 ± 14.9 years) with liver tumors who underwent CT-guided MWA were included. Of these, 25 patients had an IA catheter placed in the hepatic artery., Results: 37 patients underwent planning imaging for MWA without CM. A total of 86 patients received a standard dose of 80 mL intravenous (IV) CM for the planning scans. The patients with an IA catheter ( n = 25) received an IA application of 10 mL CM. A total of 29 patients received contrast-enhanced scans in the PV phase for control of needle positioning after IV application of a standard dose of 80 mL CM. In patients with an IA catheter, control of the needle position was performed by single-slice scans. IA CM application during the ablation enabled monitoring of the ablation zone. Over the entire intervention, patients with IA catheters received less CM as compared to patients without an IA catheter (39.1 ± 10.4 mL vs. 141 ± 39.69 mL; p < 0.001)., Conclusions: IA catheter placement was associated with a significant decrease of the amount of CM during MWA and enabled monitoring of the ablation zone.

Purpose: In the treatment of hepatocellular carcinoma (HCC) with transarterial radioembolization (TARE), identifying reliable biomarkers for predicting survival outcomes remains a critical challenge. We aimed to address this gap by investigating the significance of serum cytokines associated with inflammation as potential biomarkers for the selection of patients for TARE., Methods: Our retrospective study involved 161 patients diagnosed with HCC who underwent Y90 radioembolization at our medical center between 2010 and 2020. Serum samples from a subset of 78 patients were retrospectively analyzed to determine the concentrations of pro-inflammatory cytokines. The results from the prospective SORAMIC trial were used for independent validation., Results: With a median overall survival of 36 weeks (range 4-436), our study showed the strongest correlation between 12-week survival and IL-8 levels before treatment (p < 0.001), while other relevant interleukins, interferon-α2, INF-γ, TNF-α and MCP-1 were not associated with survival. IL-8 levels below the cut-off of 190 pg/mL were significantly associated with increased 12-week and 24-week survival, with hazard ratios of 19.01 (95% CI: 2.29-157.89) and 2.57 (95% CI: 1.05-6.31), respectively (p = 0.006 and p = 0.039, respectively). In the adjusted multivariate analysis, the 190 pg/mL cut-off for IL-8 remained independently associated with 12- (p = 0.011) and 24-week survival (p = 0.039). Similarly, the SORAMIC population showed a strong association between IL-8 levels and 36-week survival (p = 0.03)., Conclusion: Our study emphasizes the pivotal role of IL-8 as a valuable parameter, demonstrating its potential for predicting treatment outcomes and assessing liver function in patients with HCC undergoing TARE. The robustness of these findings warrants further validation., (© 2024. The Author(s).)

Objectives: To date, AI-supported programs for bone age (BA) determination for medical use in Europe have almost only been validated separately, according to Greulich and Pyle (G&P). Therefore, the current study aimed to compare the performance of three programs, namely BoneXpert, PANDA, and BoneView, on a single Central European population., Materials and Methods: For this retrospective study, hand radiographs of 306 children aged 1-18 years, stratified by gender and age, were included. A subgroup consisting of the age group accounting for 90% of examinations in clinical practice was formed. The G&P BA was estimated by three human experts-as ground truth-and three AI-supported programs. The mean absolute deviation, the root mean squared error (RMSE), and dropouts by the AI were calculated., Results: The correlation between all programs and the ground truth was prominent (R 2  ≥ 0.98). In the total group, BoneXpert had a lower RMSE than BoneView and PANDA (0.62 vs. 0.65 and 0.75 years) with a dropout rate of 2.3%, 20.3% and 0%, respectively. In the subgroup, there was less difference in RMSE (0.66 vs. 0.68 and 0.65 years, max. 4% dropouts). The standard deviation between the AI readers was lower than that between the human readers (0.54 vs. 0.62 years, p < 0.01)., Conclusion: All three AI programs predict BA after G&P in the main age range with similar high reliability. Differences arise at the boundaries of childhood., Key Points: Question There is a lack of comparative, independent validation for artificial intelligence-based bone age estimation in children. Findings Three commercially available programs estimate bone age after Greulich and Pyle with similarly high reliability in a central European cohort. Clinical relevance The comparative study will help the reader choose a software for bone age estimation approved for the European market depending on the targeted age group and economic considerations., (© 2024. The Author(s).)

Objectives: This study aimed to evaluate the performance of artificial intelligence (AI) software in bone age (BA) assessment, according to the Greulich and Pyle (G&P) method in a German pediatric cohort., Materials and Methods: Hand radiographs of 306 pediatric patients aged 1-18 years (153 boys, 153 girls, 18 patients per year of life)-including a subgroup of patients in the age group for which the software is declared (243 patients)-were analyzed retrospectively. Two pediatric radiologists and one endocrinologist made independent blinded BA reads. Subsequently, AI software estimated BA from the same images. Both agreements, accuracy, and interchangeability between AI and expert readers were assessed., Results: The mean difference between the average of three expert readers and AI software was 0.39 months with a mean absolute difference (MAD) of 6.8 months (1.73 months for the mean difference and 6.0 months for MAD in the intended use subgroup). Performance in boys was slightly worse than in girls (MAD 6.3 months vs. 5.6 months). Regression analyses showed constant bias (slope of 1.01 with a 95% CI 0.99-1.02). The estimated equivalence index for interchangeability was - 14.3 (95% CI -27.6 to - 1.1)., Conclusion: In terms of BA assessment, the new AI software was interchangeable with expert readers using the G&P method., Clinical Relevance Statement: The use of AI software enables every physician to provide expert reader quality in bone age assessment., Key Points: • A novel artificial intelligence-based software for bone age estimation has not yet been clinically validated. • Artificial intelligence showed a good agreement and high accuracy with expert radiologists performing bone age assessment. • Artificial intelligence showed to be interchangeable with expert readers., (© 2023. The Author(s).)

In newborns, white matter shows a high T2-weighted (T2w) signal in MRI with poor grey-white matter contrast. To increase this contrast, an extremely long echo time (TE) is used in the examination of children. It is not known up to what age this long TE should be used. The purpose of this study was to find up to what age a long TE should be used in infants. In the prospective study, 101 infants (0-18 months) underwent cranial MRI at 3 Tesla. T2-weighted Fast Spin Echo sequences with long TE (200 ms) and medium TE (100 ms) were used. The signal intensities of the cortex and white matter were measured and the grey-white matter contrast (MC) was calculated. A cut-off age was determined. The T2w sequences with long TE had a statistically significantly higher MC until the age of six months (medium TE: 0.1 ± 0.05, Long TE: 0.19 ± 0.07; p < 0.001). After the tenth month, the T2w sequence with medium TE provided significantly better MC (Medium TE: 0.1 ± 0.05; long TE: 0.05 ± 0.4; p < 0.001). The use of a long TE is only helpful in the first six months of life. After the tenth month of life, a medium TE should be favored as is used in adult brain MRI.

Purpose: This study aimed to determine whether ChatGPT-4o, a generative artificial intelligence (AI) platform, was able to pass a simulated written European Board of Interventional Radiology (EBIR) exam and whether GPT-4o can be used to train medical students and interventional radiologists of different levels of expertise by generating exam items on interventional radiology., Methods: GPT-4o was asked to answer 370 simulated exam items of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) for EBIR preparation (CIRSE Prep). Subsequently, GPT-4o was requested to generate exam items on interventional radiology topics at levels of difficulty suitable for medical students and the EBIR exam. Those generated items were answered by 4 participants, including a medical student, a resident, a consultant, and an EBIR holder. The correctly answered items were counted. One investigator checked the answers and items generated by GPT-4o for correctness and relevance. This work was done from April to July 2024., Results: GPT-4o correctly answered 248 of the 370 CIRSE Prep items (67.0%). For 50 CIRSE Prep items, the medical student answered 46.0%, the resident 42.0%, the consultant 50.0%, and the EBIR holder 74.0% correctly. All participants answered 82.0% to 92.0% of the 50 GPT-4o generated items at the student level correctly. For the 50 GPT-4o items at the EBIR level, the medical student answered 32.0%, the resident 44.0%, the consultant 48.0%, and the EBIR holder 66.0% correctly. All participants could pass the GPT-4o-generated items for the student level; while the EBIR holder could pass the GPT-4o-generated items for the EBIR level. Two items (0.3%) out of 150 generated by the GPT-4o were assessed as implausible., Conclusion: GPT-4o could pass the simulated written EBIR exam and create exam items of varying difficulty to train medical students and interventional radiologists.

Background: Percutaneous hepatic perfusion (CS-PHP) is a treatment option for primary and secondary liver neoplasms and subject of intensive research. This present article provides an overview of CS-PHP regarding patient safety, feasibility and effectiveness based on recent studies., Method: We performed a PubMed search including the search terms chemosaturation, hepatic chemosaturation, percutaneous perfusion and melphalan., Results and Conclusion: CS-PHP is a promising procedure for the treatment of uveal melanoma and cholangiocellular carcinoma. There are insufficient data regarding the effectiveness of CS-PHP with respect to other tumor entities. Since CS-PHP can be accompanied by multiple transient side effects and complications, close interdisciplinary cooperation is necessary., Key Points: · Chemosaturation of the liver is a safe procedure.. · CS-PHP is a potent therapy for hepatic metastatic ocular melanoma and cholangiocellular carcinoma.. · The procedure requires close interdisciplinary coordination.. · CS-PHP is a repeatable and thus long-term therapeutic option for some patients.., Citation Format: · Ebel S, Struck MF, van Boemmel F et al. Chemosaturation of the Liver - an Update. Fortschr Röntgenstr 2023; 195: 30 - 37., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Hepatic chemosaturation is a technique in which a high dose of the chemotherapeutic agent melphalan is administered directly into the liver while limiting systemic side effects. We reviewed our institutional experience regarding patient's X-ray exposure caused by the procedure., Methods: Fifty-five procedures, performed between 2016 and 2020 in 18 patients by three interventional radiologists (radiologist), were analyzed regarding the patient's exposure to radiation. Dose-area-product (DAP) and fluoroscopy time (FT) were correlated with the experience of the radiologist and whether the preprocedural evaluation (CS-EVA) and the procedure were performed by the same radiologist. Additionally, the impact of previous liver surgery on DAP/FT was analyzed., Results: Experienced radiologist require less DAP/FT (50 ± 18 Gy*cm 2 /13.2 ± 3.84 min vs. 69 ± 20 Gy*cm 2 /15.77 ± 7.82 min; p < 0.001). Chemosaturations performed by the same radiologist who performed CS-EVA required less DAP/FT (41 ± 12 Gy*cm 2 /11.46 ± 4.41 min vs. 62 ± 11 Gy*cm 2 /15.55 ± 7.91 min; p < 0.001). Chemosaturations in patients with prior liver surgery with involvement of the inferior cava vein required significantly higher DAP/FT (153 ± 27 Gy*cm 2 /25.43 ± 4.57 min vs. 56 ± 25 Gy*cm 2 /14.44 ± 7.55 min; p < 0.001)., Conclusion: There is a significant learning curve regarding the procedure of hepatic chemosaturation. Due to dose reduction the evaluation and chemosaturation therapy should be performed by the same radiologist. Procedures in patients with previous liver surgery require higher DAP/FT., (© 2022. The Author(s).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Delayed post-hypoxic leukoencephalopathy (DPHL) is an uncommon, potentially under-recognized, cause of hypoxia induced white matter injury. It characteristically follows a biphasic course: After an initial phase of altered neurologic status a recovery occurs which is then followed by a recurring phase of neurologic deterioration, typically 2-4 weeks after the initial event. At this time white matter changes can be identified on MRI, which are the hallmark of DPHL. The characteristics and the typical MR-imaging signs of DPHL are discussed in this case report.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Heterotopic gastric tissue can be found in the entire gastrointestinal tract. It is usually located in the upper intestine. Rarely, it can be found in the gallbladder. This study describes several clinically, imaging features as well as histopathology findings of heterotopic gastric tissue in gallbladder (HGM)., Methods: The radiologic database of 1 tertiary university hospital was retrospectively screened for HGM. Additionally, a systemic review of the Medline database was conducted to identify previously published cases reports. In all cases clinical, imaging as well as histopathology features were retrieved from the papers., Results: In our databases, 1 patient with HGM was identified. Additionally, the systemic review yielded 32 suitable papers with 34 patients. Clinically, most of the patients suffered from abdominal discomfort. Most of the lesions were located in the lower gallbladder, especially (n = 14, 40%) in the gallbladder neck. On sonography, in 20.7% a broad-based mass was described. In 10.3% a sessile polyp was identified. In 5 cases, the mass was characterized as hyperechoic (55.5%), as isoechoic in 3 (33.3%) cases, and hypoechoic in 1 (11.1%). On computed tomography (CT), the lesions were most frequently hyperdense and all of them showed a slightly enhancement after application of contrast medium. On histopathology, most cases revealed heterotopic gastric mucosa of body-fundic type (60%) with chief and parietal cells, followed by pyloric type glands (20%). Every patient was treated with cholecystectomy and all had an uneventful recovery., Conclusion: HGM is a rare disorder with several differential diagnoses. Typically features were described to identify HGM in clinical routine and rule out malignant diseases like gallbladder carcinoma.

Circumcision is one of the most frequent procedures performed by pediatric surgeons. A dorsal penile nerve block (DPNB) is commonly used for perioperative analgesia. We report the case of a 16-year-old boy with ischemia of the glans who presented on the first postoperative day after circumcision under DPNB (0.25% bupivacaine) at an outside hospital. The patient underwent immediate angiography under sedation. An intra-arterial spasmolysis was performed with alprostadil and nitroglycerine and a sufficient perfusion of the glans penis was confirmed. Subsequently, systemic sildenafil, arginine, and heparin were given. Following this 3-day medical treatment, ischemia resolved completely. Our case emphasizes the role of invasive angiography in the diagnostic workup and the therapeutic possibilities of local spasmolysis, systemic vasodilatation, and anticoagulation.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.