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Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term “lymphangiography.” For the review, the inclusion criterion was “studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI).” Different exclusion criteria were defined (e.g., studies with

Background To demonstrate the efficacy of percutaneous computed tomography (CT)-guided afferent lymphatic vessel sclerotherapy (ALVS) in the treatment of postoperative lymphatic leakage (LL) after ineffective therapeutic transpedal lymphangiography (TL). Methods A retrospective review in this institute involving 201 patients was conducted from May 2011 to September 2018. Patients diagnosed with postoperative LL undergoing ineffective therapeutical TL before the performance of percutaneous CT-guided ALVS were involved. Technical success and clinical success of TL and ALVS were established. The technical success and efficacy of ALVS in the treatment of postoperative LL after ineffective therapeutic TL were assessed. The clinical success rate of ALVS is also assessed, and the complications are reviewed. Results In total, nine patients were involved including three patients (33.3%) presented with chylothorax, three patients (33.3%) presented with inguinal lymphatic fistula/lymphocele, and three patients (33.3%) presented with lymphatic fistula in the thigh; 27 ± 18 days (mean ± standard deviation) after surgery, therapeutic TL was successfully performed and showed definite afferent lymphatic vessel and leakage site in all the patients. Due to clinical failure after TLs, the following ALVS was performed with a mean interval of 12 ± 8 days after TL. The technical success rate was 9/9 (100.0%, 95% confidence interval [CI] 63.1–100.0%). An average of 2.7 ± 1.3 mL 95% ethanol as sclerosant agent was injected during the procedure. The clinical success was observed in 8 of the 9 patients (88.9%, 95% CI 51.8–99.7%) with a time between ALVS and the LL cure of 8 ± 6 days. No complications were reported. Conclusions Our results showed the role of percutaneous CT-guided ALVS as a safe, feasible, and effective salvage treatment for postoperative LL after ineffective TL.

Die Therapie der Nierenarterienstenose hat sich in den letzten 10 Jahren grundlegend gewandelt. Da die letzte Leitlinie aus dem Jahr 2008 datierte und nur ein S1-Niveau aufwies, war es an der Zeit, eine neue Leitlinie aufzulegen. Alle Fachgesellschaften, die an der Diagnostik, Therapie und Nachsorge von Nierenarterienstenosen (NAS) beteiligt sind, wurden von der Deutschen Gesellschaft fur Gefaschirurgie und Gefasmedizin, Gesellschaft fur operative, endovaskulare und praventive Gefasmedizin e. V. als federfuhrende Fachgesellschaft eingeladen. Basierend auf einer Literaturrecherche uber den Zeitraum von 2008 bis 2014 und spater nochmal aktualisiert bis 2017 sowie der existierenden S1-Leitlinie wurde die Leitlinie erstellt. Die Konsensusfindung erfolgt durch ein Online-Delphi-Verfahren. Die Empfehlungen wurden uberwiegend im „starken Konsens“ (Zustimmung von ≥95 % der Teilnehmer) oder im Konsens (Zustimmung von >75 % der Teilnehmer) getroffen. Die Leitlinie behandelt neben der gesamten Diagnostik auch die Therapie, aber auch Empfehlungen zur Nachsorge von Patienten mit Nierenarterienstenosen, soweit Literaturdaten vorhanden sind.

Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated.A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI.Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated.The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.

Additional file 1.

Bei der Behandlung des lokalisierten Nierenzellkarzinoms stellt das fehlende Randomisieren in den kontrollierten Studien zur Thermoablation eine wesentliche Limitation dar. Letztgenanntes fuhrt zu wesentlichen Studienverzerrungen und es bleibt letztendlich unklar, ob das verbesserte Gesamtuberleben zugunsten der partiellen Nephrektomie tatsachlich auf die Behandlungsmethode selbst zuruckzufuhren ist. Fur T1a (≤4 cm)-Nierenzellkarzinome ohne Lymphknoten- und Fernmetastasen sind exzellente technische und klinische Ergebnisse nach bildgefuhrter Radiofrequenz- und Kryoablation beschrieben. Niedrige Majorkomplikationsraten, die Erhaltung der Nierenfunktion sowie die dreidimensionale Bestatigung negativer Ablationsrander (A0-Ablation) sind die Vorteile der CT-gesteuerten Thermoablation. Entsprechend kontrollierten (nichtrandomisierten) klinischer Studien zum T1a Nierenzellkarzinom sind die krebsspezifischen Uberlebensraten zwischen ablativen und chirurgischen Techniken vergleichbar. Es ist hochste Zeit fur prospektive randomisierte kontrollierte Studien, um den tatsachlichen Stellenwert der perkutanen Thermoablation und der partiellen Nephrektomie bei der Behandlung des T1a-Nierenzellkarzinoms zu bestimmen. Neben dem lokalisierten Nierenzellkarzinom eignen sich Angiomyolipome und Onkozytome fur die Thermoablation. Die transarterielle Embolisation erweitert das radiologische Spektrum bei der Behandlung von Nierentumoren, entweder als erganzende Embolisation (z. B. vor Thermoablation von T1a- und T1b-Nierenzellkarzinomen), als prophylaktische Embolisation (z. B. Angiomyolipome >6 cm), als praoperative Embolisation (z. B. vor laparoskopischer partieller Nephrektomie) oder als palliative Embolisation (z. B. bei inoperablen Patienten mit symptomatischer Makrohamaturie bei Nierenzellkarzinom).

In diesem Beitrag werden die Atiologie, die Pathophysiologie sowie die konservative und chirurgische Behandlung thorakaler Aortenaneurysmata dargestellt. Der Fokus liegt hierbei auf dem Aortenbogen und der Aorta descendens. Die diesbezugliche aktuelle Literatur findet kritische Berucksichtigung.

On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology – with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient’s health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient’s consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liablity of malpractice law. Key points: • On February 26th, 2013 the new patient law came into effect. Materially, there was no fundamental remodeling of the German liability for medical malpractice. • Regarding a physician‘s liability for medical malpractice two different elements of an offence come into consideration: for one the liability for malpractice and, in turn, liability for errors made during medical consultation in the process of obtaining informed consent. • Forensic practice shows that patients frequently enforce both offences concurrently. Citation Format: • Sommer SA, Geissler R, Stampfl U et al. Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology. Fortschr Rontgenstr 2016; 188: 353 – 358

Percutaneous radiofrequency ablation (RFA) for the treatment of stage I renal cell carcinoma has recently gained significant attention as the now available long-term and controlled data demonstrate that RFA can result in disease-free and cancer-specific survival comparable with partial and/or radical nephrectomy. In the non-controlled single center trials, however, the rates of treatment failure vary. Operator experience and ablation technique may explain some of the different outcomes. In the controlled trials, a major limitation is the lack of adequate randomization. In case reports, original series and overview articles, transarterial embolization (TAE) before percutaneous RFA was promising to increase tumor control and to reduce complications. The purpose of this study was to systematically review the literature on TAE as add-on to percutaneous RFA for renal tumors. Specific data regarding technique, tumor and patient characteristics as well as technical, clinical and oncologic outcomes have been analyzed. Additionally, an overview of state-of-the-art embolization materials and the radiological perspective of advanced image guided tumor ablation (TA) will be discussed. In conclusion, TAE as add-on to percutaneous RFA is feasible and very effective and safe for the treatment of Tl a tumors in difficult locations and Tl b tumors. Advanced radiological techniques and technologies such as microwave ablation, innovative embolization materials and software-based solutions are now available, or will be available in the near future, to reduce the limitations of bland RFA. Clinical implementation is extremely important for performing image-guided TA as a highly standardized effective procedure even in the most challenging cases of localized renal tumors.

In this work, we present optical R band observations of AO 0235+164 carried out during the period of November 2006 to December 2012 using the Ap6E CCD camera attached to the primary focus of the 70 cm meniscus telescope at Abastumani Observatory, Georgia. It shows a large variation of Δ R = 4.88 mag (14.19–19.07 mag) and a short time scale of Δ T v = 73.5 min during our monitoring period. When periodicity analysis methods are applied to the R-band data from both historic and our observations, periods P 1 = 8.26 yr and P 2 = 0.54 yr are found.

Purpose: The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors’ institution’s experience. Materials and Methods: Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days. Mean follow-up was 8.2 ± 5.4 months. Results: Eighteen iliac side branch devices were implanted with a branch patency of 100 % and a primary technical success rate of 94.4 % (n = 17). Perioperative 30 days mortality was 0 %. The mean diameter of treated abdominal aorta and common iliac artery was 41 ± 14 and 30 ± 8 mm. In one case partial dislocation of the iliac side branch device occurred due to severe kinking of iliac arteries with development of an iliac endoleak type Ib that had to be treated in a second intervention. Three patients (15 %) showed an endoleak type II from the inferior mesenteric artery without the need of re-intervention. After three months one patient suffered from subtotal thrombotic occlusion of the bridging stent that was successfully resolved through intra-arterial fibrinolytic therapy and additional stent graft implantation. Conclusion: Summarized, implantation of iliac side branch devices is a feasible technique with favourable short-term results in patients with aortoiliac aneurysm. Key Points: • Implantation of iliac side branch devices is a feasible technique. • Distinguish short-term results of side branch endografting in patients with aortoiliac aneurysm. • Carefully patient selection is necessary to avoid complications and re-interventions. Citation Format: • Maus V, Kurz P, Sommer CM et al. The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.. Fortschr Rontgenstr 2016; 188: 746 – 752

Purpose To evaluate the efficacy of superselective embolization in patients with late postpancreatectomy hemorrhage (PPH). Materials and Methods Between January 2002 and July 2010, 25 patients (19 men) with suspected late PPH (> 24 hours after the operation) were evaluated. The primary study endpoint was technical success, defined as complete angiographic occlusion of the site of hemorrhage. Secondary study endpoints were multidetector computed tomography (CT) and angiographic findings regarding accurate detection of the site of hemorrhage, persistence of hemorrhage, or occurrence of rebleeding during clinical follow-up. Results Multidetector CT was performed before the intervention in 17 (68%) patients with detection of hemorrhage in 15 (88%) patients. The site of hemorrhage was detected in 23 (92%) of 25 patients by angiography. Four (17%) patients required a superselective catheter position. Embolization was attempted in all 23 patients with angiographically visible hemorrhage. In three (13%) patients, embolization could not be performed because a superselective catheter position was not achievable. Technical success was 83% (19 patients). In one patient, hemostasis was not achieved by embolization. Minor complications occurred in three (13%) patients. No major complications occurred. Three patients with technically successful embolization (16%) had a second episode of bleeding during follow-up and required repeat embolization 5–23 days after the procedure. The 30-day mortality rate was 20%. Conclusions Superselective embolization is a technically and clinically effective procedure in patients with late PPH. Diagnostic angiography should be performed with a superselective microcatheter position to detect the bleeding site effectively.

Purpose To evaluate the efficacy and safety of balloon-expandable stent grafts in the emergency treatment of acute arterial hemorrhage. Materials and Methods Between July 2008 and December 2009, 15 patients with acute arterial hemorrhage from inflammatory vessel erosion or pseudoaneurysms (n = 9), noninflammatory pseudoaneurysms (n = 3), or iatrogenic vessel injury (n = 3) were treated with emergency stent graft implants. The primary study endpoints to determine treatment efficacy and safety were survival, complication rates, and freedom from recurrent hemorrhaging or reintervention. The secondary study endpoints were technical and clinical success. Results The survival rate was 73% with a mean follow-up of 119 days ± 220. The complication rate was 20%. The procedure was technically successful in 13 of 15 (87%) patients. One endoleak persisted and led to a reintervention rate of 7%. The bleeding ceased immediately after stent graft implantation in 14 patients. Conclusions Implantation of balloon-expandable stent grafts is a safe and effective emergency treatment for acute arterial hemorrhage from visceral and peripheral vessels.

Aim To report our experience of combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures. Patients and methods Eighteen patients (23 kidneys) with non-obstructive uropathy due to urine leaks underwent combined CT- and fluoroscopy-guided nephrostomy. All procedures were indicated as second-line interventions after failed ultrasound-guided nephrostomy. Thirteen males and five females with an age of 62.3±8.7 (40–84) years were treated. Urine leaks developed in majority after open surgery, e.g. postoperative insufficiency of ureteroneocystostomy (5 kidneys). The main reasons for failed ultrasound-guided nephrostomy included anatomic obstacles in the puncture tract (7 kidneys), and inability to identify pelvic structures (7 kidneys). CT-guided guidewire placement into the collecting system was followed by fluoroscopy-guided nephrostomy tube positioning. Procedural success rate, major and minor complication rates, CT-views and needle passes, duration of the procedure and radiation dose were analyzed. Results Procedural success was 91%. Major and minor complication rates were 9% (one septic shock and one perirenal abscess) and 9% (one perirenal haematoma and one urinoma), respectively. 30-day mortality rate was 6%. Number of CT-views and needle passes were 9.3±6.1 and 3.6±2.6, respectively. Duration of the complete procedure was 87±32min. Dose-length product and dose-area product were 1.8±1.4Gycm and 3.9±4.3Gycm 2 , respectively. Conclusions Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures was feasible with high technical success and a tolerable complication rate.

This study was designed to investigate the benefit of percutaneous interventional management of patients with postoperative bile leak on clinical outcome. Primary study endpoints were closure of the bile leak and duration of percutaneous transhepatic biliary drainage (PTBD) treatment. Secondary study endpoints were necessity of additional CT-guided drainage catheter placement, course of serum CRP level as parameter for inflammation, and patients' survival.Between January 2004 and April 2008, all patients who underwent PTBD placement after upper gastrointestinal surgery were analyzed regarding site of bile leak and previous attempt of operative bile leak repair, interval between initial surgery and PTBD placement, procedural interventional management, course of inflammation parameters, duration of PTBD therapy, PTBD-related complications, and patients' survival.Thirty patients underwent PTBD placement for treatment of postoperative bile leaks. In 12 patients (40%), PTBD was performed secondary to a surgical attempt of bile leak repair. Additional percutaneous drainage of bilomas was performed in 14 patients (47%). CRP serum level decreased from 138.1 ± 73.4 mg/l before PTBD placement to 43.5 ± 33.4 mg/l 30 days after PTBD placement. The mean duration of PTBD treatment was 55.2 ± 32.5 days in the surviving patients. In one patient, a delayed stenosis of the bile duct required balloon dilation. Two PTBD-related complications (portobiliary fistula, hepatic artery aneurysm) occurred, which were successfully treated by embolization. Overall survival was 73% (22 patients).PTBD treatment is an effective therapy. PTBD treatment and additional CT-guided drainage of bilomas helped to reduce intraabdominal inflammation, as shown by reduction of inflammation parameters.

To investigate the safety and efficacy of a Polyzene-F nanocoat on new low-profile self-expandable nitinol stents in minipig renal arteries.Ten bare nitinol stents (BNS) and 10 stents coated with a 50 nm-thin Polyzene-F coating were randomly implanted into renal arteries of 10 minipigs (4- and 12-week follow-up, 5 animals/group). Thrombogenicity, on-stent surface endothelialization, vessel wall injury, late in-stent stenosis, and peristrut vessel wall inflammation were determined by quantitative angiography and postmortem histomorphometry.In 6 of 10 BNS,50% stenosis was found, but no stenosis was found in stents with a nanothin Polyzene-F coating. Histomorphometry showed a statistically significant (p 0.05) different average maximum luminal loss of 55.16% ± 8.43% at 12 weeks in BNS versus 39.77% ± 7.41% in stents with a nanothin Polyzene-F coating. Stents with a nanothin Polyzene-F coating had a significantly (p 0.05) lower inflammation score after 12 weeks, 1.31 ± 1.17 versus 2.17 ± 0.85 in BNS. The results for vessel wall injury (0.6 ± 0.58 for Polyzene-F-coated stents; 0.72 ± 0.98 for BNS) and re-endothelialization, (1.16 ± 0.43 and 1.23 ± 0.54, respectively) were not statistically significant at 12-week follow-up. No thrombus deposition was observed on the stents at either follow-up time point.Nitinol stents with a nanothin Polyzene-F coating successfully decreased in-stent stenosis and vessel wall inflammation compared with BNS. Endothelialization and vessel wall injury were found to be equal. These studies warrant long-term pig studies (≥120 days) because 12 weeks may not be sufficient time for complete healing; thereafter, human studies may be warranted.

The purpose of this study was to evaluate the effect of renal artery embolization with small and narrowly calibrated microparticles on the coagulation diameter, volume, and shape of radiofrequency ablations (RFAs) in porcine kidneys. Forty-eight RFAs were performed in 24 kidneys of 12 pigs. In 6 animals, bilateral renal artery embolization was performed with small and narrowly calibrated microparticles. Upper and lower kidney poles were ablated with identical system parameters. Applying three-dimensional segmentation software, RFAs were segmented on registered 2 mm-thin macroscopic slices. Length, depth, width, volume_segmented, and volume_calculated were determined to describe the size of the RFAs. To evaluate the shape of the RFAs, depth-to-width ratio (perfect symmetry-to-lesion length was indicated by a ratio of 1), sphericity ratio (perfect sphere was indicated by a sphericity ratio of 1), eccentricity (perfect sphere was indicated by an eccentricity of 0), and circularity (perfect circle was indicated by a circularity of 1) were determined. Embolized compared with nonembolized RFAs showed significantly greater depth (23.4 ± 3.6 vs. 17.2 ± 1.8 mm; p < 0.001) and width (20.1 ± 2.9 vs. 12.6 ± 3.7 mm; p < 0.001); significantly larger volume_segmented (8.6 ± 3.2 vs. 3.0 ± 0.7 ml; p < 0.001) and volume_calculated (8.4 ± 3.0 ml vs. 3.3 ± 1.1 ml; p < 0.001); significantly lower depth-to-width (1.17 ± 0.10 vs. 1.48 ± 0.44; p < 0.05), sphericity (1.55 ± 0.44 vs. 1.96 ± 0.43; p < 0.01), and eccentricity (0.84 ± 0.61 vs. 1.73 ± 0.91; p < 0.01) ratios; and significantly greater circularity (0.62 ± 0.14 vs. 0.45 ± 0.16; p < 0.01). Renal artery embolization with small and narrowly calibrated microparticles affected the coagulation diameter, volume, and shape of RFAs in porcine kidneys. Embolized RFAs were significantly larger and more spherical compared with nonembolized RFAs.

Rationale:Intraductal papillary mucinous neoplasms of the pancreas (IPMNs) are benign cystic tumors with a relevant risk of malignant transformation over time. Currently, follow-up after surgical resection of benign IPMNs remains controversial.Patient concerns:This is a case report of a 68-y

The purpose of this study was to evaluate the technical and clinical success of superselective embolization in patients with life-threatening arterial renal hemorrhage undergoing preinterventional CT angiography. Forty-three patients with clinical signs of life-threatening arterial renal hemorrhage underwent CT angiography and catheter angiography. Superselective embolization was indicated in the case of a positive catheter angiography. Primary study goals were technical and clinical success of superselective embolization. Secondary study goals were CT angiographic and catheter angiographic image findings and clinical follow-up. The mean time interval between CT angiography and catheter angiography was 8.3 ± 10.3 h (range, 0.2–34.1 h). Arterial renal hemorrhage was identified with CT angiography in 42 of 43 patients (98%) and catheter angiography in 39 of 43 patients (91%) (overview angiography in 4 of 43 patients [9%], selective angiography in 16 of 43 patients [37%], and superselective angiography in 39 of 43 patients [91%]). Superselective embolization was performed in 39 of 43 patients (91%) and technically successful in 37 of 39 patients (95%). Therefore, coil embolization was performed in 13 of 37 patients (35%), liquid embolization in 9 of 37 patients (24%), particulate embolization in 1 of 37 patients (3%), and a combination in 14 of 37 patients (38%). Clinical failure occurred in 8 of 39 patients (21%) and procedure-related complications in 2 of 39 patients (5%). The 30-day mortality rate was 3%. Hemoglobin decreased significantly prior to intervention (P < 0.001) and increased significantly after intervention (P < 0.005). In conclusion, superselective embolization is effective, reliable, and safe in patients with life-threatening arterial renal hemorrhage. In contrast to overview and selective angiography, only superselective angiography allows reliable detection of arterial renal hemorrhage. Preinterventional CT angiography is excellent for detection and localization of arterial renal hemorrhage and appropriate for guidance of the embolization procedure.

The purpose of this study was to evaluate the impact of stent design on in-stent stenosis in rabbit iliac arteries. Four different types of stent were implanted in rabbit iliac arteries, being different in stent design (crown or wave) and strut thickness (50 or 100 microm). Ten stents of each type were implanted. Each animal received one crown and one wave stent with the same strut thickness. Follow-up was either 12 weeks (n = 10 rabbits) or 24 weeks (n = 10 rabbits). Primary study end points were angiographic and microscopic in-stent stenosis. Secondary study end points were vessel injury, vascular inflammation, and stent endothelialization. Average stent diameter, relative stent overdilation, average and minimal luminal diameter, and relative average and maximum luminal loss were not significantly different. However, a trend to higher relative stent overdilation was recognized in crown stents compared to wave stents. A trend toward higher average and minimal luminal diameter and lower relative average and maximum luminal loss was recognized in crown stents compared to wave stents with a strut thickness of 100 microm. Neointimal height, relative luminal area stenosis, injury score, inflammation score, and endothelialization score were not significantly different. However, a trend toward higher neointimal height was recognized in crown stents compared to wave stents with a strut thickness of 50 microm and a follow-up of 24 weeks. In conclusion, in this study, crown stents seem to trigger neointima. However, the optimized radial force might equalize the theoretically higher tendency for restenosis in crown stents. In this context, also more favorable positive remodeling in crown stents could be important.

PURPOSE Evaluation as to whether diagnosis of large bowel disease and TNM staging of colorectal carcinoma are possible by colorectal hydrosonography (HUS). METHOD 52 patients with suspected neoplastic or inflammatory large bowel disease, underwent HUS. Before performing abdominal ultrasound, the colon was filled with fluid. Morphological alterations of the bowel wall were judged benign or malignant. Colorectal carcinomas were classified according to the TNM system. RESULTS Laparotomy was performed in 46 of 52 patients. Correlation with surgery and histopathology showed that 77% of morphologic alterations of the colonic wall were detected by HUS. While benign lesions of the colonic wall occasionally mimicked malignant disease, colonic carcinomas were reliably diagnosed by HUS, because destruction and invasion of the bowel wall was visible. Carcinomas of the lower part of the rectum, however, were missed in most cases. Accuracy to determine the infiltration depth of colorectal carcinomas was 89%, but hydrosonographic N-staging was unreliable. Inflammatory disease of the large bowel as well as changes complicating the inflammatory bowel disease were accurately diagnosed by HUS. CONCLUSION In selected patients, colorectal HUS is suited for diagnosis and staging of colonic tumours. It also helps to evaluate inflammatory bowel disease, because small and large bowel can be reliably distinguished from each other and the degree of stenosis of inflamed colonic segments becomes visible. Furthermore, HUS increases the visibility of fistulas.

Aim: The purpose of this study was to evaluate the safety and efficacy of percutaneous transhepatic portal vein embolization of the right portal vein with an Ethibloc/Lipiodol mixture to induce hypertrophy of the left liver lobe in patients with primarily unresectable liver tumor. Methods: 15 patients (8 primary liver tumors, 7 liver metastases) underwent portal vein embolization. Liver volumetry, duration of hospitalization, complication rates, relevant laboratory values were documented. Results: In 13/15 patients (84.6%) embolization could be performed with a median of 8.8 ml (range 1.5–28 ml) Ethibloc/Lipiodol. One minor procedure-related complication (subcapsular hematoma) occurred, which did not affect the two-step liver resection. No patient developed acute liver failure after embolization or liver resection. The volume of the left liver lobe increased significantly (p = 0.0015) by 25% from a median of 750 ml (587–1,114 ml) to 967 ml (597–1,249 ml). 11/13 (81.8%) of the embolized patients underwent liver resection at a median of 49 days after embolization. Median hospitalization time was 4 days after embolization and 7 days after liver resection. Median overall survival of the 11 operated patients was 376 days. Conclusion: Percutaneous transhepatic portal vein embolization using an Ethibloc/Lipiodol mixture is a safe, feasible, and efficient interventional procedure.

Purpose The purpose of this study was to evaluate the clinical long-term success of uterine artery embolization (UAE) in patients with symptomatic fibroids using spherical particles (Embosphere). Materials and methods 34 consecutive patients treated with UAE were initially enrolled in the study which had the following study goals 1) 1-year follow-up MRI evaluation of the fibroid behavior and 2) clinical long-term success due to standardized assessment of the main fibroid-related symptoms (hypermenorrhoea, dysmenorrhoea and dysuria) of the patients' individual overall health status and their therapy satisfaction at 1-year, 2- year and 3-year intervals after UAE. Results Technical success was achieved in all procedures. Four patients had to be excluded from the long-term evaluation schedule: one because of a hysterectomy due to bleeding after 6 weeks, 3 patients were not available for the designated minimum follow-up interval. The preinterventional severe hypermenorrhoea (n = 27) with a score of 4.4 +/- 0.7 (5 = extreme menstrual bleeding) decreased after one year to 2.1 +/- 0.5 (p = 0.0001), after two years to 1.7 +/- 0.5 (p = 0.0042) and after three years to 1.3 +/- 0.6 (p = 0.0001). The preinterventional dysmenorrhoea (n = 15) with a score of 3.1 +/- 1.5 (3 = distinctly increased dysmenorrhoea) decreased after one year to 1.1 +/- 0.3 (p = 0.0001), after two years to 1.2 +/- 0.2 and after three years to 1.2 +/- 0.4 (p = 0.148). The pretreatment dysuria (n = 12) with a preinterventional score of 3.1 +/- 1.5 (3 = distinctly increased dysuria) decreased after one year to 1.1 +/- 0.3 (p = 0.0069) and remained after two years at 1.1 +/- 0.2 and after three years at 1.2 +/- 0.4 (p = 0.905). The initial overall health status was 54.7 +/- 20.1 (maximal value 100). After one year it rised to 90.5 +/- 15.4 (p = 0.0001), was 91.8 +/- 5.6 after two years and was 91.3 +/- 8.5 (p = 0.8578) after three years. The satisfaction with the therapy was 2.9 +/- 0.2 after one year, 2.6 +/- 0.3 after two years and 2.7 +/- 0.5 (3 = extremely satisfied) after three years. We observed 12 minor and 3 major complications (one hysterectomy, one fibroid expulsion associated with a short bleeding episode and one transient amenorrhoea for three months). All patients benefited clinically from the procedure and a clinical benefit was achieved in all cases. Conclusion Under controlled study conditions, flow-guided UAE with spherical embolization particles achieves high clinical success for all relevant clinical symptoms without negative changes during follow-up after at least 3 years. Accordingly, patient therapy satisfaction remained extraordinarily high even 3 years after UAE.

Akute gastrointestinale Blutungen sind bei Leberzirrhosepatienten mit einer hohen Mortalitat verbunden. Ileale Varizen und Kollateralen aus anderen ektopen Gefasen des Darms sind extrem selten und treten bei weniger als 5% aller Zirrhosepatienten auf. Die Diagnosestellung erfolgt oft verspatet, da die ublichen diagnostischen Untersuchungsmethoden wie Gastroskopie oder Koloskopie in den meisten Fallen die Blutungsquelle nicht ausreichend darstellen. Wir berichten uber einen ungewohnlichen Fall von massiver und unkontrollierbarer unterer gastroinstestinaler (GI-)Blutung aus ilealen Varizen mit Verbindung zur rechten V. ovarica einer 56-jahrigen Frau, bei der anamnestisch eine Leberzirrhose und abdominelle Operationen sowie Operationen im Bereich des Beckens bekannt waren. Die genaue angiographische und computertomographische Diagnose erlaubte eine rasche Dekompression des Portalvenensystems mittels eines transjugularen portosystemischen Shunts.

In the context of the connection among galaxy-galaxy interaction, starbursts and nuclear activity, we present and discuss a quantitative morphological analysis based on BVR images and a detailed spectroscopic investigation of two interacting galaxies, the Seyfert 2 Tol1238-364 (IC 3639) and its companion ESO381-G009, forming a triple system with ESO381-G006. Broad-band optical photometry is complemented by Halpha imaging, which provides information about the distribution of star forming regions across the galaxies. Long-slit spectroscopic data obtained at different position angles of the slit are employed to determine the physical conditions of circumnuclear and extranuclear regions. A mixture of thermal and non-thermal ionizing radiation is found in the surroundings of the nucleus of Tol1238-364 and the energy budget supports the presence of a circumnuclear starburst.Several regions in both the galaxies show anomalous line ratios: additional ionization by shock-heating and low ionization of some extranuclear HII regions are suggested as possible explanations. An analysis of the emission-line profiles reveals the presence of a broad Halpha component in the nuclear region of Tol1238-364. Independent estimates of the star formation rates (SFR) were obtained through flux-calibrated Halpha-images and FIR emission in the four IRAS bands. Overall SFR densities have been compared with the SFR densities derived from Halpha emission in the individual regions of the galaxies sampled by long-slit spectra. In both galaxies an enhancement of the star formation activity with respect to isolated galaxies is revealed. The prevalence of starburst or nuclear activity has been examined through FIR color indices. The interaction scenario is discussed on the basis of the observed galaxy properties., Tentatively scheduled for publication in ApJS, v184 n2 October 2003 issue. A version with full resolution figures is available as unedited preprint at http://www.journals.uchicago.edu/ApJ/future.html

As a result of the cooperation between the Sofia Sky Archive Data Center (Bulgaria) and Bamberg Observatory (Germany), Royal Observatory of Edinburgh (UK), Konkoly Observatory (Hungary), Strasbourg Observatory, Institute of Astronomy in Cambridge (UK), etc., a programme for investigation of the long-term behaviour of the Pleiades active dwarf stars (in particular, flare stars) is in progress. Existing plates in the Pleiades are found in different European plate archives, made since the end of the nineteenth century, by the searching tool of the wide-field plate database (http://www.skyarchive.org), which provides detailed information for astronomical plate archives all over the world, as well as for plates themselves. We investigate the Pleiades flare stars (UV Cet-type stars) included in the flare Stars database and identified in the USNO A2.0 catalogue. 68 Pleiades plates are already digitized with different scanning machines such as PDS 1010 (Sofia), PDS 2020 (Munster), SUPER COSMOS (Edinburgh), APM (C...

Zielsetzung. Bei der akuten Divertikulitis entscheidet eine exakte Stadieneinteilung der Erkrankung uber das therapeutische Vorgehen.Die Diagnostik mittels Computertomographie (CT) wird der klinischen Einteilung der akuten Divertikulitis und den sich daraus ableitenden therapeutischen Strategien gegenubergestellt. Material und Methode. Die Durchfuhrung der CT bei Verdacht auf akute Divertikulitis erfolgt nach transanaler, intraluminaler Kontrastierung des Darms mit positivem wasserloslichem Kontrastmittel, um eine Penetration oder Darmperforation nachzuweisen. Anschliesend erfolgt eine intravenose Kontrastmittelapplikation, um das Kontrastverhalten der abdominellen Strukturen/Organe, insbesondere der Darmwand, zu beurteilen und Abszesse zu diagnostizieren. Die CT-Morphologie der verschiedenen Stadien der akuten Divertikulitis wird beschrieben und anhand von Beispielen vorgestellt. Ergebnisse. Die CT kombiniert bei der notfallmasigen Abklarung einer akuten Divertikulitis als einziges Verfahren Sicherheit mit Genauigkeit.Auf der einen Seite ist die CT schnell und damit sicher im Hinblick auf die Uberwachung des Patienten.Auf der anderen Seite erlaubt die CT eine exakte Stadieneinteilung der Entzundung mit einer Sensitivitat und Spezifitat von bis zu 100%. Durch den sicheren Nachweis von Komplikationen wie die Ausbildung eines Abszesses, einer Penetration oder Darmperforation,hat die CT unmittelbaren Einfluss auf die Therapie des Patienten. Diskussion. Die CT ist bei Verdacht auf eine akute Divertikulitis aufgrund der hohen Relevanz fur die Therapie und das Management von Komplikationen die diagnostische Methode der Wahl.

Therapiestrategie und Prognose werden bei malignen Lymphomen entscheidend vom jeweiligen Stadium beeinflusst. Die Festlegung des Ausbreitungsgrades durch sorgfaltige Beurteilung ist daher von besonderer Bedeutung. Bei der Auswertung maligner Lymphome in der Computertomographie bestehen jedoch zahlreiche Moglichkeiten einer Fehlinterpretation durch Verwechslung mit normalen anatomischen Strukturen oder Ubersehen einzelner Befallsregionen, deren sich insbesondere weniger Erfahrene in der Radiodiagnostik nicht immer gegenwartig sind.Zudem erfordert das Lymphomstaging in der Computertomographie die Kenntnis rontgenmorphologischer Kriterien und eine adaquate Untersuchungsplanung. Der vorliegende Ubersichtsartikel verfolgt daher das Ziel, mogliche Fehlerquellen in der computertomographischen Lymphombeurteilung zu verdeutlichen und Moglichkeiten einer Fehlervermeidung anzusprechen.

Mit der Entwicklung CT-gesteuerter Biopsieverfahren sowie zuverlassiger Biopsiesysteme hat sich die Vorgehensweise bei der Diagnostik maligner Lymphome geandert. Reprasentative Stanzzylinder mit hoher Praparatequalitat ermoglichen dem Pathologen eine Subklassifikation der Lymphome in uber 90%. Eine ahnlich hohe Treffsicherheit ist auch bei der Rezidivdiagnostik moglich. Deshalb sind perkutane Biopsien bei fehlender peripherer Lymphadenopathie als primare diagnostische Methode geeignet. Unter Beachtung der Kontraindikationen sowie der regional unterschiedlichen Komplikationsmoglichkeiten konnen die meisten CT-gesteuerten Biopsien ambulant unter Analgosedierung durchgefuhrt werden. Die Akzeptanz perkutaner Biopsien durch Pathologen und Onkologen ist an die diagnostische Genauigkeit gekoppelt. Diese wird durch Gewinnung von mindestens 3 reprasentativen Biopsiezylindern aus den soliden Anteilen eines Lymphoms signifikant erhoht. Die vorliegende Ubersichtsarbeit beschreibt den Stellenwert CT-gesteuerter Biopsien maligner Lymphome im Vergleich zu den operativen Verfahren. Auserdem werden anhand der Literatur die Aspekte diskutiert, die einer erfolgreichen perkutanen Biopsie zugrunde liegen.

Purpose: To describe angiographic, computed-tomography (CT) and pathologic features of ETHIBLOC_Reloaded as a re-designed zein-based fluid embolic agent. Materials and methods: In eight pigs, both kidneys underwent selective transarterial embolization (with complete embolization as embolization endpoint). Each group consisted of two pigs with four embolized kidneys: I-pure ETHIBLOC_Reloaded, II-ETHIBLOC_Reloaded/iodized oil mixture (1:1), III-ETHIBLOC_Reloaded/ethanol-60% mixture (8:2) and IV-Histoacryl/iodized oil mixture (1:3). One hour after embolization, CT imaging, sacrifice and kidney harvest followed. Angiographic (visibility and vascular occlusion pattern), CT (visibility) and pathologic (vascular occlusion pattern) features were compared. Results: The embolization endpoint was reached in all animals. Applying Angiography, embolic agents were definitely visible during embolization in all study groups. Vascular occlusion occurred from distal (arcuate and interlobar arteries) to proximal (renal artery), whereby the most distal levels were reached in II and III. Applying CT imaging, embolic agents were definitely visible in hilar and intraparenchymal arteries in all groups. Pathology proved occlusion of segmental, interlobar and arcuate arteries in all groups, and additionally occlusion of interlobular arteries, pre-glomerular arterioles and glomerular capillaries in I, II and III. Conclusion: ETHIBLOC_Reloaded is a promising re-designed zein-based embolic agent that can be used safely and effectively for transarterial embolization of the pig kidney.

A tumour score for venous invasion in patients with pancreatic adenocarcinoma was evaluated by means of computed tomography (CT), in order to improve the assessment of medical treatment and clinical outcome with special attention to borderline resectable disease.Fifty-six consecutive patients who underwent curative surgical resection for pancreatic cancer were analysed. On the basis of CT criteria, tumour involvement of the portal vein (PV) and superior mesenteric vein (SMV) was graded according to an adapted 4-point scale: score 1, definite absence of invasion; score 2, probable absence of invasion; score 3, probable presence of invasion; score 4, definite presence of invasion. Correlations between the venous infiltration scores and the patients' clinical features were also evaluated.After radiological evaluation of PV and SMV grades of infiltration, 21/56 (37 %) and 37/56 (66 %) patients, respectively, were found to have borderline resectable disease. The 4-point scale achieved a sensitivity of 80 %, a specificity of 96 % and an accuracy of 93 % in the evaluation of the PV, and a sensitivity of 100 %, a specificity of 94 % and an accuracy of 95 % in the evaluation of the SMV. Analysis of the distribution of clinical characteristics by PV and SMV infiltration showed that both scores correlated with the presence of distal metastasis (p = 0.016 and p = 0.028, respectively), and resection margins status (p = 0.015 and p = 0.006, respectively).This adapted tumour score is reliable for assessing venous invasion and might improve preoperative staging in patients with borderline resectable pancreatic cancer.

We present the results of observations both in imaging and spectroscopy of the nearby active galaxy ESO 202-G23 (Carafe Nebula). The main result of this investigation is that the peculiar morphology of the galaxy, formerly attributed to the presence of an asymmetric bar, is produced by the merging of two galaxies both hosting an active nucleus. Our deep R image reveals unexpectedly the presence of a knot (G2), not visible in the B image, at 3.5 kpc on the northern of the nucleus (G1), classified in the literature as a Seyfert 2. A long-slit spectrum provides evidence that G1 is a Seyfert 1.5 nucleus and that G2 is also a nucleus, showing features typical of a LINER heavily reddened by dust. The presence of tails and plumes in the outermost parts of the galaxy and the double U shape of the rotation curve of the gas around G1 and G2 strongly support the hypothesis of a merger that occurred 106–109 years ago, as suggested by the comparison of the current (14 M⊙ yr-1) and the recent (24 M⊙ yr-1) star formation rates. The system ESO 202-G23 is an infrared bright source (LFIR/L⊙ = 2.18 × 1010) and the IRAS flux ratios suggest a predominantly thermal origin of the infrared emission. The analysis of the IRAS data allows us to obtain some important properties concerning both the gas and the dust: Td(warm) ~ 36 K; Md(warm) = 4.1 × 106 M⊙; Td(cold) ~ 21 K; Md(cold) = (6.9–8.3) × 107 M⊙; MH I = 8.6 × 109 M⊙; MH II = (2.3–4.3) × 109 M⊙; Mgas = (1.1–1.3) × 1010 M⊙. The derived mass-to-light ratio MH I/LB = 2.23 and the value of the parameter K = vmax/rmax, K(G1) = 201, K(G2) = 179, indicate that the precursor is not later than Sbc.

Ziel. Der endoluminale Bypass (TPEG) hat sich in den letzten Jahren zu einer bedeutenden minimal-invasiven Alternative zur offenen Chirurgie des Aortenaneurymas und der Aortendissektion entwickelt. In der vorliegenden Arbeit werden moderne Nachsorgekonzepte basierend auf unserer 7-jahrigen Erfahrung mit 10 verschiedenen Endoprothesen vorgestellt. Material und Methode. Evaluation der Relevanz bildgebender Verfahren in der Nachsorge nach TPEG mit Schwerpunkt der Darstellung von Endoleckagen, Schrumpfung des Aneurysmasackes, Langzeitintegritat und MR-Kompatibilitat von Stentgrafts. Ergebnisse. Bei endovaskular ausgeschalteten Aortenaneurysmen besteht in 20–30% eine persistierende Perfusion des Aneurysmasackes auserhalb der Endoprothese. Diese hohe Rate des primaren Therapieversagens entspricht zwar nicht zugleich einem klinischen Misserfolg, sie macht jedoch eine engmaschige radiologische Befundkontrolle erforderlich. Der rationale Einsatz der radiologischen Verfahren wird bestimmt durch die individuellen anatomischen Gegebenheiten des Patienten, die klinischen Relevanz der Befunde und nicht zuletzt die therapeutischen Moglichkeiten. Die native Rontgenaufnahme erfasst die Integritat und Position des Stentgrafts. Die Sonographie ist lediglich ein orientierendes Verfahren, da sie nicht alle Fragen in der Nachsorge nach TPEG beantworten kann. Die Angiographie ist der CT und der MRT im Nachweis von Endoleckagen unterlegen, sie dient der Therapieplanung bei bekannter Endoleckage, in der Regel in Interventionsbereitschaft. Die MRT ist der CT im Nachweis von Endoleckagen ebenburtig, wenn nicht uberlegen. Obwohl seit Jahren bekannt ist, dass ferromagnetische Implantate fur die MRT problematisch sind, haben sich jedoch von 8 untersuchten Endoprothesen 2 als MR-inkompatibel erwiesen (LifePath, Zenith). Schlussfolgerung. Das Standardverfahren in der Nachsorge nach endoluminalem Bypass ist die CT als CT-Angiographie, erganzt durch Spataufnahmen, alternativ die MRT. Bei haufig notwendigen Verlaufskontrollen ist bei jungen Patienten die MRT vorzuziehen, bei Patienten mit Kontraindikationen zur Gabe jodhaltiger Kontrastmittel ist die MRT die einzige Alternative. Der MR-Kompatibilitat sollte bei der Auswahl des Endografts besondere Aufmerksamkeit gewidmet werden.

Purpose To compare thin-section hydro-CT and MRI in the detection of pancreatic neoplasms. Evaluation of an oral, superparamagnetic contrast agent (OMP) for pancreatic MRI. Material and methods 45 patients with suspected pancreatic neoplasms were examined with consecutive thin-section helical CT (Hydro-CT, 3/6/3, 130 ml Ultravist, Schering) and MRI (1.0 T, breath-holding, T1w-GRE, T1w-GRE fat-sat, T2w-TSE). The MRI protocol included precontrast studies, studies after oral administration of OMP (Abdoscan, Nycomed Amersham) and studies after administration of OMP and Gadodiamide i.v. (Omniscan, Nycomed Amersham). All images were assessed by two independent radiologists in a blinded fashion. Radiologic diagnosis was correlated with histology or clinical follow-up (> or = 3 month). Results 39 patients could be included in analysis. In 13 cases a pancreatic neoplasm was proven by histology. Thin-section hydro-CT and MRI showed no statistically significant differences for the detection of pancreatic neoplasia. The sensitivity of helical hydro-CT was superior compared to MRI (88.5% vs. 65.44/73.1%/76.9%). The specificity of MRI was superior compared to helical hydro-CT (86.5% vs. 94.2%/90.4%/88.5%). Conclusion Thin-section hydro-CT and MRI show similar results for the detection of pancreatic neoplasms. Compared to thin-section helical CT, MRI still has the drawbacks of much more time consumption and, still, lower spatial resolution. The use of an oral, superparamagnetic contrast agent added no advantage for pancreatic MRI.

Dissections due to deceleration trauma are rarely limited to the infradiaphragmal aorta (only 2-3%) and are usually lethal. Here we report the unusual course of an abdominal aortic dissection with aneurysmatic enlargement of the false lumen. Based on diagnostic imaging, a therapeutic stent application was planned in order to close the entry and to prevent rupture. During the intervention sondation of the false lumen revealed that the left renal artery had a reentry. Due to the complexity of the entry-reentry situation of the left renal artery the intervention was not possible, and the patient had to undergo vascular surgery.

Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T1-weighted gradient echo and T2-weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data.

Purpose: Development of an optimized Spiral CT protocol type for the diagnosis of aortic dissections. Material and Methods: 121 consecutive CT examinations applying 5 different protocol types were blindly read by two experienced radiologists and then compared with: (a) 45 biplane transesophageal echocardiographies (TEE), (b) 52 transthoracic echographies (TTE), (c) 52 operative findings and, furthermore, related to the clinical course over at least six months in 79 patients. Results: The sensitivity of the spiral computed tomography for detection of dissection was 97% (biplane TEE: 88 %), the specificity 100% (biplane TEE: 91 %). In 15% dissections with atypical origin and entries (mid-portion of the aortic arch, distal thoracic aorta, etc.) were found. The optimal CT-protocol was the one with a combination of two separate but adjacent spiral scans achieving high spatial resolution for the aortic arch and enough spatial resection for the residual aorta (1. helical scan 3 mm collimation, pitch 2. 2. helical scan 5 mm collimation and pitch 2, 130 ml contrast medium at 5 ml/s) with a classification accuracy of 100%, visualization of entries of 100 %, reentries of 100% (40% direct, 60% indirect). The identification of the ostia of the aortic branches were: supraaortic 93%, visceral 100 %, left renal artery 100%, right renal artery 93 %, iliac 64%. The CT angiography, designed as aortic arch angiography, showed a good contrast in the aortic arch vessels (79-86%) and the visceral vessels too (91 %). Conclusion: Thoracic CT angiography can be used as gold standard in the primary evaluation of aortic dissections.