Search

ZusammenfassungSeit den 1990er-Jahren ist die Autoimmunpankreatitis (AIP) als eigenständige Form der Pankreatitis bekannt, seit Kurzem ist sie als solche auch anerkannt. In diesem Beitrag liegt der Schwerpunkt auf der Diagnostik der Autoimmunpankreatitis und dabei insbesondere auf der Bildgebung, die dabei eine entscheidende Rolle spielt.

Zusammenfassung Hintergrund Zur Diagnosestellung, Erkennung von Erkrankungskomplikationen sowie zur Verlaufskontrolle bei Patienten mit Morbus Crohn und Colitis ulcerosa wird zunehmend der Darmultraschall eingesetzt. Eine systematische Befunderhebung und Dokumentation sind wichtig, um die Qualität der Befunderstellung und die Kommunikation zwischen den Fachgruppen zu verbessern. Das vorliegende Positionspapier beschreibt die Voraussetzungen für eine optimale Befunderhebung des Darmultraschalls bei Patienten mit chronisch-entzündlichen Darmerkrankungen (CED). Methoden Eine Experten-Konsensusgruppe bestehend aus Gastroenterologen, Radiologen, Pathologen, Kinder- und Jugend-Gastroenterologen und Chirurgen führte eine systematische Literaturrecherche durch. In einem Delphi-Verfahren wurde unter Mitgliedern des Kompetenznetzes Darmerkrankungen und der Deutschen Röntgengesellschaft (DRG) über relevante Kriterien bei der Befunderhebung von Darmultraschallbefunden abgestimmt. Die daraus resultierenden Statements wurden in einer Experten-Konsensusgruppe verabschiedet. Ergebnis Praxisorientierte Empfehlungen für eine optimale Befunderhebung mit einer standardisierten Terminologie wurden entwickelt. Der Fokus der Erhebung lag auf der Beschreibung der Entzündungsaktivität sowie der Komplikationen bei CED. Minimale Anforderungen für eine standardisierte Befunderhebung wurden definiert. Zusammenfassung Das vorliegende Manuskript bietet praktische Empfehlungen zur Optimierung und Vereinheitlichung der Befunderhebung bei Darmultraschall-Untersuchungen bei CED.

Background MR-enterography/enteroclysis (MRE) is increasingly used for primary diagnosis, detection of complications, and monitoring of patients with inflammatory bowel disease (IBD). Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different faculties. The current manuscript describes the features that are required for optimized reporting of MRE in IBD. Methods An expert consensus panel of radiologists and gastroenterologists conducted a systematic search of the literature. In a Delphi process, members of the German Radiological Society (DRG) and members of the Competence Network for Inflammatory Bowel Diseases voted on relevant criteria for the reporting of findings in MRE. Based on the voting results, statements were developed by the expert consensus panel. Results Clinically relevant aspects of MRE findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on the description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images. Conclusion The current manuscript provides standardized parameters and gives practical recommendations on how to report and how to characterize MRE findings in patients with IBD. Key points: Citation Format

To analyze the impact of the COVID-19 pandemic in 2020 on the radiological imaging volume in Germany.In this retrospective multicenter study, we analyzed CT and MRI examinations of 7 radiology institutes across Germany from January to December 2020. The imaging volume was compared to 2019 (Wilcoxon-Mann-Whitney test). Modality, patient service locations, and examined body parts were assessed in consideration of time periods of the pandemic. In addition, correlation with the incidence of SARS-CoV-2 cases and associated death was performed (Spearman-test).In total, in 2020, imaging volume declined by 4 % (n = 8314) compared with 2019 (p 0.05). The hard lockdown during the first pandemic wave (calendar week 12-16, March 22 - April 19) revealed the highest decrease with 29 % (n = 894, p 0.01), with the greatest decrease in CT (36 % vs. MRI 26 %), outpatients (38 %, p 0.01), and imaging of the spine and extremities (51-72 %, 0.05 - p 0.01). Examinations referred from the emergency department (-13 %, p 0.05) and CT of the chest (-16 %, p 0.05) were least affected. With the end of the first wave, gradual normalization of the imaging volume was observed and persisted until the end of the observation period. A reduction of imaging volume negatively correlated with the incidence of SARS-CoV-2-positive cases and associated deaths (r = 0.28 and 0.49, p 0.05 and p 0.001).The COVID-19 pandemic was associated with a significant temporary decline in imaging volume. After the first lockdown period, a quick recovery was observed with radiologic imaging examinations steadily approaching prior-year figures.· This study assesses the impact of dynamic pandemic activity on radiological imaging in a multicenter analysis in Germany.. · The COVID-19 pandemic was associated with a temporary decline in CT and MRI scans.. · Relaxation of restrictions was associated with fast normalization of imaging volumes to prior-year levels, which persisted until the end of the year.. · Significant catch-up effects were not observed..· Schmidbauer M, Grenacher L, Juchems MS et al. Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. Fortschr Röntgenstr 2022; 194: 625 - 633.ZIEL: Untersuchung der Auswirkungen der COVID-19-Pandemie auf die Durchführung radiologischer Bildgebung in Deutschland.In dieser retrospektiven multizentrischen Studie wurden die durchgeführten CT- und MRT-Bildgebungen 7 deutschlandweiter radiologischer Zentren von Januar bis Dezember 2020 analysiert. Das Untersuchungsvolumen wurde mit dem Vorjahreszeitraum verglichen (Wilcoxon-Mann-Whitney-Test). Die Auswertung der aggregierten Daten erfolgte differenziert nach Modalität, Zuweiser, Körperregion und unter besonderer Berücksichtigung der zeitlichen Pandemieentwicklung. Die Untersuchungszahlen wurden zudem mit der Inzidenz von SARS-CoV-2-positiven Fällen und assoziierten Todesfällen korreliert (Spearman-Test).Im Pandemiejahr 2020 wurden insg. 4 % (n = 8314) weniger CT- und MRT-Untersuchungen durchgeführt als im Vorjahr (p 0,05). Die Differenz ist vornehmlich auf den Zeitraum des harten Lockdowns (Kalenderwoche 12–16, 22. März bis 19. April 2020) zurückzuführen, welcher im Vergleich zum Vorjahreszeitraum zu einem Rückgang der Untersuchungen um 29 % geführt hat (n = 894, p 0,01). MRT-Untersuchungen waren dabei stärker betroffen als CT-Untersuchungen (36 % vs. 26 %). Der größte Rückgang war mit –38 % (p 0,01) bei ambulanten Patienten zu verzeichnen und bei Untersuchungen von Wirbelsäule und Extremitäten (–51 % bis –72 %, p 0,05 bis p 0,01). Am geringsten tangiert waren Untersuchungen aus den Zentralen Notaufnahmen (–13 %, p 0,05) sowie CT-Untersuchungen des Thorax (–16 %, p 0,05). Das Ende des harten Lockdowns ging mit einer sukzessiven Normalisierung des Untersuchungsvolumens auf das Vorjahresniveau einher, die auch mit Beginn der zweiten Pandemiewelle und des milderen Lockdowns am Jahresende anhielt. Der Rückgang der Untersuchungen 2020 korrelierte dabei negativ mit der Inzidenz an SARS-CoV-2-positiven Fällen und assoziierten Todesfällen (r = 0,28 und 0,49; p 0,05 und p 0,001).Die COVID-19-Pandemie in Deutschland führte 2020 temporär zu einem signifikanten Rückgang radiologischer CT- und MRT-Untersuchungen. Nach Ende des ersten Lockdowns im Frühjahr zeigte sich eine rasche Erholung der Untersuchungszahlen mit weitgehender Stabilisierung des Untersuchungsvolumens auf das Vorjahresniveau.· Die Studie zeigt die pandemiebedingten Veränderungen radiologischer Bildgebung in einer multizentrischen, deutschlandweiten Analyse.. · Im Jahr 2020 kam es während des ersten Lockdowns zu einem temporären quantitativen Rückgang an CT- und MRT-Untersuchungen.. · Mit Beginn der ersten Lockerungen trat eine zügige Normalisierung der Untersuchungsvolumina auf Vorjahresniveau ein, die bis zum Jahresende anhielt.. · Signifikante Nachholeffekte wurden nicht beobachtet..· Schmidbauer M, Grenacher L, Juchems MS et al. Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. Fortschr Röntgenstr 2022; 194: 625 – 633.

CLINICAL PROBLEM Imaging plays a major role to differentiate interstitial edematous from necrotic pancreatitis and to describe relevant local complications for proper patient management and decision-making in acute pancreatitis. STANDARD RADIOLOGICAL PROCEDURES The revised Atlanta classification 2012 of acute pancreatitis divides patients into mild, moderately severe and severe groups. Computed tomography (CT) and magnetic resonance imaging (MRI) are well established for diagnosis and follow-up of acute pancreatitis and its complications METHODOLOGICAL INNOVATIONS AND ASSESSMENT: Based on the revised Atlanta classification, CT and MRI allow for adequate categorization of interstitial edematous and necrotic pancreatitis. Imaging and standardized reporting nomenclature enable confident differentiation of early and late complications in acute pancreatitis. RECOMMENDATIONS The aim of this review article is to present an image-rich overview of different morphologic characteristics of acute pancreatitis and associated local complications by CT or MRI using case examples.

Background There is currently no S3 guideline that contains statements on the diagnosis and treatment of acute, chronic and autoimmune pancreatitis in a single guideline. Objectives This article presents the most relevant recommendations relating to radiological imaging from the new "S3 guideline for pancreatitis". Materials and methods The guideline was developed by the DGVS (German Society for Digestive and Metabolic Diseases). After an online-based Delphi survey, the statements were discussed by an interdisciplinary expert team at a 3-day consensus conference and then agreed upon. The level of evidence scheme (version 2) of the Oxford Centre for Evidence-based Medicine was used. Results The new German "S3 guideline pancreatitis" comprises for the first time all entities of pancreatitis, acute, chronic and autoimmune pancreatitis and contains a large number of innovations with regard to diagnostic imaging and therapy. In addition to the evidence-based recommendations for diagnosis and therapy, a German-language glossary of the revised Atlanta classification on acute pancreatitis was adopted by consensus of the interdisciplinary guideline expert team. Furthermore, protocol recommendations for the performance of computed tomography (CT) are provided for the first time. In this article we introduce the key recommendations and innovations in the field of diagnostic radiologic imaging for acute, chronic and autoimmune pancreatitis. Conclusions In the future, every radiologist should have deep knowledge of the recommended time intervals for radiological imaging in acute pancreatitis and know the German terms for the description of acute pancreatitis; furthermore they should be able to classify the morphologies to the appropriate stages.

Background and study aims Due to demographic transition, neurogenic dysphagia has become an increasingly recognized problem. Patients suffering from dysphagia often get caught between different clinical disciplines. In this study, we implemented a defined examination protocol for evaluating the whole swallowing process by functional endoscopy. Special focus was put on the esophageal phase of swallowing. Patients and methods This prospective observational multidisciplinary study evaluated 31 consecutive patients with suspected neurogenic dysphagia by transnasal access applying an ultrathin video endoscope. Thirty-one patients with gastroesophageal reflux symptoms were used as a control group. We applied a modified approach including standardized endoscopic positions to compare our findings with fiberoptic endoscopic evaluation of swallowing and high-resolution manometry. The primary outcome measure was feasibility of functional endoscopy. Secondary outcome measures were adverse events (AEs), tolerability, and pathologic endoscopic findings. Results Functional endoscopy was successfully performed in all patients. No AEs were recorded. A variety of disorders were documented by functional endoscopy: incomplete or delayed closure of the upper esophageal sphincter in retroflex view, clearance disturbance of tubular esophagus, esophageal hyperperistalsis, and hypomotility. Analysis of results obtained with the diagnostic tools showed some discrepancies. Conclusions By interdisciplinary cooperation with additional assessment of the esophageal phase of deglutition using the innovative method of functional endoscopy, the diagnosis of neurogenic disorders including dysphagia may be significantly improved, leading to a better clinical understanding of complex dysfunctional patterns. To the best of our knowledge, this is the first study to show that a retroflex view of the ultrathin video endoscope within the esophagus can be safely performed. [NCT01995929]

Die im Jahr 1992 veröffentlichte Atlanta-Klassifikation zur Beurteilung von Schweregraden und Komplikationen der akuten Pankreatitis sollte ursprünglich eine einheitliche Terminologie für Kliniker und Forscher etablieren. Nach einer kontinuierlichen Weiterentwicklung wurde dann 2012 die revidierte Atlanta-Klassifikation publiziert, um die Aspekte der Bildgebung besser zu integrieren sowie Unschärfen in der Terminologie zu optimieren. Diese Begrifflichkeiten bezüglich der Krankheitseinteilung, -phasen, Schweregradbeurteilung und lokaler Komplikationen lagen bisher lediglich als englische Ausdrücke vor. Dies verhinderte eine weitere Verbreitung und Anwendung im klinischen Alltag im deutschsprachigen Raum. Um eine Anpassung in der deutschsprachigen Medizin zu erreichen, wurden die Termini der revidierten Atlanta-Klassifikation durch ein Expertenteam der Deutschen Röntgengesellschaft basierend auf aktueller Literatur übersetzt und im Rahmen der Konsensuskonferenz der neu erstellten S3-Leitlinie Pankreatitis im Februar 2020 mit einer Zustimmung von 97,3 % als Teil der Leitlinienempfehlung angenommen. Im folgenden Text mit Glossar werden die übersetzten und konsentierten Begrifflichkeiten anhand von Bildbeispielen erläutert. Kernaussagen

Due to its excellent intrinsic soft tissue contrast, magnetic resonance imaging allows excellent visualization and anatomical separation of therapy-relevant risk structures such as the mesorectal fascia, local lymph nodes, and vascular structures in patients with rectal carcinoma. This makes magnetic resonance imaging (MRI) a valuable evaluation method for further therapeutic stratification. In particular, MRI is indispensable for the decision to refrain from neoadjuvant therapy and to choose a primary surgical approach. In addition to the oncologically generally relevant T-, N-, and M-criteria, two further parameters are included: the extramural vascular infiltration and the circumferential resection margin. Due to the significant impact of MRI on further therapeutic decision-making, standardized MR image quality is considered essential. KEY POINTS:: · Magnetic resonance imaging is a valuable evaluation method for further therapeutic stratification.. · Critical anatomic landmarks for evaluation are circumferential resection margins.. CITATION FORMAT: · Attenberger UI, Clasen S, Ghadimi M et al. Importance and Qualitative Requirements of Magnetic Resonance Imaging for Therapy Planning in Rectal Cancer - Interdisciplinary Recommendations of AIO, ARO, ACO and the German Radiological Society. Fortschr Röntgenstr 2021; 193: 513 - 520.Die Magnetresonanztomografie (MRT) erlaubt aufgrund ihres ausgezeichneten intrinsischen Weichteilkontrastes bei Patienten mit Rektumkarzinom eine hervorragende Darstellung und anatomische Separation therapierelevanter Risikostrukturen wie der mesorektalen Faszie, lokaler Lymphknoten und benachbarter Organe. Dies macht die MRT zu einer wertvollen Bewertungsmethode für die therapeutische Stratifizierung. Insbesondere ist die MRT unverzichtbar für die Entscheidung für den Verzicht auf eine neoadjuvante Therapie und die Wahl eines primär operativen Vorgehens. Neben den onkologisch allgemein relevanten T-, N- und M-Kriterien finden 2 weitere Parameter Eingang: die extramurale Gefäßinfiltration und der zirkumferenzielle Resektionsrand. Aufgrund des wesentlichen Einflusses des MRTs auf die therapeutische Entscheidungsfindung ist eine flächendeckende, standardisierte Bildqualität essenziell. KERNAUSSAGEN:: · Die MRT ist eine wertvolle Bewertungsmethode für die weitere therapeutische Stratifizierung des Rektumkarzinoms.. · Wesentliche Kriterien für die therapeutische Stratifizierung sind: mesorektale Faszie (MRF), Lymphknotensituation, extramurale Gefäßinfiltration.. ZITIERWEISE: · Attenberger UI, Clasen S, Ghadimi M et al. Importance and Qualitative Requirements of Magnetic Resonance Imaging for Therapy Planning in Rectal Cancer – Interdisciplinary Recommendations of AIO, ARO, ACO and the German Radiological Society. Fortschr Röntgenstr 2021; 193: 513 – 520.

The working group for gastrointestinal and abdominal imaging within the German Radiological Society performed a nationwide online survey in order to assess the current status regarding the awareness and application of LI-RADS, a classification for evaluation of liver lesions in patients at risk. Using the website www.deutsches-krankenhausverzeichnis.de a list of hospitals was generated meeting the criteria internal medicine, gastroenterology, general and visceral surgery and radiology (n = 391). Randomly, 102 department directors were contacted, and asked to name one consultant and one resident from their department in order to participate in the survey. 177 potential participants were invited to fill out an approximately 10-minute online survey in the form of 17 questions regarding the awareness and application of LI-RADS. The results of the survey were analyzed by means of descriptive statistics. 77 participants were registered, which corresponds to a response rate of 43.5 %. 47 % of all participants were radiologists, 30 % surgeons and 23 % internal doctors/gastroenterologists, respectively, many with more than 13 years of professional experience (37.2 %). The majority of participants worked in a hospital with a focus (37.2 %) or a university hospital (29.1 %). Even though the majority of participants knows about or has heard of LI-RADS (73.2 %), only a minority uses the classification themselves (26 %) or within the context of tumor boards (19.2 %). The results of our survey demonstrate that LI-RADS is relatively known in Germany, the application however quite sparse. This is in contrast to the general desire and endeavor for more standardized reporting in radiology.· LI-RADS is not yet broadly implemented in clinical routine in Germany. · The sparse application is in contrast to the general desire for more standardized reporting in radiology. · Interdisciplinary education may support the propagation and use of the LI-RDAS classification.· Ringe KI, Gut A, Grenacher L et al. LI-RADS in the year 2020 - Are you already using it or still considering? Fortschr Röntgenstr 2021; 193: 186 - 193.ZIEL: In einer bundesweiten Online-Umfrage der Arbeitsgemeinschaft Gastrointestinal- und Abdominaldiagnostik der Deutschen Röntgengesellschaft erfolgte eine aktuelle Standorterhebung im Hinblick auf die Bekanntheit und Nutzung der LI-RADS (Liver Imaging Reporting and Data System)-Klassifikation bei der Beurteilung von Leberläsionen im Risikokollektiv. Über die Internetseite www.deutsches-krankenhausverzeichnis.de wurde eine Liste von Krankenhäusern generiert, welche die Kriterien Innere Medizin, Gastroenterologie, Allgemein- und Viszeralchirurgie und Radiologie erfüllten (n = 391). Per Zufall wurden 102 Chefärzte der entsprechenden Abteilungen kontaktiert mit der Bitte, jeweils einen Fach- bzw. Oberarzt sowie einen Weiterbildungsassistenten zwecks Kontaktaufnahme und Teilnahme an der Umfrage zu benennen. Den insgesamt 177 eingeladenen Teilnehmern wurde mithilfe des SurveyMonkey Insgesamt beantworteten 77 Teilnehmer den Fragebogen, entsprechend einer Rücklaufquote von 43,5 %. Bei den Teilnehmern handelte es sich zu 47 % um Radiologen, zu 30 % um Chirurgen und zu 23 % um Internisten, der überwiegende Anteil mit mehr als 13 Jahren Berufserfahrung (37,2 %). Die Mehrheit der Teilnehmer arbeitete an einem Krankenhaus mit Schwerpunktversorgung (37,2 %) oder einem Universitätsklinikum (29,1 %). Auch wenn die Mehrheit der Teilnehmer (73,2 %) LI-RADS kennt bzw. schon einmal davon gehört hat, so wird LI-RADS lediglich von der Minderheit selbst (26 %) bzw. im Rahmen von Tumorkonferenzen (19,2 %) verwendet. Die Ergebnisse der Umfrage zeigen, dass die LI-RADS-Klassifikation zwar relativ bekannt ist, aber nur vereinzelt genutzt wird. Dies steht im Gegensatz zu dem allgemeinen Wunsch und Bestreben nach mehr standardisierter Befundung in der Radiologie.· Die Anwendung der LI-RADS-Klassifikation hat sich im deutschsprachigen Raum noch nicht durchgesetzt.. · Es besteht eine Diskrepanz zwischen dem Wunsch bzw. Bestreben nach mehr standardisierter Befundung und der tatsächlichen Anwendung genau dieser.. · Interdisziplinäre Fortbildungen können helfen, die Verbreitung und Anwendung der LI-RADS-Klassifikation zu verbessern..· Ringe KI, Gut A, Grenacher L et al. LI-RADS in the year 2020 – Are you already using it or still considering? Fortschr Röntgenstr 2021; 193: 186 – 193.

Radiological reports of pancreatic lesions are currently widely formulated as free texts. However, for optimal characterization, staging and operation planning, a wide range of information is required but is sometimes not captured comprehensively. Structured reporting offers the potential for improvement in terms of completeness, reproducibility and clarity of interdisciplinary communication. Interdisciplinary consensus finding of structured report templates for solid and cystic pancreatic tumors in computed tomography (CT) and magnetic resonance imaging (MRI) with representatives of the German Society of Radiology (DRG), German Society for General and Visceral Surgery (DGAV), working group Oncological Imaging (ABO) of the German Cancer Society (DKG) and other radiologists, oncologists and surgeons. Among experts in the field of pancreatic imaging, oncology and pancreatic surgery, as well as in a public online survey, structured report templates were developed by consensus. These templates are available on the DRG homepage under www.befundung.drg.de and will be regularly revised to the current state of scientific knowledge by the participating specialist societies and responsible working groups. This article presents structured report templates for solid and cystic pancreatic tumors to improve clinical staging (cTNM, ycTNM) in everyday radiology. · Structured report templates offer the potential of optimized radiological reporting with regard to completeness, reproducibility and differential diagnosis.. · This article presents consensus-based, structured reports for solid and cystic pancreatic lesions in CT and MRI.. · These structured reports are available open source on the homepage of the German Society of Radiology (DRG) under www.befundung.drg.de..· Persigehl T, Baumhauer M, Baeßler B et al. Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). Fortschr Röntgenstr 2020; 192: 641 - 655. In der klinischen Radiologie werden aktuell radiologische Befundberichte bei Pankreasläsionen weitverbreitet als Freitexte formuliert. Für die optimale klinische Versorgung, das Staging und die Operationsplanung sind mannigfaltige Informationen erforderlich, die mitunter nicht umfänglich erfasst werden. Die strukturierte Befundung bietet hier das Potenzial einer Verbesserung in Bezug auf Vollständigkeit, Reproduzierbarkeit sowie Klarheit der interdisziplinären Kommunikation. Interdisziplinäre Erstellung von strukturierten Befundvorlagen für solide und zystische Pankreastumoren in der Computertomografie (CT) und in der Magnetresonanztomografie (MRT) mit Vertretern der Deutschen Röntgengesellschaft (DRG), der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), der Arbeitsgemeinschaft Onkologische Bildgebung (ABO) der Deutschen Krebsgesellschaft (DKG) sowie weiteren Radiologen, Onkologen und Chirurgen. Unter Experten auf dem Gebiet der Pankreasbildgebung, onkologischen Versorgung und Pankreaschirurgie sowie in einer öffentlichen Online-Umfrage wurden strukturierte Befundvorlagen im Konsensus-Verfahren entwickelt, die im weiteren Verlauf regelmäßig durch die beteiligten Fachgesellschaften und verantwortlichen Arbeitsgemeinschaften auf den aktuellen Stand der wissenschaftlichen Erkenntnis angepasst werden sollen. Dieser Artikel stellt strukturierte Befundvorlagen für solide und zystische Pankreastumoren vor, die im radiologischen Alltag helfen sollen, das klinische Staging (cTNM, ycTNM) zu verbessern. · Strukturierte Befundvorlagen bieten das Potenzial einer optimierten radiologischen Befundung in Bezug auf Vollständigkeit, Reproduzierbarkeit und Differenzialdiagnose.. · Dieser Artikel stellt Konsensus-basierte, strukturierte Befundvorlagen für solide und zystische Pankreasläsionen im CT und MRT vor.. · Die von der Deutsche Röntgengesellschaft entwickelten Befundvorlagen werden unter www.befundung.drg.de zur Verfügung gestellt..· Persigehl T, Baumhauer M, Baeßler B et al. Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). Fortschr Röntgenstr 2020; 192: 641 – 656.

Die weiter zunehmende Verbreitung von SARS-CoV-2 als von der WHO anerkannte Pandemie prägt gegenwärtig entscheidend unser gesellschaftliches und ärztliches Handeln.

ZusammenfassungDer Beitrag liefert das Rüstzeug für ein fundiertes radiologisch-anatomisches Verständnis des Intra- und Retroperitonealraums. Typische Ausbreitungsmuster von Erkrankungen werden systematisch pathoanatomisch erläutert und ihr Potenzial für (differenzial-)diagnostische Rückschlüsse aufgezeigt.

Good training is the basis for high job satisfaction and high-quality patient care in radiology. The aim of this survey was to record the current state of working conditions for residents in radiology training in Germany and to focus on the aspects of training and psychosocial workload. The description of the actual state should help to identify possible problem areas and to develop improvement approaches. At the beginning of 2018, we sent an electronic questionnaire to the German Roentgen Society (DRG), the German Association of Chairmen in Academic Radiology (KLR), the Chief Physician Forum of the DRG (CAFRAD) and the Forum of Registered Radiologists (FUNRAD) with the request to forward it to radiology residents. With 63 questions, the questionnaire covered seven essential areas of medical working and training conditions. In order to ensure interdisciplinary comparability, most questions were identical to previous surveys among residents of other disciplines. 643 residents started the survey. 501 (78 %) questionnaires were fully processed and included in the final analysis. 65 % of respondents were satisfied with their current job situation. At the same time, shortcomings, especially with regard to the reconciliation of family and work as well as scientific and clinical work, became clear. Only 36 % of participants with children were satisfied with the compatibility of family and work at their workplace. Only 31 % of the researchers were satisfied with their research conditions. In addition, residents experienced a high psychosocial workload. Job satisfaction is high among radiology residents in direct comparison to other disciplines. However, based on this survey, adjustments to working conditions and training in radiology seem necessary to maintain the health of the physicians concerned, to encourage motivation for scientific work and to enhance development opportunities, especially for women, through a better compatibility of work and family life. The present survey identifies strategies and leadership tools that can help to achieve this. Residents in radiology training ... · have a relatively high job satisfaction.. · experience a high psychosocial workload.. · evaluate the compatibility of family and work as in need of improvement.. · are interested in research, but evaluate research conditions as insufficient.· Oechtering TH, Panagiotopoulos N, Völker M et al. Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Röntgenstr 2020; 192: 458 - 469.ZIEL: Eine qualitativ hochwertige Weiterbildung ist Grundlage für eine hohe Arbeitszufriedenheit und eine exzellente Patientenversorgung in der Radiologie. Ziel dieser Umfrage war es, den aktuellen Stand der Arbeitsbedingungen von Ärzten in der Weiterbildung Radiologie in Deutschland zu erfassen und einen Fokus auf die Teilaspekte Weiterbildung sowie psychosoziale Arbeitsbelastung zu legen. Die Beschreibung des Ist-Zustandes soll helfen, mögliche Problemfelder zu identifizieren und Verbesserungsansätze zu entwickeln. Anfang 2018 wurde ein elektronischer Fragebogen über die Deutsche Röntgengesellschaft (DRG) e. V., die Konferenz der Lehrstuhlinhaber für Radiologie (KLR), das Chefarztforum der DRG (CAFRAD) und das Forum Niedergelassener Radiologen (FUNRAD) an radiologische Weiterbildungsassistenten verschickt. Der Fragebogen deckte mit 63 Fragen 7 wesentliche Themenfelder ärztlicher Arbeits- und Weiterbildungsbedingungen ab. Um eine fächerübergreifende Vergleichbarkeit zu sichern, wurden Fragen von bisherigen Erhebungen unter Ärzten in Weiterbildung anderer Fachrichtungen übernommen. 643 Ärzte haben die Umfrage begonnen. 501 (78 %) Fragebögen wurden vollständig bearbeitet und in die endgültige Analyse einbezogen. 65 % der Befragten waren mit ihrer derzeitigen beruflichen Situation zufrieden. Gleichzeitig wurden Defizite besonders in Bezug auf die Vereinbarkeit von Familie und Beruf sowie die Möglichkeit zu wissenschaftlichem Arbeiten deutlich. Nur 36 % der Teilnehmer mit Kindern waren zufrieden mit der Vereinbarkeit von Familie und Beruf an ihrem Arbeitsplatz. Nur 31 % der wissenschaftlich Tätigen waren zufrieden mit ihren Forschungsbedingungen. Zudem war die psychosoziale Arbeitsbelastung unter den befragten Ärzten stark ausgeprägt. Die Arbeitszufriedenheit ist unter radiologischen Assistenzärzten im Vergleich zu anderen Fachrichtungen hoch. Dennoch scheinen auf Basis dieser Erhebung Anpassungen der Arbeits- und Weiterbildungsbedingungen in der Radiologie erforderlich, um die Gesundheit der betroffenen Ärzte zu erhalten, die Motivation für wissenschaftliches Arbeiten zu fördern und die Entwicklungsmöglichkeiten insbesondere von Frauen durch eine bessere Vereinbarkeit von Familie und Beruf aufzuwerten. Die vorliegende Umfrage zeigt Strategien und Führungsinstrumente auf, mit denen dies erreicht werden kann. Ärzte in radiologischer Weiterbildung ... · sind zufrieden mit ihrer beruflichen Situation.. · stehen unter hoher psychosozialer Arbeitsbelastung.. · bewerten die Vereinbarkeit von Familie und Beruf als verbesserungsbedürftig.. · sind an Forschung interessiert, bewerten die Forschungsbedingungen aber als unzureichend..· Oechtering TH, Panagiotopoulos N, Völker M et al. Work and Training Conditions of German Residents in Radiology – Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Röntgenstr 2020; 192: 458 – 470.

Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

The Atlanta classification published in 1992 was supposed to classify the severity and complications in acute pancreatitis with the goal of providing uniform terminology for clinicians and researchers. After continuous evolution, the revised Atlanta classification was published in 2012. In this updated classification, imaging aspects were better integrated and unclear terms were better defined. To date, this terminology for disease grading, severity, and local complications has been solely available in English. This prevented wide acceptance of the classification by the German-speaking medical community. Therefore, an expert team of the German Radiological Society translated the terms based on German medical literature. This translation was approved by consensus in the new S3 guideline meeting in February 2020 with an approval rate of 97.3 %. This manuscript explains the translated and approved German terminology of the revised Atlanta classification and offers additional imaging examples. KEY POINTS:: · The revised Atlanta classification allows correct definition of the grading and complication assessment of acute pancreatitis.. · An expert group translated the terms into the German language. The translation was approved by the S3 guideline committee for pancreatitis.. · Based on the new German S3 guideline for pancreatitis, the translated terms should be employed consistently.. CITATION FORMAT: · Schreyer AG, Seidensticker M, Mayerle J et al. German Terminology of the Revised Atlanta Classification of Acute Pancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis. Fortschr Röntgenstr 2021; 193: 909 - 918.Die im Jahr 1992 veröffentlichte Atlanta-Klassifikation zur Beurteilung von Schweregraden und Komplikationen der akuten Pankreatitis sollte ursprünglich eine einheitliche Terminologie für Kliniker und Forscher etablieren. Nach einer kontinuierlichen Weiterentwicklung wurde dann 2012 die revidierte Atlanta-Klassifikation publiziert, um die Aspekte der Bildgebung besser zu integrieren sowie Unschärfen in der Terminologie zu optimieren. Diese Begrifflichkeiten bezüglich der Krankheitseinteilung, -phasen, Schweregradbeurteilung und lokaler Komplikationen lagen bisher lediglich als englische Ausdrücke vor. Dies verhinderte eine weitere Verbreitung und Anwendung im klinischen Alltag im deutschsprachigen Raum. Um eine Anpassung in der deutschsprachigen Medizin zu erreichen, wurden die Termini der revidierten Atlanta-Klassifikation durch ein Expertenteam der Deutschen Röntgengesellschaft basierend auf aktueller Literatur übersetzt und im Rahmen der Konsensuskonferenz der neu erstellten S3-Leitlinie Pankreatitis im Februar 2020 mit einer Zustimmung von 97,3 % als Teil der Leitlinienempfehlung angenommen. Im folgenden Text mit Glossar werden die übersetzten und konsentierten Begrifflichkeiten anhand von Bildbeispielen erläutert. KERNAUSSAGEN:: · Die revidierte Atlanta-Klassifikation ermöglicht eine korrekt definierte Bezeichnung von Krankheitsstadien und Komplikationen der akuten Pankreatitis.. · Die von einer Expertengruppe ins Deutsche übersetzten Begrifflichkeiten wurden im Rahmen der neuen S3-Leitlinie Pankreatitis konsentiert.. · Basierend auf der neuen S3-Leitlinie Pankreatitis sollen die deutschen Begriffe konsequent verwendet werden..

The working group for abdominal and gastrointestinal diagnosis is a group of the German Radiological Society (DRG) focusing clinically and scientifically on the diagnosis and treatment of the gastrointestinal tract as well as the parenchymal abdominal organs. In this article we give an up-to-date literature review of scientific radiological topics especially covered by German radiologists. The working group experts cover the most recent relevant studies concerning liver-specific contrast media with an emphasis on a new classification system for liver adenomas. Additionally studies regarding selective internal radiotherapy (SIRT) are reviewed. For the pancreas the most important tumors are described followed by an introduction to the most recently introduced functional imaging techniques. The manuscript concludes with some remarks on recent studies and concerning chronic pancreatitis as well as autoimmune pancreatitis. Key Points: • Different subtypes of liver adenomas with different therapeutic consequences can be differentiated by MRI • Most recently published studies focus on liver imaging with extracelluar liver specific contrast media as well as diffusion weighted imaging. They consider this new method having a high diagnostic potential. • For pancreatic neoplasm diagnosis diffusion – as well as perfusion – imaging is considered as a highly promising method. Citation Format: • Grenacher L, Juchems MS, Holzapfel K et al. A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 2: Abdominal Parenchymal Organs. Fortschr Rontgenstr 2016; 188: 245 – 252

The working group for abdominal and gastrointestinal diagnosis is a group of the German Radiological Society (DRG) focusing clinically and scientifically on the diagnosis and treatment of the gastrointestinal tract with all parenchymatous abdominal organs. In addition to the clinical and scientific further development of abdominal radiology, the education of radiologists within this core discipline of radiology is one of the major aims. In this article we give an up-to-date literature review of scientific radiological topics especially covered by German radiologists. This manuscript focuses on the most recent literature on the diagnosis of the stomach, small bowel, colon and rectum. The review with a focus on the most recent studies published by German radiologists concludes with a synopsis of mesenterial bleeding and ischemia followed by a critical appraisal of the current literature on conventional abdominal radiography. Key Points: • Based on recent literature and guidelines there is a change of paradigms regarding the diagnosis of esophagus and gastric cancer towards CT, which is considered equally to endosonography. • For small bowel imaging in Crohn’s disease ultrasound as well as MRI with a new focus on DWI are the most important imaging modalities scientifically. • For colonic diagnosis virtual colonoscopy has replaced the conventional radiological methods. For staging of rectal carcinoma as well as for therapeutic stratification a high resolution MRI of the pelvis is of paramount interest. • Multislice CT is considered the most important modality to assess mesenteric ischemia or bleeding. Citation Format: • Schreyer AG, Wessling J, Kinner S et al. A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 1: Gastrointestinal Tract. Fortschr Rontgenstr 2016; 188: 134 – 145

Evaluation of diagnostic accuracy of abdominal CT depending on the type of enteric contrast agent. Multislice CTs of 2,008 patients with different types of oral preparation (positive with barium, n = 576; neutral with water, n = 716; and no enteric contrast, n = 716) were retrospectively evaluated by two radiologists including delineation of intestinal segments and influence on diagnosis and diagnostic reliability exerted by the enteric contrast, using a three-point scale. Furthermore, diagnostic reliability of the delineation of selected enteric pathologies was noted. CT data were assigned into groups: oncology, inflammation, vascular, pathology, trauma and gastrointestinal pathology. Delineation of the bowel was clearly practicable across all segments irrespective of the type of enteric contrast, though a slight impairment was observed without enteric contrast. Although delineation of intestinal pathologies was mostly classified “clearly delimitable” more difficulties occurred without oral contrast (neutral/positive/no contrast, 0.8 %/3.8 %/6.5 %). Compared to examinations without enteric contrast, there was a significant improvement in diagnosis that was even increased regarding the reader’s diagnostic reliability. Positive opacification impaired detection of mucosal enhancement or intestinal bleeding. Water can replace positive enteric contrast agents in abdominal CTs. However, selected clinical questions require individual enteric contrast preparations. Pathology detection is noticeably impaired without any enteric contrast. • Neutral oral contrast ensures an equivalent delineation of the bowel. • Neutral contrast ensures a similar detection rate for intestinal pathologies. • Positive enteric contrast should be used in selected questions (suspected fistulas, abscesses). • Detection of pathologies and bowel delineation proved more difficult without oral contrast. • Diagnosis and the reporting physician’s diagnostic reliability are impaired without enteric contrast.

Purpose: The working group for abdominal imaging within the German Roentgen Society (DRG) performed an online survey amongst radiologist concerning the current status of techniques for abdominal imaging. The results of this survey were compared with the most recent guidelines. Materials and Methods: We performed an online survey open for all members of the DRG during a 76-day period with 65 questions and an overall estimated time for finishing the questionnaire of 15 minutes concerning technical specifications for abdominal radiological imaging. The results were evaluated using descriptive statistics. Results: 90 of all participants, who filled out the survey covering more than 80 % of the questions, were included in the statistical evaluation. 27 % of all participants were registered radiologists while 73 % represented radiologists working in a hospital. Most participants worked in a managerial position. The participants gave detailed information regarding the radiological techniques used in dedicated organ systems (esophagus, stomach, pancreas, liver, small intestines, colon) regarding acquired contrast phases and oral and intravenous administration of contrast medium. Conclusion: The results confirm that most radiologists participating in this survey perform their examinations and choose their modalities in conformity with the current existing clinical guidelines. Because most clinical guidelines do not specify radiological examinations in detail, there is a noteworthy heterogeneity of the acquired contrast phases and major divergence in terms of technical parameters. Therefore a joint radiological effort should be initiated for developing and publishing updated radiological parameters for abdominal imaging. Key Points: • In German speaking countries indications for abdominal radiological examinations are performed with a high compliance to published guidelines. • There is a significant heterogeneity regarding the acquisition of different contrast phases for parenchymal abdominal organs. • There is an urgent need to publish radiological recommendations and guidelines based on current radiological literature for radiological abdominal imaging. Citation Format: • Schreyer AG, Wessling J, Grenacher L. Versorgungsrealitat vs. leitliniengerechte Bildgebung in der Abdominalradiologie im deutschsprachigen Raum: Ergebnisse einer Online-Umfrage. Fortschr Rontgenstr 2016; 188: 1 – 12

Background The use of pre-filled syringes for contrast media (CM) administration allows efficient and optimized workflow during radiologic diagnostic procedures, and reduces the risk of contamination, providing benefits for both patients and healthcare workers. Purpose To compare the efficiency and safety of ioversol (OptirayTM) bottles and pre-filled syringes in clinical practice. Material and Methods This was an observational, non-interventional, prospective, multicenter study conducted at 72 centers in Germany. Patients undergoing contrast-enhanced computed tomography (CT) examinations with ioversol were enrolled. The use of ioversol bottles and pre-filled syringes in the diagnostic procedure was recorded in terms of efficiency (residual volume, re-use of CM) and safety (adverse events [AEs]). Results A total of 10,836 patients were enrolled and included in this study. Ioversol bottles and syringes were used in 72% and 28% of cases, respectively. Analysis of the volume of CM in bottles before and after examinations, together with the volume used during the examination, suggested that in 22.5% of cases a new bottle was connected during the procedure. Further analysis revealed that in 80.2% of cases, the remaining volume of CM in the bottles could potentially be used for subsequent investigations, compared with Conclusion Administration of ioversol for contrast-enhanced CT examinations is associated with a low incidence of AEs and is generally safe and well tolerated. Ioversol pre-filled syringes were associated with lower residual volumes and less potential re-use compared with bottles.

Ausschlaggebend fur die individuelle Therapieentscheidung und die Abschatzung der Prognose bei Patienten mit vermutetem Lungenkarzinom ist die korrekte Klassifizierung der Erkrankung. Hierfur liegt die momentan gultige 7. Version der TNM-Klassifikation vor, die auf einer Analyse einer grosen Zahl von Patientendatensatzen beruht und somit eine valide prognostische Gruppierung der Patienten mit Lungenkarzinom erlaubt. Sowohl fur die initiale Diagnostik als auch fur das Staging gibt es eine Vielzahl an invasiven und nicht invasiven Untersuchungsmethoden. Eine evidenzbasierte Grundlage fur das diagnostische Vorgehen und die anschliesende Therapie bietet die aktuell gultige nationale S3-Leitlinie fur die Pravention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms. Basierend auf dieser Leitlinie sollen in dieser Ubersicht die etablierten diagnostischen Verfahren bewertet werden.

Objective: Comparison of 2-dimensional and semiautomated 3-dimensional (3D) measurements to distinguish between benign and malignant lymph nodes in patients with malignant lymphoma. Methods: Whole-body positron emission tomography-computed tomography (PET-CT) was performed in 33 patients before therapy for malignant lymphoma. Two hundred fifty-seven peripheral lymph nodes (mean size, 13.4 ± 5.4 mm) were evaluated independently by 2 radiologists, both manually and with the use of semiautomated segmentation software. Long-axis diameter (LAD), short-axis diameter (SAD), maximal 3D diameter, volume, and elongation were measured. Positron emission tomography-CT and PET-CT follow-up and/or histology served as the reference standard. Statistical analysis encompassed intraclass correlation coefficients and receiver operating characteristic curves. Results: The standard of reference revealed involvement in 116 (45%) of 257 lymph nodes. Manual and semiautomated LAD and SAD showed good correlation with intraclass coefficients of 0.85 and 0.72, respectively. Semiautomated prediction of malignant lymph nodes revealed the highest areas under the receiver operating characteristic curves for volume (0.760; 95% confidence interval [CI], 0.639-0.887) followed by SAD (0.740; 95% CI, 0.616-0.862). The findings for LAD (0.722; 95% CI, 0.588-0.855), maximal 3D diameter (0.697; 95% CI, 0.565-0.830), and lymph node elongation (0.605; 95% CI, 0.466-0.745) were significantly lower (P < 0.05). Conclusions: Volumetric lymph node analysis is significantly superior compared with established LAD in the prediction of lymph node involvement and therefore can add to the definition of peripheral lymphoma target lesions.

Cystic pancreatic lesions are often discovered incidentally as an asymptomatic finding, at a rate which is increasing considerably. In recent years the understanding of such tumors has become clearly differentiated. The spectrum of relevant lesions includes in particular the intraductal papillary mucinous neoplasm (IPMN), serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN). With certain knowledge of their histological and radiomorphological structure as well as their distribution in terms of location, age and sex, such tumors are easy to differentiate and demarcate from common pancreatic pseudocysts. This also implies the fundamental understanding of complementary endoscopic procedures such as endosonography, which enables aspiration of the content of the cyst. A number of cystic pancreatic lesions have the potential to undergo malignant transformation along the adenoma-carcinoma sequence and therefore necessitate a differentiated approach to their radiological management. This review aims to develop a broad understanding of the pathological and radiomorphological characteristics of cystic pancreatic lesions and provides advice regarding procedures, particularly with respect to incidentally detected lesions.

Multiple use of syringes in automatic injectors is considered to place patients at risk of septic complications. The purpose of this study was to evaluate the microbiologic contamination and time efficiency associated with routine clinical use of single-use prefilled disposable syringes for contrast administration.To ensure a hygienic background, imprints of devices and the palms of the hands of staff members were microbiologically analyzed before the clinical investigation. The microbiologic contamination of prefilled contrast and saline syringes was analyzed according to two protocols: single use of prefilled contrast syringes and saline syringes (n = 60) and single use of prefilled contrast syringes but multiple use of saline syringes for four injections or patients (n = 60). The time required for assembly of the injection system and filling and refilling for each protocol was measured.Contamination of the surfaces of devices and palms in the CT department was within the acceptable range for hygienic conditions. Prefilled disposable syringes for the contrast agent and saline solution used once had no microbiologic contamination. Microbial contamination with coagulase-negative staphylococci was found in two saline syringes used repeatedly. The time for assembly of the injection system and installation of prefilled syringes did not differ significantly (p = 0.45) between the single-use protocol (2.3 +/- 1.1 minutes) and the multiple-use protocol (2.0 +/- 1.4 minutes).Use of prefilled contrast syringes with single-use saline syringes is associated with time-efficient assembly of injection systems and prevents microbiologic contamination in clinical routine, especially in the care of immunocompromised patients.

The aim of this study was to determine whether individually tailored protocols for the injection of contrast medium (CM) result in higher and more homogeneous vascular attenuation throughout the coronary arteries at coronary CT angiography compared with conventional injection protocols using fixed injection parameters. Of 120 patients included in the study, 80 patients were randomized into two groups. Group 1 received 80 mL of CM at 6 mL/s. For group 2 injection parameters were individually adjusted to patient weight, the duration of CT data acquisition, and attenuation parameters following a test bolus. In the control group (group 3) the volume of CM was adjusted to the duration of CT data acquisition and injected at 5 mL/s. Attenuation was measured in the proximal, middle, and distal right coronary artery (RCA), in the proximal and middle left anterior descending artery (LAD), and in cranial and caudal sections of both ventricles. Patient parameters, scan delay, and scan duration did not differ significantly between the groups. Mean CM volume was 82.5 mL (flow rate 5.1 mL/s) in group 2 and 73.5 mL in group 3. Attenuation in both RCA and LAD was significantly higher for group 2 vs. group 3 (RCA: 414.9 + or - 49.9)-396.1(+ or - 52.1) HU vs. 366.0(+ or - 64.3)-341.6(+ or - 72.5) HU; LAD: 398.9(+ or - 48.6)-364.6(+ or - 44.6) HU vs. 356.3(+ or - 69.5)-323.0(+ or - 67.2) HU). For group 1 vs. group 2 only attenuation in the distal RCA differed significantly: 396.1(+ or - 52.1) vs. 370.7(+ or - 70.5) HU. Individually tailored CM injection protocols yield higher attenuation, especially in the distal segments of the coronary vessels, compared with injection protocols using fixed injection parameters.

Purpose To assess the accuracy of liver lesion measurement using automated measurement and segmentation software depending on the vascularization level. Materials and methods Arterial and portal venous phase multislice CT (MSCT) was performed for 58 patients. 94 liver lesions were evaluated and classified according to vascularity (hypervascular: 13 hepatocellular carcinomas, 20 hemangiomas; hypovascular: 31 metastases, 3 lymphomas, 4 abscesses; liquid: 23 cysts). The RECIST diameter and volume were obtained using automated measurement and segmentation software and compared to corresponding measurements derived visually by two experienced radiologists as a reference standard. Statistical analysis was performed using the Wilcoxon test and concordance correlation coefficients. Results Automated measurements revealed no significant difference between the arterial and portal venous phase in hypovascular (mean RECIST diameter: 31.4 vs. 30.2 mm; p = 0.65; kappa = 0.875) and liquid lesions (20.4 vs. 20.1 mm; p = 0.1; kappa = 0.996). The RECIST diameter and volume of hypervascular lesions were significantly underestimated in the portal venous phase as compared to the arterial phase (30.3 vs. 26.9 mm, p = 0.007, kappa = 0.834; 10.7 vs. 7.9 ml, p = 0.0045, kappa = 0.752). Automated measurements for hypovascular and liquid lesions in the arterial and portal venous phase were concordant to the reference standard. Hypervascular lesion measurements were in line with the reference standard for the arterial phase (30.3 vs. 32.2 mm, p = 0.66, kappa = 0.754), but revealed a significant difference for the portal venous phase (26.9 vs. 32.1 mm; p = 0.041; kappa = 0.606). Conclusion Automated measurement and segmentation software provides accurate and reliable determination of the RECIST diameter and volume in hypovascular and liquid liver lesions. Hypervascular lesions are prone to be underestimated with regard to size in the portal venous phase and therefore should preferentially be segmented in the arterial phase.

The purpose of this study was to assess the effect of dose reduction and the potential of noise reduction filters on image quality and the detection of liver lesions using MSCT. Twenty-nine patients with a total of 40 liver lesions underwent 16-slice CT (120 kV; 180 mAs). Virtual noise was added to CT raw datasets simulating effective mAs levels of 155, 130, 105, 80, 55, 30 and 10 mAs. All datasets were post-processed with an edge-preserving noise-reduction filter (ANR-3D), yielding a total of 15 datasets per patient. Ten radiologists performed independent evaluations of image quality, the presence of liver lesions and diagnostic confidence. Quantitative noise and contrast-to-noise ratios (CNR) were obtained. Superior image quality (P < 0.02), reduction of image noise (P < 0.001) and the increase of lesion-to-liver CNR (P < 0.001) were observed in images processed with the ANR-3D filter. Sensitivity for lesion detection remained unchanged down to 105 mAs (CTDI(w) 6.6 mGy) without filter and 80 mAs (CTDI(w) 5.1 mGy) with ANR-3D. Confidence was rated significantly higher for datasets reconstructed with ANR-3D. The use of a noise-reducing, but edge-preserving filter (ANR-3D) is a promising option to reduce further the radiation dose in liver CT.

To compare multi-detector row (four- and 16-section) computed tomography (CT), including a low-dose protocol, with high-field-strength (1.5- and 3.0-T) magnetic resonance (MR) imaging for reader detection of colorectal polyps in a colon phantom.A colon phantom with simulated haustral folds and 10 polyps of varying size (2.0-8.0 mm) was imaged at four- and 16-section CT (section thicknesses of 1.25 and 0.75 mm, reconstruction increments of 0.8 and 0.7 mm, and 100 and 10 mAs, respectively, and 120 kV for both) and at 1.5- and 3.0-T MR imaging (three-dimensional gradient-recalled echo sequence, section thickness of 1.4 mm). Three-dimensional endoluminal images were assessed by 10 reviewers for each modality regarding polyp detection. Comparisons of sensitivities were performed by using logistic regression.Overall, polyps were detected with a sensitivity of 87% (95% confidence interval [CI]: 80%, 94%) at four-section CT, 92% (95% CI: 87%, 97%) at 16-section CT, 56% (95% CI: 46%, 66%) at 1.5-T MR imaging, and 55% (95% CI: 45%, 65%) at 3.0-T MR imaging. The detection of polyps at least 4 mm in diameter was not influenced by the modality or radiation dose (sensitivity of 100%). CT performed in low-dose mode depicted all polyps with a diameter of at least 3 mm. Polyps smaller than 3 mm in diameter were detected with a sensitivity of 7.5% (1.5-T MR imaging), 22.5% (3.0-T MR imaging), and 20% (low-dose CT); detection rates were significantly greater (P.001) with normal-dose CT (four section, 67.5%; 16 section, 82.5%). Increased spatial resolution (with CT) and higher field strength (with MR imaging) had no significant effect on polyp detection.With both multi-detector row CT and MR imaging, readers detected polyps above the clinically relevant threshold diameter of 6 mm, with similar sensitivities.

A variety of imaging techniques are available to diagnose bile duct strictures; the most effective imaging technique, however, has not been established yet. In the present study, we compared the impact of endoscopic retrograde cholangiopancreatography (ERCP), intraductal ultrasonography (IDUS), and magnetic resonance cholangiopancreatography (MRCP) with regard to diagnosing bile duct strictures.We prospectively examined 33 patients with jaundice due to bile duct strictures by ERCP plus IDUS and MRCP. The objectives were to assess diagnostic quality of imaging, complete presentation of the bile duct, and differentiation of malignant from benign lesions. Surgical and histopathological correlations, which were used as the gold standard, were available in all cases since all included patients underwent laparotomy.Diagnostic image quality for ERCP was 88% and 76% for MRCP (p0.05). Comparing ERCP and MRCP, complete presentation of the biliary tract was achieved in 94% and 82%, respectively (p0.05). ERCP and MRCP allowed correct differentiation of malignant from benign lesions in 76% and 58% (p= 0.057), respectively. By supplementing ERCP with IDUS, the accuracy of correct differentiation of malignant from benign lesions increased significantly to 88% (p= 0.0047).Comparing ERCP with MRCP, we found adequate presentation of bile duct strictures in high imaging quality for both techniques. ERCP supplemented by IDUS gives more reliable and precise information about differentiation of malignant and benign lesions than MRCP alone without additional imaging sequences.

To determine optimal detector collimation, section thickness, and tube current for multi-detector row computed tomography (CT) colonography.An anthropomorphic colon phantom with simulated polyps of varying size (2, 6, 8, 10, and 12 mm) was examined by using multi-detector row CT with varying combinations of detector collimation (4 x 1.0 mm and 4 x 2.5 mm), dose per section (10, 20, 40, 60, 80, 100, and 140 mAs), and section thickness/reconstruction interval (1.25/0.6, 2.0/1.0, 3.0/1.0, and 5.0/2.0 mm). Polyp depiction, longitudinal polyp distortion, and presence of rippling artifacts were assessed on reformatted three-dimensional endoluminal images by three reviewers.Longitudinal distortion and rippling artifacts increased with increasing section thickness and use of broader detector collimation. Polyps 8 mm or larger were depicted with any combination of section thickness, detector collimation, and tube current. Depiction of polyps 6 mm or smaller depended on the detector collimation/reconstructed section thickness and was rated optimal for the 4 x 1.0-mm detector collimation with a section thickness of 1.25 mm. This was also observed for low-dose protocols. Polyps 6 mm or smaller that were not detected with 3-mm section thickness and 4 x 2.5-mm detector collimation were detected with 1.25-mm section thickness and 10 mAs.A narrow detector collimation with thin-section imaging (4 x 1.0-mm detector collimation, 1.25-mm section thickness) is a prerequisite for low-dose (10-mAs) multi-detector row CT colonography.

AIM: To compare endoscopic retrograde cholangio-pancreatography (ERCP), intraductal ultrasound (IDUS), endosonography (EUS), endoscopic transpapillary forceps biopsies (ETP) and computed tomography (CT) with respect to diagnosing malignant bile duct strictures. METHODS: A patient cohort with bile duct strictures of unknown etiology was examined by ERCP and IDUS, ETP, EUS, and CT. The sensitivity, specificity, and accuracy rates of the diagnostic procedures were calculated based on the definite diagnoses proved by histopathology or long-term follow-up in those patients who did not undergo surgery. For each of the diagnostic measures, the sensitivity, specificity, and accuracy rates were calculated. In all cases, the gold standard was the histopathologic staging of specimens or long-term follow-up of at least 12 mo. A comparison of the accuracy rates between the localization of strictures was performed by using the Mann-Whitney U-test and the χ2 test as appropriate. A comparison of the accuracy rates between the diagnostic procedures was performed by using the McNemar’s test. Differences were considered statistically significant if P < 0.05. RESULTS: A total of 234 patients (127 males, 107 females, median age 64, range 20-90 years) with indeterminate bile duct strictures were included. A total of 161 patients underwent operative exploration; thus, a surgical histopathological correlation was available for those patients. A total of 113 patients had malignant disease proven by surgery; in 48 patients, benign disease was surgically found. In these patients, the decision for surgical exploration was made due to the suspicion of malignant disease in multimodal diagnostics (ERCP, CT, or EUS). Fifty patients had a benign diagnosis and were followed by a surveillance protocol with a follow-up of at least 12 mo; the median follow-up was 34 mo. Twenty-three patients had extended malignant disease, and thus were considered palliative. A comparison of the different diagnostic tools for detecting bile duct malignancy resulted in accuracy rates of 91% (ERCP/IDUS), 59% (ETP), 92% (IDUS + ETP), 74% (EUS), and 73% (CT), respectively. In the subgroup analysis, the accuracy rates (%, ERCP + IDUS/ETP/IDUS + ETP; EUS; CT) for each tumor entity were as follows: cholangiocellular carcinoma: 92%/74%/92%/70%/79%; pancreatic carcinoma: 90%/68%/90%/81%/76%; and ampullary carcinoma: 88%/90%/90%/76%/76%. The detection rate of malignancy by ERCP/IDUS was superior to ETP (91% vs 59%, P < 0.0001), EUS (91% vs 74%, P < 0.0001) and CT (91% vs 73%, P < 0.0001); EUS was comparable to CT (74% vs 73%, P = 0.649). When analyzing accuracy rates with regard to localization of the bile duct stenosis, the accuracy rate of EUS for proximal vs distal stenosis was significantly higher for distal stenosis (79% vs 57%, P < 0.0001). CONCLUSION: ERCP/IDUS is superior to EUS and CT in providing accurate diagnoses of bile duct strictures of uncertain etiology. Multimodal diagnostics is recommended. peerReviewed

To evaluate the imaging characteristics of various iliac artery stents and stent-grafts in a multislice, computed tomography angiography (MSCTA) phantom study.Twelve types of stents and three stent-grafts made of different materials (steel, nitinol, tantalum, cobalt-based alloy) were implanted in plastic tubes with an 8-mm inner diameter filled with iodinated contrast medium diluted to 200 HU. To evaluate the influence of scan parameters on artifacts, the Palmaz stent (as one example) was scanned with a four-slice scanner (Siemens VolumeZoom) with different detector collimations and pitches. All other stents were examined with a collimation of 4 x 1 mm and a table feed of 4 mm/rotation. Axial images and multiplanar reformations were evaluated regarding artifact size, lumen visibility, and intraluminal attenuation values.Higher pitch values caused more pronounced artifacts. Image quality and delineation of the stent struts improved with thinner detector collimation. The size of the stent-related artifacts and the visibility of the stent lumen depended on the underlying stent material and design. Pronounced artifacts, resulting in an insufficient delineation of the stent lumen, were caused by the Strecker tantalum stent and the Zenith stent. Moderate artifacts were caused by the Wallgraft, Passager, Palmaz P 395 and P 424, Bridge, Perflex, and ZA stents. Some artificial lumen narrowing but good lumen delineation was seen with the Strecker nitinol, Symphony, Memotherm, SMART, Corinthian, and Wallstent stents.Scanning parameters, stent material, and stent design influence lumen assessability and image quality in MSCTA. Detailed lumen assessment is impossible in the Strecker tantalum and Zenith stents and limited in the Wallgraft, Passager, Palmaz P 395 and PS 424, Bridge, Perflex, and ZA-stent stent-grafts but feasible in all other examined products.

PURPOSE To evaluate the image quality and radiation exposure of different spiral CT scanning parameters for routine staging examination of the abdomen in oncologic patients using a multi-slice CT scanner. METHODS/MATERIALS Examination of 40 patients in 4 groups on a multi-slice CT scanner (Somatom VolumeZoom, Siemens AG, Forchheim). Functional detector width (4 x 2.5, 4 x 5 mm) and pitch (table feed in relation to collimated slice width) were varied (3 and 5). Tube voltage (120 kV), effective tube current (160 mAs), slice-thickness (6 mm), increment (4 mm), kernel (B 30), and contrast injection parameters were kept constant. Axial images were assessed by three radiologists regarding delineation of anatomic structures, artifacts, and overall image quality. RESULTS Significantly reduced image quality especially due to artifacts was observed using a 5 mm detector configuration with a pitch of 5 (scan time 9 sec). Image quality was rated best for a 2.5 mm detector configuration with a pitch of 3 and a scan time of 28 sec. The effective dose was independent of the pitch. However, the mean effective dose was 9% higher using the smaller detector configuration (9.9 mSv vs 10.9 mSv). CONCLUSIONS For routine staging CT of the abdomen use of a 4 x 2.5 mm detector configuration with a pitch between 3 and 5 is recommended. A 4 x 5 mm detector configuration using overlapping data acquisition can also be recommended, but additional thin slice reformations are not possible.