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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..

Background Measurement of iodine concentration from dual-energy or spectral computed tomography (CT) provides useful diagnostic information especially in patients suffering from malignant tumors of various origins. Purpose The purpose of this study was to systematically investigate the accuracy of the measurement of iodine concentration, focusing on potential influencing factors and assessing its suitability for routine clinical use. Material and Methods First, a 3D-printed cylindrical phantom was used to assess reliability of dual-energy CT-based iodine concentration measurement. Second, a semi-anthropomorphic phantom was used to evaluate the potential impact of positional variation of the target volume as typically seen in clinical scans. Finally, a reference vial was placed on the body surface of 38 patients undergoing abdominal dual-energy CT to analyze correlations between applied doses and patient diameters. Results The position of the target volume within the cylindrical phantom and the applied dose level significantly influenced the magnitude of measured iodine concentrations ( P vol: r = −0.385, P = 0.017) Conclusion Dual-energy CT-based iodine concentration measurement should be interpreted with caution. In clinical examinations, placement of a reference vial could be a potential solution to relativize errors.

INTRODUCTION Tumour response in lung cancer treatment is monitored by measuring lesion size in computed tomography (CT). Spectral CT (SCT) offers additional information on tumour tissue besides morphology. We evaluated SCT iodine content (IC) and performed spectral slope analysis to assess the response of non-small-cell lung cancer (NSCLC) to chemoradiotherapy (CRT). METHODS Eighty-three patients with advanced NSCLC treated by CRT prospectively underwent single-phase, contrast-enhanced SCT. Evaluation of all patients included treatment response (RECIST 1.1), quantitative measurements as well as SCT IC determination and spectral slope analysis in NSCLC primaries. Measurements were performed at the maximum cross-diameter of tumours and in areas with high iodine values (hotspot analysis). Iodine difference (ΔIC) was calculated. Secondary outcome parameters were IC and spectral slopes in mediastinal lymph nodes (n = 61). RESULTS Twenty-four patients (29%) showed complete remission after CRT. Thirty-four patients (41%) had stable disease (SDSCT ) or partial regression (PRSCT ). Progressive disease (PDSCT ) was seen in 25 patients (30%). Hotspot analysis showed significantly higher iodine values in PDSCT than in SDSCT /PRSCT (P

AIM To investigate how spectral computed tomography (SCT) values impact the staging of non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS One hundred and thirteen patients with confirmed NSCLC were included in a prospective cohort study. All patients underwent single-phase contrast-enhanced SCT (using the fast tube voltage switching technique, 80–140 kV). SCT values (iodine content [IC], spectral slope pitch, and radiodensity increase) of malignant tissue (primary and metastases) and lymph nodes (LNs) were measured. Adrenal masses were evaluated in a virtual non-contrast series (VNS). If pulmonary embolism was present, pulmonary perfusion was analysed as an additional finding. RESULTS Fifty-two untreated primary NSCLC lesions were evaluable. Lung adenocarcinoma had significantly higher normalised IC (NIC: 19.37) than squamous cell carcinoma (NIC: 12.03; p=0.035). Pulmonary metastases were not significantly different from benign lung nodules. A total of 126 LNs were analysed and histologically proven metastatic LNs (2.08 mg/ml) had significantly lower IC than benign LNs (2.58 mg/ml; p=0.023). Among 34 adrenal masses, VNS identified adenomas with high sensitivity (91%) and specificity (100%). In two patients, a perfusion defect due to pulmonary embolism was detected in the iodine images. CONCLUSION SCT may contribute to the differentiation of histological NSCLC subtypes and improve the identification of LN metastases. VNS differentiates adrenal adenoma from metastasis. In case of pulmonary embolism, iodine imaging can visualise associated pulmonary perfusion defects.

Die Behandlung des symptomatischen Lungenemphysems mittels Lungenvolumenreduktion hat sich in den vergangenen 15 Jahren etablieren konnen. Wahrend die chirurgische Lungenteilresektion von verbesserten und weniger invasiven Operationstechniken profitierte, wurden verschiedene endoskopische Interventionsverfahren entwickelt und stehen mittlerweile zur Anwendung bereit. Allen Therapieansatzen ist gleich, dass sie von individuellen anatomischen Varianten und regionalen Verteilungen des Lungenemphysems abhangig sind, weshalb kein Verfahren als Goldstandard fur alle Patienten bezeichnet werden kann. Die hochauflosende Computertomographie kann quantitativ ausgewertet werden und therapieentscheidende Informationen liefern, weshalb Radiologen bei der Planung und in der Nachsorge eines lungenvolumenreduktiven Eingriffs eine besonders wichtige Rolle einnehmen. Der vorliegende Artikel soll die verschiedenen endoskopischen Techniken vorstellen, die Anforderungen der behandelnden Kollegen an den beratenden Radiologen nennen und schlieslich beschreiben, wie aus den erhobenen Befunden eine Therapieempfehlung wird.

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

AIM To evaluate the potential of new spectral computed tomography (SCT)-based tools in patients with neuroendocrine neoplasms (NEN). MATERIAL AND METHODS Eighty-eight consecutive patients with NENs were included prospectively. The patients underwent multiphase CT with spectral and standard mode. The signal-to-noise ratio (SNR)/contrast-to-noise-ratio (CNR)tumour-to-liver, iodine concentrations (ICs, total tumour/hotspot) and attenuation slopes in virtual monochromatic images (VMIs) were used to assess NEN-specific SCT values in primary tumours and metastatic lesions and investigate a possible lesion contrast improvement as well as possible correlations of SCT parameters to primary tumour location and tumour grade. Furthermore, the usability of SCT parameters to differentiate between the primary tumour and metastatic lesions, and to predict tumour response after 6-months follow-up was analyzed. The applied dose of spectral and standard mode was compared intra-individually. RESULTS SNR/CNRtumour-to-liver significantly increased in low-energy VMIs. NENs showed significant differences in ICs between primary and metastatic lesions for both absolute and normalised values (p CONCLUSION SCT was comparable regarding applied dose, improved tumour contrast, and contributed to differentiation between primary NEN and metastasis.

Minimal invasive local therapies are alternative treatment options in patients with primary and metastatic lung malignancies being not eligible for resection. However, thermal ablations are often limited by large tumour volumes.To evaluate the efficacy and safety of CT-HDRBT in pulmonary tumours ≥4 cm compared to smaller tumours.In this retrospective study, 74 consecutive patients (mean age: 63 ± 12; m: 39, w: 35) with a total of 175 tumours treated in 132 interventions were enrolled between October 2003 and September 2016. Primary and assisted local tumour control (LTC), progression free survival (PFS) and overall survival (OS) after first CT-HDBRT were identified for two subgroups with tumours4 cm (A) as well as ≥4 cm (B) using the Kaplan-Meier-Method. Radiation parameters and side effects were recorded. Log-Rank-Test and Mann-Whitney-U-Test were performed for statistical analyses with p-values0.05 considered as significant.There was no statistical difference in coverage with prescribed radiation dose (A:19.78 ± 8.62 mm (range 5-39 mm), 99.56 ± 0.99%; B:61.70 ± 21.09 mm (41-100 mm), 94.81 ± 7.19%, p = 0.263). LTC rates after 0.5-,1-,2-,3- and 5-years were higher in A compared to B (A:85%/74%/63%/60%/46%, B:71%/37%/32%/32%/32%) with longer primary (A:11months, B:5months, p = 0.003) and assisted LTC (A:9months B:20months, p = 0.339). Longer OS was observed in A (A:18.5months, B:14.5months, p = 0.011) with longer OS rates (A:96%/87%/60%/48%/19%, B:92%/73%/20%/20%/0%). Complication assessment revealed no bleedings, 16.6% pneumothoraxes and 48.5% of mild radiation fibrosis without clinical symptoms.In conclusion, higher LTC and OS were observed in patients with primary lung malignancies4 cm. Nevertheless, CT-HDRBT is a safe and feasible alternative even in larger tumours ≥4 cm.

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

Background Virtual monochromatic images (VMI) generated using spectral computed tomography (CT) are promising recently available tools to improve diagnostic performance in oncologic patients. Purpose To investigate if virtual monochromatic datasets are suitable for clinical routine use in patients with hypervascularized abdominal tumors. Material and Methods A total of 41 patients with hypervascularized hepatocellular carcinoma (HCC), renal cell carcinoma (RCC), or neuroendocrine tumors (NET) were enrolled in the study; 451 CT series were analyzed. In an intra-individual study design, virtual monochromatic datasets of the arterial phase of each scan were computed. Image quality was assessed objectively by determining signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR) and subjectively by using five-point Likert-scales. The volume CT dose index (CTDIvol) was taken from each radiation dose report. The increase in reading time was estimated from the increase in the number of images. Results Intra-individual comparison of the spectral mode in the arterial phase with the portal venous phase revealed no significant increase in the applied dose. SNR, CNRtumor-to-liver , and CNRtumor-to-muscle were significantly increased by lowering virtual monochromatic energy. Subjective image quality scores revealed an increase of contrast in low energy datasets, resulting in significantly higher diagnostic confidence, but an increased image noise at low energies. While diagnostic confidence improved, taking all datasets into account resulted in a significantly longer estimated reading time. Conclusion In clinical practice, the use of low energy VMI improved diagnostic confidence without a significant increase in dose. The main disadvantage is a decrease in efficiency due to longer reading times.

We determined whether the Smart MAR metal artifact reduction tool - a three-stage, projection-based, post processing algorithm - improves subjective and objective image quality and diagnostic confidence in patients with dental artifacts and suspected head and neck pathology compared to standard adaptive statistical iterative reconstructions (ASIR V) alone.The study included 100 consecutive patients with nonremovable oral implants or dental fillings and suspected oropharyngeal cancer or abscess. CT raw data of a single-source multislice CT scanner were postprocessed using ASIR V alone and with additional Smart MAR reconstruction. Image quality of baseline ASIR V and Smart MAR-based reconstruction series was compared both quantitatively (5 regions of interest, ROIs) and qualitatively (two independent raters).Additional Smart MAR reconstruction significantly seems to improve both attenuation and noise adjacent to implants and in more distant areas (all p 0.001) compared to standard ASIR V reconstructions alone. Signal-to-noise ratio (SNR; p = 0.001) and contrast-to-noise ratio were improved significantly (CNR; p = 0.001). Smart MAR improved visualization of tumor/abscess (detected in 36 of 100 patients, 36%) and representative oropharyngeal tissue (p 0.001). In 8 of 36 patients (22%), tumor was only detected in Smart MAR series. Mean total DLP was 506.8mGy*cm; average CTDIvol was 5.5 mGy.The supplementary use of the Smart MAR post-processing tool seems to significantly improve both subjective and objective image quality as well as diagnostic confidence and lesion detection in CT of the head and neck. In 22% of cases, the tumor was detected only in Smart MAR reconstructed images.

Objective The first two authors contributed equally to this work. A prospective, randomized study to evaluate efficacy, safety, and comfort of thigh-high, round knitted medical compression stockings (MCSs) with different pressure six weeks after vein surgery. Methods Female patients undergoing vein surgery were randomized for a compression therapy with low (18–21 mmHg, group A) or moderate (23–32 mmHg, group B) pressure MCSs. Follow-up was done by a phlebological experienced, blinded physician (pressure control, clinical aspect, duplex scan, and questionnaire) one and six weeks after surgery. Results Totally, 88 patients (41 in group A and 47 in group B) were analyzed. One week after surgery, patients of group B had significantly lower edema scores than patients of group A either in the clinical assessment (0.7 vs. 0.3; p = 0.016) or in the B-mode scan (0.9 vs. 0.4; p = 0.013). Significant less patients of group B had a feeling of “tightness” ( p = 0.01) and significant more a reduction of discomfort ( p = 0.01) after week 1 but with no significance in week 6. There was no significant difference according to other clinical and ultrasound findings such as hematoma, infection, hyperpigmentation, cording, or thrombosis after one or six weeks. In week 1 and week 6, more patients suffered from pain in group A (week 1 p = 0.24, week 6 p = 0.063). Application of the MCSs was easier in group A in week 1 but similar in groups A and B in week 6. Muscle vein thrombosis occurred in one patient of group A. Conclusion Compression stockings with a pressure of 23–32 mmHg facilitate a faster resolution of clinical and ultrasound verified edema and the subjective feelings of pain, tightness, and discomfort of the leg in the early period after surgery but have no difference in the longer post-surgical period compared to stockings with a pressure of 18–21 mmHg.