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In addition to direct oncologic therapy, interventional radiology plays an important supportive role in oncologic therapy primarily guided by other disciplines. These supporting measures include diagnostic punctures, drainages, biliary interventions, central venous access including port implantations, osteoplasties, pain therapies etc.). This study investigated the extent to which these radiologically guided supportive measures are available in Germany.All interventional procedures documented in the DeGIR-registry (excluding transhepatic portosystemic shunts) of the years 2018 and 2019 were recorded (DeGIR-module C). A breakdown of the documented interventions was performed based on federal states as well as 40 individual regions (administrative districts and former administrative districts).A total of 136,328 procedures were recorded at 216 centers in DeGIR Module C in 2018 and 2019. On average, 389 cases were documented per hospital in 2018 and 394 cases in 2019; the increase per hospital from 2019 is not statistically significant but is relevant in the aggregate when new participating centers are included, with an overall increase of 10 % (6,554 more cases than the previous year). Normalized to one million inhabitants, an average of 781 procedures took place across Germany in 2018 and 860 in 2019. Districts with no registered procedures are not found for Module C.Indications for Module C interventions were mostly interdisciplinary in 2018 and 2019. In this context, the quality of outcome was very high; for the procedures drain placement, marking and biopsy the technical success was 99 %, while the complication rate was lower than 1 %.The structural analysis of this work concludes that in Germany there is good nationwide availability of radiologically guided supportive measures in oncological therapy. Accordingly, the training situation for prospective interventional radiologists is good, as the distribution to centers with high experience is excellent. In addition, the overall outcome quality of radiology-guided interventions is very high.· In Germany, there is good nationwide coverage of radiologically guided supportive interventions in oncological therapy.. · The training situation for prospective interventional radiologists is good, as the distribution to centers with high experience is excellent.. · The overall outcome quality of radiology-guided interventions is very high..· Nadjiri J, Schachtner B, Bücker A et al. Nationwide Provision of Radiologically-guided Interventional Measures for the Supportive Treatment of Tumor Diseases in Germany - An Analysis of the DeGIR Registry Data. Fortschr Röntgenstr 2022; 194: 993 - 1002.ZIEL: Die interventionelle Radiologie spielt neben der direkten onkologischen Therapie auch eine wichtige unterstützende Rolle in der primär von anderen Disziplinen geführten onkologischen Therapie. Diese unterstützenden Maßnahmen umfassen diagnostische Punktionen, Drainagen, PTCD, Portimplantationen, Osteoplastien, Schmerztherapien etc. In der vorliegenden Arbeit wurde untersucht, inwiefern in Deutschland eine flächendeckende Verfügbarkeit dieser Eingriffe vorliegt.Erfasst wurden alle im DeGIR-Register dokumentierten interventionellen Eingriffe (exklusive der Anlage des transhepatischen portosystemischen Shunts) der Jahre 2018 und 2019 (DeGIR-Modul C). Es erfolgte eine Aufschlüsselung der dokumentieren Eingriffe anhand von Bundesländern sowie 40 Einzelregionen (Regierungsbezirke und ehemalige Regierungsbezirke).Insgesamt wurden in den Jahren 2018 und 2019 im DeGIR-Modul C 136.328 Eingriffe an 216 Zentren erfasst. Im Durchschnitt wurden 2018 pro Klinik 389 Fälle dokumentiert und 2019 394 Fälle; der Anstieg pro Klinik zu 2019 ist nicht statistisch signifikant, jedoch in der Summe unter Einbeziehung neuer teilnehmender Zentren relevant mit einem Gesamtzuwachs von 10 % (6.554 Fälle mehr als im Vorjahr). Normiert auf 1 Million Einwohner fanden deutschlandweit 2018 im Durchschnitt 781 und 2019 860 Eingriffe statt.Bezirke ohne registrierte Eingriffe finden sich für das Modul C nicht. Die Indikationsstellung für Modul-C-Eingriffe erfolgte 2018 und 2019 zumeist interdisziplinär. Dabei war die Ergebnisqualität sehr hoch; für die Verfahren Drainagenanlage, Markierung und Biopsie betrug der technische Erfolg 99 %, während die Komplikationsrate deutlich kleiner als 1 % war.Die Strukturanalyse dieser Arbeit kommt zu dem Schluss, dass in Deutschland eine gute flächendeckende Versorgung mit radiologisch geführten, supportiven Maßnahmen in der onkologischen Therapie vorliegt. Entsprechend ist die Ausbildungssituation für angehende interventionelle Radiologen gut, da die Verteilung an Zentren mit großer Erfahrung hoch ist. Zudem ist die Ergebnisqualität der radiologisch geführten Maßnahmen insgesamt sehr hoch.· In Deutschland liegt eine gute flächendeckende Versorgung mit radiologisch geführten supportiven Eingriffen bei der onkologischen Therapie vor.. · Die Ausbildungssituation für angehende interventionelle Radiologen in Deutschland ist gut, da die Verteilung an Zentren mit großer Erfahrung hoch ist.. · Die Ergebnisqualität der radiologisch geführten Maßnahmen insgesamt sehr hoch..· Nadjiri J, Schachtner B, Bücker A et al. Nationwide Provision of Radiologically-guided Interventional Measures for the Supportive Treatment of Tumor Diseases in Germany – An Analysis of the DeGIR Registry Data. Fortschr Röntgenstr 2022; 194: 993 – 1002.

Peripheral artery disease (PAD) is a common condition with high socio-economic relevance. Therefore, qualified nationwide provision of interventional treatments of PAD is important for maintaining a high quality medical service in Germany.All data on revascularization procedures from the quality management system of the German interventional radiological society (DeGIR) for the years 2018 and 2019 were retrospectively analysed. Number and distribution of DeGIR certified endovascular specialists and treatment centres was mapped. Documented procedures were broken down to the level of administrative districts. Absolute number of revascularization procedures and normalized number per one million inhabitants were computed.In 2019 there were 57 732 revascularization procedures from 228 participating centres performed by DeGIR certified interventional radiologists. A median of 62 recanalization procedures were documented per centre. 36 centres were considered to be high volume centres, with more than 500 procedures each. On a regional level in the years 2018 and 2019 combined a median (range) of 2324 (323-12 518) revascularization procedures per administrative district were performed by DeGIR certified interventional radiologist.There is a comprehensive nationwide high quality interventional-radiology service for the provision of revascularization procedures available in Germany.· In Germany there is a nationwide comprehensive infratsructure for the interventional-radiological treatment of PAD. · The volume of interventional-radiological treatments for PAD is growing. · There is a sufficient number of training and treatment centres for the delivery of interventional radiology procedures.· Mahnken AH, Nadjiri J, Schachtner B et al. Availability of interventional-radiological revascularization procedures in Germany - an analysis of the DeGIR Registry Data 2018/19. Fortschr Röntgenstr 2022; 194: 160 - 168.Die periphere arterielle Verschlusskrankheit ist eine häufige, sozioökonomisch bedeutsame Erkrankung. Die qualifizierte flächendeckende Versorgung mit interventionellen Therapieangeboten für Patienten mit pAVK ist daher von besonderer Bedeutung für die medizinische Versorgungsqualität in Deutschland.Die Daten der Jahre 2018 und 2019 des Qualitätssicherungsregisters für interventionelle Therapien der Deutschen Gesellschaft für Interventionelle Radiologie (DeGIR) für das Modul A (gefäßeröffnende und gefäßrekonstruierende Verfahren) wurden analysiert. Zahl und Verteilung zertifizierter interventioneller Radiologen der DeGIR für Gefäßmedizin und entsprechende Behandlungszentren wurden erfasst. Es erfolgte eine Aufschlüsselung der dokumentierten Interventionen nach Regionen bis auf Ebene der Regierungsbezirke. Es wurden absolute Zahlen sowie auf 1 Million Einwohner normierte Zahlen bestimmt.Im Jahr 2019 wurden an 228 teilnehmenden Einrichtungen 57 732 interventionell-radiologisch erbrachte Eingriffe im Modul A dokumentiert. Im Jahr 2019 wurden im Median 162,0 Eingriffe je Zentrum dokumentiert. Davon waren 36 Einrichtungen „High Volume“-Zentren mit mehr als 500 dokumentierten Eingriffen pro Jahr. Auf Ebene der Regierungsbezirke wurden 2018 und 2019 zusammengenommen im Median (Bandbreite) 2324 (323–12 518) interventionell-radiologische Gefäßrevaskularisationen je Regierungsbezirk dokumentiert.Die qualitätsgesicherte Versorgung mit interventionell-radiologischen Prozeduren zur Gefäßrevaskularisation durch zertifizierte interventionelle Radiologen ist in Deutschland flächendeckend verfügbar.· In Deutschland existiert eine flächendeckende Versorgung für interventionell-radiologisch geführte Gefäßrekanalisationen.. · Das Untersuchungsvolumen von interventionell-radiologisch geführten Gefäßrekanalisationen nimmt weiter zu.. · In der Fläche besteht eine gute Versorgung mit interventionell-radiologischen Versorgungs- und Ausbildungszentren..· Mahnken AH, Nadjiri J, Schachtner B et al. Availability of interventional-radiological revascularization procedures in Germany – an analysis of the DeGIR Registry Data 2018/19. Fortschr Röntgenstr 2022; 194: 160 – 168.

Zusammenfassung Hintergrund Die transarterielle Chemoembolisation (TACE) oder auch Gallenganginterventionen stellen häufige Leberinterventionen dar. Ziel der Arbeit In dieser retrospektiven Studie soll die Strahlenexposition der Patienten mit einem hepatischen Eingriff in Abhängigkeit von Art und Feinziel der Intervention analysiert und verglichen werden. Material und Methoden Dies ist eine Analyse von 7003 DeGIR-Registerdatensätzen aus den Jahren 2016 bis 2018 für TACE und Gallenganginterventionen. Das Dosisflächenprodukt (DFP) und die Durchleuchtungszeit (DL) sowie die Interventionsart und das anatomisch definierte Feinziel der Interventionen wurden erfasst. Ergebnisse Insgesamt lagen Dosiswerte für 4985 durchgeführte TACE und 2018 Gallenganginterventionen vor. Bei Gallenganginterventionen lag der Median des DFP bei 2594 (Interquartilbereich [IQR] = 1174–5858) cGy*cm2. Bei der TACE betrug der Median des DFP 11.632 [IQR = 5530–22.800] cGy*cm2 und lag damit signifikant höher als bei Gallenganginterventionen (p Diskussion Die individuelle Strahlendosis für einen Patienten bei einer Leberintervention hängt weniger von der Komplexität des Eingriffs bzw. Durchleuchtungszeit ab, sondern von der Art des Eingriffs und vom Feinziel der Intervention. Die vorliegenden Dosisdaten können eine Hilfe sein, die Strahlenexposition bei einer Leberintervention bereits vor dem Eingriff grob abzuschätzen.

ZUSAMMENFASSUNGTrotz großer Fortschritte in der Diagnostik sowie der systemischen und chirurgischen Therapie belegt das hepatozelluläre Karzinom (HCC) den vierten Platz unter den tumorassoziierten Todesfällen. Der diagnostische Stellenwert der Ultraschalluntersuchung der Leber besteht in erster Linie in der HCC-Früherkennung bei Risikopatienten. Die histologische Sicherung eines HCCs ist in der nicht-zirrhotischen Leber bzw. im Falle unklarer Bildgebungsbefunde erforderlich. Die Computertomographie (CT) ermöglicht im Vergleich zur Magnetresonanztomografie (MRT) eine schnelle Untersuchung. Es sind Anzahl, Lokalisation und Größe der Tumorknoten sowie deren Bezug zu Pfortader und Lebervenen zu beschreiben. Die prätherapeutische Planung erfordert eine exakte Segmentzuordnung. Die Therapie des hepatozellulären Karzinoms ist abhängig vom Stadium der Tumorerkrankung. In Europa und den USA sind die BCLC (Barcelona Clinic Liver Cancer)-Kriterien für die Stadieneinteilung etabliert. Der operative Eingriff wird vor dem Hintergrund patientenspezifischer, klinischer Gesichtspunkte sowohl durch den Grad einer vorliegenden Leberzirrhose als auch durch das Stadium der Tumorerkrankung bestimmt. Grundsätzlich besteht für das HCC neben der Resektion auch die Möglichkeit einer Lebertransplantation. Im fortgeschritten HCC (BCLC C) mit Gefäßeinbruch des Tumors oder Metastasierung besteht die Indikation zur systemischen Tumortherapie. Bis heute sind Tyrosinkinaseinhibitoren beim fortgeschrittenen HCC (BCLC C) sowie im intermediären Stadium nach Progress unter lokoregionärer Therapie die einzig zugelassenen Erst- und Zweitlinientherapeutika in Europa. Der VEGFR2 Antikörper Ramucirumab ist das erste Präparat für eine individualisierte, Biomarker-abhängige Tumortherapie beim HCC. Große Hoffnung für die Therapie des HCCs liegt in der Immuntherapie mittels Checkpoint-Inhibitoren.

The S3 guideline on hepatocellular carcinoma has been expanded to include malignant biliary carcinoma (synonym cholangiocarcinoma [CCA]). Magnetic resonance imaging (MRI) with additional magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice to evaluate local findings. Use of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-based contrast agent increases its diagnostic value. Histologic confirmation is always required when diagnosing intrahepatic CCA (iCCA) because using imaging alone there is a risk of confusion with HCC subtypes.Die S3-Leitlinie zum hepatozellulären Karzinom (HCC) wurde aktuell um die malignen biliären Karzinome (synonym: Cholangiokarzinome, CCA) erweitert. Die Magnetresonanztomographie (MRT) mit Cholangiopankreatikographie (MRCP) ist die bildgebende Methode der Wahl zur Beurteilung des Lokalbefundes. Die Anwendung von Kontrastmittel auf Basis von Gadolinium Ethoxybenzyl‐Diethylentriaminpentaessigsäure (Gd‐EOB‐DTPA) steigert ihre diagnostische Genauigkeit noch weiter. Im Rahmen der Diagnostik eines intrahepatischen CCA (iCCA) ist in jedem Fall eine histologische Sicherung erforderlich, da allein bildgebend eine Verwechslungsgefahr mit HCC-Subtypen besteht.

Background Catheter-directed thrombolysis (CDT) is an effective and safe endovascular method used in critical limb ischemia and many other thromboembolic events. Ultrasound-assisted catheter-directed thrombolysis (US-CDT) is an emerging technique considered to accelerate thrombolysis and therefore is supposed to improve outcome. Purpose To evaluate the efficacy of US-CDT in comparison to standard CDT in vitro. Material and Methods A total of 69 sets of human venous blood were evaluated, each comprising a tube just treated with CDT, a tube treated with US-CDT, and a control tube. All tubes were kept under physiological conditions. Except for the controls, in all tubes 5 mg of tissue-type plasminogen activator was administered over the predetermined treatment interval. Thrombus mass was weighted at the end of the lysis intervals at 6 h or 24 h, respectively. Results CDT led to a mean thrombus reduction of 32% and ultrasound-assisted lysis led to a mean thrombus reduction of 41% ( P Conclusion In vitro US-CDT is significantly superior to standard CDT; this effect is apparent at an early timepoint of lysis and slightly further increases over time.

To observe the technical and clinical outcome as well as safety of CT fluoroscopy-guided drain placement in the multimodal clinical complication management of superinfected gastric leakage after sleeve gastrectomy. All consecutive patients who underwent CT fluoroscopy-guided drain placement to treat superinfected postoperative leakage after sleeve gastrectomy in our department between 2007 and 2014 were included in this retrospective study. All interventions were performed on a 16- or 128-row CT scanner under intermittent CT fluoroscopy guidance (15-25 mAs, 120 kV). The technical and clinical success rates as well as complications, additional therapies and patient radiation dose were analyzed. 14 patients (mean age: 43.8 ± 11.3 years, mean BMI: 52.9 ± 13.5, 7 women) who underwent a total of 31 CT fluoroscopy-guided drain placement procedures were included. 30 of 31 interventions (96.8 %) were technically successful. 7 patients underwent more than one intervention due to drain obstruction or secondary dislocation or as further treatment. During and after the intervention no procedure-associated complications occurred. In all patients, inflammation parameters decreased within days after the CT-guided intervention. The total interventional dose length product (DLP) was 1561 ± 1035 mGy*cm. CT fluoroscopy-guided drain placement has been shown to be a safe minimally invasive procedure that rarely leads to complications for treating superinfected gastric leakage occurring after sleeve gastrectomy. We assume that operative revisions in a high-risk patient group can be avoided using this procedure. · CT fluoroscopy-guided drain placement in obese - often medically highly complex - patients is a technically feasible procedure.. · Multimodal treatment (CT intervention, endoscopy and surgery) is required to successfully treat gastric leakage after bariatric surgery.. · High-risk surgery might be avoided by the CT-guided drain placement..· Schwarz J, Strobl FF, Paprottka PM et al. CT Fluoroscopy-Guided Drain Placement to Treat Infected Gastric Leakage after Sleeve Gastrectomy: Technical and Clinical Outcome of 31 Procedures. Fortschr Röntgenstr 2020; 192: 163 - 170.ZIEL: In dieser Studie wurden die technischen und klinischen Ergebnisse sowie die Sicherheit von CT-fluoroskopisch gesteuerten Drainageneinlagen in entzündete Verhalte bei Nahtinsuffizienz nach Sleeve-Gastrektomien als Teil eines multimodalen Komplikationsmanagements evaluiert. In diese retrospektive Studie wurden alle Patienten eingeschlossen, die zwischen 2007 und 2014 in unserer Abteilung eine CT-fluoroskopisch gesteuerte Drainageneinlage in entzündete Verhalte nach Sleeve-Gastrektomien erhalten haben. Alle Interventionen wurden auf einem 16- oder 128-Zeilen-CT unter intermittierender Fluoroskopie (15–25 mAs, 120 kV) durchgeführt. Technischer und klinischer Erfolg, die Patientenstrahlendosis (DLP), die Komplikationsrate und ergänzende Therapien wurden analysiert. 14 Patienten (Altersdurchschnitt 43,8 ± 11,3 Jahre, BMI 52,9 ± 13,5, 7 Frauen) wurden eingeschlossen, die insgesamt 31 CT-fluoroskopisch gesteuerte Drainagen erhalten haben. 30 der 31 Interventionen (96,8 %) waren technisch erfolgreich. Sieben Patienten erhielten mehr als eine Intervention aufgrund einer Drainageobstruktion, sekundärer Dislokationen oder als Verlaufstherapie. Peri- und postinterventionell traten keine interventionsbedingten Komplikationen auf. Bei allen Patienten fielen die laborchemischen Entzündungsparameter innerhalb von Tagen nach der Intervention. Das durchschnittliche gesamte Dosislängenprodukt einer Intervention lag bei 1561 ± 1035 mGy*cm. CT-fluoroskopisch gesteuerte Drainageneinlagen sind sichere, minimalinvasive und komplikationsarme Interventionen, um infizierte Verhalte nach Nahtinsuffizienzen bei Sleeve-Gastrektomien zu therapieren. Wir gehen davon aus, dass durch diese Interventionen komplexe Revisionsoperationen bei Hochrisikopatienten vermieden werden können. · CT-fluoroskopisch gesteuerte Drainageneinlagen bei adipösen, oft multimorbiden Patienten sind eine technisch gut durchführbare Intervention.. · Eine multidisziplinäre Behandlung (CT-Intervention, Endoskopie und Chirurgie) ist notwendig, um Nahtinsuffizienzen nach bariatrischer Chirurgie erfolgreich zu therapieren.. · Hochrisiko-Revisionsoperationen könnten in vielen Fällen durch CT-gesteuerte Drainageneinlagen verhindert werden..

To evaluate the rate and types of complications after minimally invasive radiological central vein port implantation without ultrasound guidance. We retrospectively evaluated 8654 patients who underwent port implantations in the subclavian vein without ultrasound guidance in our institution from 1998 to 2014 with regard to types and rates of peri-, early and late post-interventional complications according to the common classification for complications published by the Society of Interventional Radiology (SIR). Additionally, the impact of the training level of the operators on the rate of complications was analyzed. Successful port implantations were performed in 99.8% (8636/8654 procedures). From 1998 to 2014, a total of 565 (6.52%) complications were recorded. The overall percentage of the peri-, early and late post-interventional complications according to the SIR criteria was 1.69, 0.15 and 4.68, respectively. Significant differences due to the training level of the performing physician could be seen for the rates of pneumothorax, arterial puncture and hematoma. Minimally invasive radiological interventional port implantation is a safe treatment option with a low rate of complications even without ultrasound guidance.

Transcatheter arterial chemoembolization (TACE) and biliary interventions are common procedures.In this retrospective study, the radiation exposure of patients undergoing hepatic intervention will be analyzed and compared depending on the type and objective of the intervention.This is an analysis of 7003 data sets of performed TACEs and biliary interventions from the DeGIR registry for the years 2016, 2017, and 2018. The dose area product (DAP), fluoroscopy time (FT), type of intervention, and anatomically defined target were recorded.Data with documented radiation doses were available for 4985 TACEs and for 2018 biliary interventions. For biliary interventions the median DAP was 2594 (interquartile range [IQR] = 1174-5858) cGycmThe individual radiation exposure during liver interventions is less dependent of the complexity of the procedure or the fluoroscopy time, but rather on the type of intervention and the anatomic target. The presented data can help to approximately estimate the radiation exposure in advance when planning an intervention.HINTERGRUND: Die transarterielle Chemoembolisation (TACE) oder auch Gallenganginterventionen stellen häufige Leberinterventionen dar.In dieser retrospektiven Studie soll die Strahlenexposition der Patienten mit einem hepatischen Eingriff in Abhängigkeit von Art und Feinziel der Intervention analysiert und verglichen werden.Dies ist eine Analyse von 7003 DeGIR-Registerdatensätzen aus den Jahren 2016 bis 2018 für TACE und Gallenganginterventionen. Das Dosisflächenprodukt (DFP) und die Durchleuchtungszeit (DL) sowie die Interventionsart und das anatomisch definierte Feinziel der Interventionen wurden erfasst.Insgesamt lagen Dosiswerte für 4985 durchgeführte TACE und 2018 Gallenganginterventionen vor. Bei Gallenganginterventionen lag der Median des DFP bei 2594 (Interquartilbereich [IQR] = 1174–5858) cGy*cmDie individuelle Strahlendosis für einen Patienten bei einer Leberintervention hängt weniger von der Komplexität des Eingriffs bzw. Durchleuchtungszeit ab, sondern von der Art des Eingriffs und vom Feinziel der Intervention. Die vorliegenden Dosisdaten können eine Hilfe sein, die Strahlenexposition bei einer Leberintervention bereits vor dem Eingriff grob abzuschätzen.

Aim The aim of this study was to retrospectively analyze the prognostic value of combined Tc-99m-macroaggregated albumin (MAA) SPECT/CT and [F-18]-fluoroethylcholine (FEC) PET/CT before radioembolization for survival of patients with intermediate-stage hepatocellular carcinoma. Methods Twenty-four patients with known hepatocellular carcinoma Barcelona Clinic Liver Cancer stage B were eligible for this analysis. All patients were scheduled for radioembolization and received a pretherapeutic [F-18]FEC PET/CT scan as well as Tc-99m-MAA SPECT/CT for hepatopulmonary shunting. Laboratory and semiquantitative PET parameters and morphologic and metabolic (intersection) volumes of MAA and FEC were evaluated. Spearman correlation with overall survival, receiver operating curve analyses, univariate and multivariate Cox regression, and Kaplan-Meier-analysis was applied. Results All patients (5 female/19 male) are deceased within the observational period. Median survival was 395 days (51 days;range, 23-1122 days). The percentage of hypervascularized metabolically active tumor volume (vascularized tumor ratio;defined as high MAA and FEC uptake) correlated significantly with survival. Vascularized tumor ratio was a significant predictor in univariate and multivariate analyses (P = 0.026;hazard ratio, 11.65;95% confidence interval, 1.62-83.73;P = 0.015). Statistical significance was not reached by all other variables in multivariate analysis. Receiver operating curve analysis for 1-year survival revealed an area under the curve of 0.77 (P = 0.024) for vascularized tumor ratio. At a cutoff value of 9%, sensitivity, specificity, and positive and negative prediction were 83%, 67%, and 71% and 80% (P = 0.036). Patients with a higher tumor vascularization had a median survival of 274 +/- 80 versus 585 +/- 284 days (P = 0.015). Conclusion: s Hepatocellular carcinoma with high vascularization in metabolic active areas as assessed by combined FEC PET/CT and Tc-MAA SPECT/CT represents an unfavorable subgroup with reduced overall survival after radioembolization.

BACKGROUND Allocation of patients with hepatocellular carcinoma (HCC) to the adequate therapy is determined by both tumor burden and liver function. The Barcelona Clinic Liver Cancer (BCLC) staging system and therapeutic algorithm recommends transarterial chemoembolization (TACE) based on the best evidence available to patients with intermediate-stage HCC (BCLC-B). However, many centers also treat subgroups of patients outside these recommendations and with more advanced disease by TACE. The purpose of this study was to identify prognostic factors in a TACE cohort, including BCLC-B patients, as well as patients treated outside of BCLC-B, to test the prognostic capabilities of published staging systems and to optimize prognostication for TACE patients. PATIENTS AND METHODS A cohort of 186 first-line TACE patients was analyzed. Independent prognostic factors were identified and used to construct the Munich-TACE score (M-TACE). M-TACE was tested against established staging systems (including BCLC and two recently published TACE-specific scores) and a ranking using concordance index and Akaike Information Criterion was performed. Finally, an external validation in an independent TACE cohort (n=71) was conducted. RESULTS Bilirubin, Quick/international normalized ratio, C-reactive protein, creatinine, α-feto protein, and tumor extension were identified as independent prognostic factors and used to construct M-TACE. M-TACE identifies three distinct subgroups (P

Our objective was to predict the outcome of 90Y radioembolization in patients with intrahepatic tumors from pretherapeutic baseline parameters and to identify predictive variables using a machine-learning approach based on random survival forests. Methods: In this retrospective study, 366 patients with primary (n = 92) or secondary (n = 274) liver tumors who had received 90Y radioembolization were analyzed. A random survival forest was trained to predict individual risk from baseline values of cholinesterase, bilirubin, type of primary tumor, age at radioembolization, hepatic tumor burden, presence of extrahepatic disease, and sex. The predictive importance of each baseline parameter was determined using the minimal-depth concept, and the partial dependency of predicted risk on the continuous variables bilirubin level and cholinesterase level was determined. Results: Median overall survival was 11.4 mo (95% confidence interval, 9.7–14.2 mo), with 228 deaths occurring during the observation period. The random-survival-forest analysis identified baseline cholinesterase and bilirubin as the most important variables (forest-averaged lowest minimal depth, 1.2 and 1.5, respectively), followed by the type of primary tumor (1.7), age (2.4), tumor burden (2.8), and presence of extrahepatic disease (3.5). Sex had the highest forest-averaged minimal depth (5.5), indicating little predictive value. Baseline bilirubin levels above 1.5 mg/dL were associated with a steep increase in predicted mortality. Similarly, cholinesterase levels below 7.5 U predicted a strong increase in mortality. The trained random survival forest achieved a concordance index of 0.657, with an SE of 0.02, comparable to the concordance index of 0.652 and SE of 0.02 for a previously published Cox proportional hazards model. Conclusion: Random survival forests are a simple and straightforward machine-learning approach for prediction of overall survival. The predictive performance of the trained model was similar to a previously published Cox regression model. The model has revealed a strong predictive value for baseline cholinesterase and bilirubin levels with a highly nonlinear influence for each parameter.

Purpose: To evaluate factors associated with survival following transarterial 90Y (yttrium) radioembolization (TARE) in patients with advanced intrahepatic cholangiocarcinoma (ICC). Methods: This retrospective multicenter study analyzed the outcome of three tertiary care cancer centers in patients with advanced ICC following resin microsphere TARE. Patients were included either after failed previous anticancer therapy, including relapse after surgical resection, or for having a minimum of 25% of total liver volume affected by ICC. Patients were stratified and response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria at 3 months. Kaplan&ndash, Meier analysis was performed to analyze survival followed by cox regression to determine independent prognostic factors for survival. Results: 46 patients were included (19 male, 27 female), median age 62.5 years (range 29&ndash, 88 years). A total of 65% of patients had undergone previous therapy, while 63% had a tumor volume &gt, 25% of the entire liver volume. Median survival was 9.5 months (95% CI: 6.1&ndash, 12.9 months). Due to loss in follow-up, n = 37 patients were included in the survival analysis. Cox regression revealed the extent of liver disease to one or both liver lobes being associated with survival, irrespective of tumor volume (p = 0.041). Patients with previous surgical resection of ICC had significantly decreased survival (3.9 vs. 12.8 months, p = 0.002). No case of radiation-induced liver disease was observed. Discussion: Survival after 90Y TARE in patients with advanced ICC primarily depends on disease extent. Only limited prognostic factors are associated with a general poor overall survival.

Obesity leads to better survival in critically ill patients. Although there are several studies confirming this thesis, the "obesity paradox" is still surprising from the clinician's perspective. One explanation for the "obesity paradox" is the fact that the body mass index (BMI), which is used in almost all clinical evaluations to determine weight categories, is not an appropriate measure of fat and skeletal muscle mass and its distribution in critically ill patients. In addition, height and weight are frequently estimated rather than measured. Central obesity has been identified in many disorders as an independent risk factor for an unfavourable outcome. The first clues are to be found in intensive care. Along with obesity, an individual's entire muscle mass is a variable that has an influence on outcome. Central obesity can be measured relatively easily with an abdominal calliper, but the calculation of muscle mass is more complex. A valid and detailed measurement of this can be obtained using computed tomography (CT) images, acquired during routine care. For future clinical observation or interventional studies, single cross-sectional CT is a more sophisticated tool for measuring patients' anthropometry than a measuring tape and callipers. Patients with sarcopenic obesity, for example, who may be at a particular risk, can only be identified using imaging procedures such as single cross-sectional CT. Thus, BMI should take a back seat as an anthropometric tool, both in the clinic and in research.

Our aim was to provide further evidence for the efficacy/safety of radioembolization using yttrium-90-resin microspheres for unresectable chemorefractory liver metastases from colorectal cancer (mCRC). We followed 104 consecutively treated patients until death. Overall survival (OS) was calculated from the day of the first radioembolization procedure. Response was defined by changes in tumour volume as defined by Response Evaluation Criteria in Solid Tumours (RECIST) v1.0 and/or a ≥30 % reduction in serum carcinoembryonic antigen (CEA) at 3 months. Survival varied between 23 months in patients who had a complete response to prior chemotherapy and 13 months in patients with a partial response or stable disease. Median OS also significantly improved (from 5.8 months to 17.1 months) if response durability to radioembolization extended beyond 6 months. Patients with a positive trend in CEA serum levels (≥30 % reduction) at 3 months post-radioembolization also had a survival advantage compared with those who did not: 15.0 vs 6.7 months. Radioembolization was well tolerated. Grade 3 increases in bilirubin were reported in 5.0 % of patients at 3 months postprocedure. After multiple chemotherapies, many patients still have a good performance status and are eligible for radioembolization. This single procedure can achieve meaningful survivals and is generally well tolerated. • After multiple chemotherapies, many patients are still eligible for radioembolization (RE). • RE can achieve meaningful survival in patients with chemorefractory liver-predominant metastatic colorectal cancer (mCRC). • Tumour responsiveness to prior systemic treatments is a significant determinant of overall survival (OS) after RE. • Radioembolization in patients with a good performance status is generally well tolerated.

The present study evaluated safety, efficacy, and prognostic factors for (90)Y-yttrium microsphere radioembolization of unresectable liver metastases from breast cancer.Eighty-one patients were treated with radioembolization. Acute toxicity was monitored through daily physical examination and serum tests until 3 d after radioembolization; late toxicity was evaluated until 12 wk after radioembolization. Overall survival and response according to (18)F-FDG PET (30% decrease of tracer uptake) and CA15-3 serum level (any decline) were recorded. Pretherapeutic characteristics, including pretreatment history, liver function tests, and PET/CT parameters, were assessed by univariate and subsequent multivariate Cox regression for predicting patient survival.A toxicity grade of 3 or more based on clinical symptoms, bilirubin, ulcer, pancreatitis, ascites, or radioembolization-induced liver disease occurred in 10% or less of patients. Two patients eventually died from radioembolization-induced liver disease. Sequential lobar treatment and absence of prior angiosuppressive therapy were both associated with a lower rate of serious adverse events. On the basis of PET/CA15-3 criteria, 52/61% of patients responded to treatment. Median overall survival after radioembolization was 35 wk (interquartile range, 41 wk). Pretherapeutic tumor burden of the liver greater than 50% or more (P0.001; hazard ratio, 5.67; 95% confidence interval, 2.41-13.34) and a transaminase toxicity grade of 2 or more (P= 0.009; hazard ratio, 2.15; 95% confidence interval, 1.21-3.80) independently predicted short survival.Radioembolization for breast cancer liver metastases shows encouraging local response rates with low incidence of serious adverse events, especially in those patients with sequential lobar treatment or without prior angiosuppressive therapy. High hepatic tumor burden and liver transaminase levels at baseline indicate poor outcome.

Purpose To test combined dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and 18F-FDG positron emission tomography (FDG-PET)-derived parameters for prediction of histopathological grading in a rat Diethyl Nitrosamine (DEN)-induced hepatocellular carcinoma (HCC) model. Methods 15 male Wistar rats, aged 10 weeks were treated with oral DEN 0.01 % in drinking water and monitored until HCCs were detectable. DCE-MRI and PET were performed consecutively on small animal scanners. 38 tumors were identified and manually segmented based on HCC-specific contrast enhancement patterns. Grading (G2/3: 24 tumors, G1:14 tumors) alongside other histopathological parameters, tumor volume, contrast agent and 18F-FDG uptake metrics were noted. Class imbalance was addressed using SMOTE and collinearity was removed using hierarchical clustering and principal component analysis. A logistic regression model was fit separately to the individual parameter groups (DCE-MRI-derived, PET-derived, tumor volume) and the combined parameters. Results The combined model using all imaging-derived parameters achieved a mean ± STD sensitivity of 0.88 ± 0.16, specificity of 0.70 ± 0.20 and AUC of 0.90 ± 0.03. No correlation was found between tumor grading and tumor volume, morphology, necrosis, extracellular matrix, immune cell infiltration or underlying liver fibrosis. Conclusion A combination of DCE-MRI- and 18F-FDG-PET-derived parameters provides high accuracy for histopathological grading of hepatocellular carcinoma in a relevant translational model system.

Background To report our experience with SBRT in primary and secondary liver tumors. Methods We retrospectively analysed 55 patients (70 lesions) with a median follow-up of 10 months (range 1–57) treated from 2011 to 2016. All patients had not been eligible for other local treatment options. Median age was 64 years and 64% were male. 27 patients (36 lesions) suffered from hepatocellular carcinoma (HCC, Child A:78%, Child B:18%, Child C:4%), 28 patients (34 lesions) had oligometastatic liver disease (MD). Treatment planning was based on 4D-CT usually after placement of fiducials. Dose and fractionation varied depending on localization and size, most commonly 3 × 12.5 Gy (prescribed to the surrounding 65%-isodose) in 56% and 5x8Gy (80% isodose) in 20% of the treated lesions. Results Local recurrence was observed in 7 patients (13%) and 8 lesions (11%), resulting in estimated 1- and 2-year local control rates (LC) of 91 and 74%. Estimated 1- and 2-year rates of Freedom from hepatic failure (FFHF) were 42 and 28%. Number of lesions was predictive for LC and FFHF in the entire cohort. Estimated 1- and 2-year overall survival (OS) was 76 and 57%. OS was significantly affected by number of treated lesions and performance status. In the HCC subgroup, pretreatment liver function and gender were also predictive for OS. Maximum acute non-hepatic toxicity was grade 1 in 16% and grade 2 in 10% of the patients. Three HCC patients (11%) developed marked deterioration of liver function (grade 3/4). Conclusions SBRT resulted in high local control and acceptable survival rates in patients with HCC or MD not amendable to other locally-ablative treatment options with limited toxicity. Care should be taken in HCC patients with Child B cirrhosis.

Background/Aims: The recently proposed Munich-transarterial chemoembolisation-score (M-TACE) was tailored to suit hepatocellular Carcinoma (HCC) patients evaluated for TACE. M-TACE outperformed the established HCC-staging-systems and successfully passed external validation. Modifications of staging-systems through the rearrangement of stages or by adding prognostic factors are methods of improving prognostic power. M-TACEs performance compared to scores modified this way should be tested. Methods: Seven well-known HCC staging-systems (including Cancer of the Liver Italian Program-score [CLIP] and Barcelona Clinic liver cancer [BCLC]) and 2 TACE-specific scores (Selection for Transarterial Chemoembolisation Treatment [STATE] and Hepatoma Arterial embolisation Prognostic [HAP]) were rearranged in a cohort of 186 TACE-patients through score-point-analysis and subsequent linking of non-significant adjacent score-points. Additionally, a new score was constructed by combining the top established staging-system in TACE patients (CLIP-TACE) and the prognostic parameter with the highest hazard ratio for death in the TACE-cohort [C-reactive protein (CRP)]. Additionally, the TACE-tailored-scores were applied to an external TACE-cohort (n = 71). ­Results: Rearrangement resulted in optimal stratification and monotonicity. CLIP-TACE demonstrated the best prognostic capability of all rearranged scores (c-index 0.668, AIC 1294) and the addition of CRP yielded further prognostic improvement (c-index 0.680, AIC 1289). However, superiority over M-TACE could not be achieved by any of the new scores in the internal and external cohort. Conclusion: M-TACE outperforms TACE-tailored modifications of all relevant HCC-staging-systems. Prospective validation of M-TACE to promote its role as the preferred staging-system for TACE-patients is therefore justified.

Purpose: Radioembolisation is part of the multimodal treatment of hepatocellular carcinoma (HCC) at specialist liver centres. This study analysed the impact of prior treatment on tolerability and survival following radioembolisation. Methods: This was a retrospective analysis of 325 consecutive patients with a confirmed diagnosis of HCC, who received radioembolisation with yttrium-90 resin microspheres at eight European centres between September 2003 and December 2009. The decision to treat was based on the clinical judgement of multidisciplinary teams. Patients were followed from the date of radioembolisation to last contact or death and the nature and severity of all adverse events (AEs) recorded from medical records. Results: Most radioembolisation candidates were Child-Pugh class A (82.5%) with multinodular HCC (75.9%) invading both lobes (53.1%); 56.3% were advanced stage. Radioembolisation was used first-line in 57.5% of patients and second-line in 34.2%. Common prior procedures were transarterial (chemo)embolisation therapies (27.1%), surgical resection/transplantation (17.2%) and ablation (8.6%). There was no difference in AE incidence and severity between prior treatment subgroups. Median (95% confidence interval [CI]) survival following radioembolisation was similar between procedure-naive and prior treatment groups for Barcelona Clinic Liver Cancer (BCLC) stage A: 22.1 months (15.1–45.9) versus 30.9 months (19.6–46.8); p = 0.243); stage B: 18.4 months (11.2–19.4) versus 22.8 months (10.9–34.2); p = 0.815; and stage C: 8.8 months (7.1–10.8) versus 10.8 months (7.7–12.6); p = 0.976. Conclusions: Radioembolisation is a valuable treatment option for patients who relapse following surgical, ablative or vascular procedures and remain suitable candidates for this treatment.

PURPOSE To evaluate the diagnostic benefits of multimodality imaging using image fusion with magnetic-resonance-imaging (MRI) and contrast-enhanced-ultrasound (CEUS) in an experimental small-animal-squamous-cell-carcinoma-model for the assessment of tissue hemodynamics and morphology. MATERIAL AND METHODS Human hypopharynx-carcinoma-cells were injected subcutaneously into the left flank of 15 female athymic nude rats. After 10 daysof subcutaneous tumor growth, CEUS and MRI measurements were performed using a high-end-ultrasound-system and 3-T-MRI. After successful point-to-point or plan registration, the registered MR-images were simultaneously shown with the respective ultrasound sectional plane. Data evaluation was performed using the digitally stored video sequence data sets by two experienced radiologists using a subjective 5-point scale. RESULTS CEUS and MRI are well-known techniques for the assessment of tissue hemodynamics (score: mean 3.8 ± 0.4 SD and score 3.8 ± 0.4 SD). Real-time image fusion of MRI and CEUS yielded a significant (p < 0.001) improvement in score (score 4.8 ± 0.4 SD). Reliable detection of small necrotic areas was possible in all animals with necrotic tumors. No significant intraobserver and interobserver variability was detected (kappa coefficient = +1). CONCLUSION Image fusion of MRI and CEUS gives a significant improvement for reliable differentiation between different tumor tissue areas and simplifies investigations by showing the morphology as well as surrounding macro-/microvascularization.

This study analyzed the predictive value of (99m)Tc-labeled macroaggregated albumin ((99m)Tc-MAA) SPECT for (90)Y-labeled resin microsphere therapy (radioembolization) by comparing uptake on pretherapeutic (99m)Tc-MAA SPECT with uptake on posttherapeutic (90)Y-bremsstrahlung SPECT.We included 502 patients (55% male; mean age ± SD, 62 ± 11 y) who underwent radioembolization between 2005 and 2013 because of primary or secondary liver malignancies (colorectal cancer [n = 195, 38.8%], neuroendocrine tumors [n = 77, 15.3%], breast cancer [n = 68, 13.5%], hepatocellular carcinoma [n = 59, 11.8%], cholangiocellular carcinoma [n = 40, 8.0%], or urologic tumors [n = 14, 2.8%]). Manually drawn regions of interest around tumors and adjacent healthy liver tissue for up to 3 lesions per patient on (99m)Tc-MAA and (90)Y-bremsstrahlung scans were used to quantify mean counts per pixel and evaluate the mean tumor-to-background ratio (TBR). Data were given as mean ± SD. Additionally, uptake in lesions on (99m)Tc-MAA and (90)Y-bremsstrahlung scans was graded visually as homogeneously higher than (grade 1), heterogeneously higher than (grade 2), equal to (grade 3), or lower than (grade 4) uptake in normal liver tissue. The Mann-Whitney U test and Spearman correlation were used to evaluate statistically significant differences between (99m)Tc-MAA and (90)Y-bremsstrahlung SPECT.In total, 1,008 lesions were analyzed. Of the 23% (230/1,008) of lesions that had grade 1 uptake on (99m)Tc-MAA SPECT, 81% (186/230) remained grade 1 after radioembolization whereas 16% (37/230) were grade 2. Of the lesions with grade 2 uptake on (99m)Tc-MAA SPECT, 16% had grade 1 uptake and 82% grade 2 uptake after radioembolization. Of the lesions with grade 3 uptake, however, 27% had grade 1 uptake and 47% grade 2 uptake after radioembolization. Even among the lesions with grade 4 uptake on (99m)Tc-MAA SPECT, 21% had grade 1 uptake and 46% grade 2 uptake after radioembolization. The mean TBR on (99m)Tc-MAA and (90)Y-bremsstrahlung SPECT showed a significant, though low, correlation in the total population (r = 0.26; P0.001) and in hepatocellular carcinoma (r = 0.4; P0.001), cholangiocellular carcinoma (r = 0.3; P0.05), breast cancer (r = 0.3; P0.001), colorectal cancer (r = 0.2; P0.001), and neuroendocrine tumors (r = 0.2; P0.01).Although significant for most lesions, the correlation between (99m)Tc-MAA and (90)Y-microsphere mean TBR was low. Classifying uptake into 4 grades revealed that lesions with high uptake on (99m)Tc-MAA SPECT maintain high uptake within radioembolization. More than 60% of lesions with a pretherapeutically lower uptake than in healthy liver tissue, however, showed high uptake within radioembolization. Patients with low tumor uptake on pretherapeutic (99m)Tc-MAA imaging should not be excluded from radioembolization.

Clinical cases of stent-fractures show that corrosion behavior might play a role in these fractures. Implanted in vivo, especially in combination with other implanted foreign materials, these metallic products are exposed to special conditions, which can cause a process of corrosion. Here, we aimed to test the corrosion potential of stents made of different materials in an in vitro setting.A total of 28 peripheral stents of different materials (nitinol, cobalt-chromium-nickel, tantalum, V4A) and surface treatments (electropolish, mechanical polish, no polish) were tested in vitro. Corrosion was accelerated by applying a constant voltage of 3.5 V and amperage of 1.16 mA in 0.9% NaCl.Nitinol stents showed the lowest susceptibility to corrosion and the longest period without damage. The Memotherm II® (BARD Angiomed®) was the only stent that showed neither macroscopic nor microscopic damages. The worst performing material was cobalt-chromium-nickel, which showed corrosion damages about ten times earlier compared to nitinol. Considering the reasons for termination of the test, nitinol stents primarily showed length deficits, while V4A and tantalum stents showed fractures. Cobalt-chromium-nickel stents had multiple fractures or a complete lysis in equal proportions. When placed in direct contact, nitinol stents showed best corrosion resistance, regardless of what material they were combined with. In terms of polishing treatments, electropolished stents performed the best, mechanical-polished stents and those without polishing treatment followed.The analysis of corrosion behavior may be useful to select the right stent fulfilling the individual needs of the patient within a large number of different stents.

After edovascular repair of infrarenal aortic aneurysms (EVAR) endoleaks may occur necessitating further therapy. Therefore a reliable method for follow-up imaging after EVAR for detection and control of endoleaks is of high importance. Contrast-enhanced sonography (CEUS) does not require the application of nephrotoxid contrast media and does not stress the patient. CEUS is increasingly used and enables a quick, non-invasive follow-up examination for patient after EVAR. In addition, interventions as therapy for endoleaks may be executed using ultrasound. Initial experience with CEUS-guided aortic stenting shows that the amount of contrast media as well as X-ray time may be reduced.

To evaluate the safety of radioembolization (RE) with (90)Yttrium ((90)Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels.Early and late toxicity after 566 RE procedures were analyzed retrospectively in accordance with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group).Clinically relevant late toxicities (≥ Grade 3) were observed in 1% of our overall cohort. The no-coiling group had significantly less "any" (P = 0.0001) or "clinically relevant" (P = 0.0003) early toxicity. There was no significant difference (P0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures.RE with (90)Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.

Background Novel anti-angiogenic treatments are increasingly complementing established cancer therapy strategies in head and neck tumors. Contrast-enhanced magnetic resonance imaging (MRI) can be applied for early and non-invasive therapy monitoring by non-invasive quantitative assessment of tumor microcirculation as in vivo imaging biomarkers of therapy response. Purpose To monitor the anti-angiogenic effects of a novel combination therapy on experimental head and neck squamous cell carcinomas (HNSCC) with dynamic contrast-enhanced (DCE)-MRI. Material and Methods Athymic rats ( n = 18) with subcutaneous HNSCC xenografts were investigated by DCE-MRI before and after 7 days of a daily triple therapy regimen combining the COX-II-inhibitor celecoxib, the matrix-metalloproteinase-inhibitor GM6001, and the uPA-inhibitor upamostat. Quantitative measurements of tumor blood flow (tBF), tumor blood volume (tBV), and permeability-surface area product (PS) were calculated and validated by immunohistochemistry. Results Mean tBF and tBV in triple-therapy animals decreased significantly from day 0 to day 7 (tBF, 41.0 ± 14.2 to 20.4 ± 5.7 mL/100 mL/min; P 0.05). Immunohistochemical analysis showed a significantly lower tumor vascularity in the therapy group than in the control group (CD31), significantly fewer Ki-67+ proliferating tumor cells and significantly more Capase-3+ apoptotic tumor cells ( P Conclusion DCE-MRI may be a suitable tool for the non-invasive monitoring of the anti-vascular effects of this innovative triple therapy regimen with potential for clinical translation.

Pre-therapeutic prediction of outcome is important for clinicians and patients in determining whether selective internal radiation therapy (SIRT) is indicated for hepatic metastases of colorectal cancer (CRC). Pre-therapeutic characteristics of 100 patients with colorectal liver metastases (CRLM) treated by radioembolization were analyzed to develop a nomogram for predicting survival. Prognostic factors were selected by univariate Cox regression analysis and subsequent tested by multivariate analysis for predicting patient survival. The nomogram was validated with reference to an external patient cohort (n = 25) from the Bonn University Department of Nuclear Medicine. Of the 13 parameters tested, four were independently associated with reduced patient survival in multivariate analysis. These parameters included no liver surgery before SIRT (HR:1.81, p = 0.014), CEA serum level ≥ 150 ng/ml (HR:2.08, p = 0.001), transaminase toxicity level ≥2.5× upper limit of normal (HR:2.82, p = 0.001), and summed computed tomography (CT) size of the largest two liver lesions ≥10 cm (HR:2.31, p

The aim of this study was to evaluate the 99mTc-macroaggregated albumin (99mTc-MAA) uptake of primary and secondary liver tumors in a large patient cohort before 90Y radioembolization. Methods: We included 502 patients during the years 2005–2013 (55% male; mean age, 62 ± 11 y), who were examined with 99mTc-MAA SPECT or SPECT/CT before planned radioembolization. The patients had colorectal cancer (CRC; n = 195, 38.8%), neuroendocrine tumors (NET; n = 77, 15.3%), mammary cancer (MAM; n = 68, 13.5%), hepatocellular carcinoma (HCC; n = 59, 11.8%), cholangiocellular carcinoma (CCC; n = 40, 8.0%), or urologic tumors (URO; n = 14, 2.8%). SPECT with coregistered contrast-enhanced CT or MR imaging and SPECT/CT images of these patients were analyzed using dedicated software with regard to the 99mTc-MAA uptake of the liver tumors. Regions of interest were drawn around the lesions manually and quantified the uptake of up to 3 lesions per patient and also adjacent healthy liver tissue without evidence of tumor. We quantified maximum and mean counts per pixel and calculated tumor-to-background ratio (TBR). Data are reported as mean ± SD. Lesion uptake was classified as being homogeneously high (grade 1), heterogeneously high (grade 2), equal to that of the liver (grade 3), or low (grade 4). Results: Grade 1 uptake was seen in 230 of 1,008 lesions (with the highest rates in sarcoma [47%], MAM [37%], and NET [32%]), grade 2 in 706 lesions (with the highest rates in CRC [77%], HCC [75%], and CCC [74%]), grade 4 in 57 lesions (with the highest rates in pancreatic cancer [17%], sarcoma [SAR] [13%], and MAM [8%]), and grade 3 in only 15 lesions. In quantitative analysis, the mean TBRmax of all lesions was 4.8 ± 4.1 (range, 0.2–50.1), with the highest values in HCC (6.0 ± 4.7; range, 1.4–21.6), NET (5.4 ± 4.9; range, 0.8–43.0), pancreatic cancer (4.0 ± 2.8; range, 0.9–12.2), and CCC (4.7 ± 2.9; range, 0.9–11.6), and the lowest values in SAR (3.5 ± 1.8; range, 0.8–2.7) and MAM (3.6 ± 2.2; range, 0.9–11.6). The mean TBRmean was 1.9 ± 1.0 (range, 0.1–7.2), with the highest values in NET (2.2 ± 1.2; range, 0.2–7.2), HCC (2.1 ± 1.2; range, 0.3–6.3), and CCC (2.0 ± 1.0; range, 0.2–6.3) and the lowest values in MAM (1.7 ± 0.8; range, 0.2–4.1), CRC (1.8 ± 0.9; range, 0.4–6.6), and SAR (1.7 ± 1.1; range, 0.3–3.9). Conclusion: The 99mTc-MAA uptake of different tumor entities shows a wide variation, with generally highest values for NET, HCC, and CCC and lowest values for MAM, CRC, and SAR. However, the variation of uptake within the different tumor entities is high.

Background: Recent scientific work proved that knowledge about body composition beyond the body mass index is essential. Both adipose tissue and muscular status are determining risk factors of morbidity and mortality. Analysis of single cross-sectional computed tomography (CT) images, acquired during routine care only to prevent additional radiation exposure, provide a detailed insight into the body composition of chronically and critically ill patients. Methods: This retrospective study included 490 trauma patients of whom a whole-body multiple detector CT scan was acquired at admission. From a single cross-sectional CT, we compared eight diametric and planimetric techniques for the assessment of core muscle mass as well as visceral and subcutaneous adipose tissue. Furthermore, we derived formulas for converting the measurement results of various techniques into each other. Results: For intra- and interobserver reliability, we obtained intraclass correlation coefficients (ICCs) ranging from 0.947 to 0.997 (intraobserver reliability) and from 0.850 to 0.998 (interobserver reliability) for planimetric measurements. Diametric techniques conferred lower ICCs with 0.851–0.995 and 0.833–0.971, respectively. Overall, area-based measurements of abdominal adipose tissue yielded highly correlated results with diametric measures of obesity. For example, the Pearson correlation of visceral adipose tissue and sagittal abdominal diameter was 0.87 for male and 0.82 for female patients. Planimetric and diametric muscle measurements correlated best for lean psoas area and bilateral diametric measurement of the psoas with a Pearson correlation of 0.90 and 0.93 for male and female patients, respectively. Conclusion: Planimetric measurements should remain the gold standard to describe fat and muscle compartments. Diametric measurements could however serve as a surrogate if planimetric techniques are not readily available or feasible as for example in large registries.

Radioembolization (RE) with 90yttrium (90Y) resin microspheres generally employs a sandwich technique with separate sequential administration of contrast medium (CM), followed by vehicle (e.g., glucose 5% [G5] solution), then 90Y resin microspheres (in G5), then G5, and then CM again to avoid contact of CM and microspheres under fluoroscopic guidance. This study evaluates the visualization quality and safety of a modified sandwich technique with a 50/50-mixture of CM (Imeron 300) and G5 for administration of 90Y resin microspheres. A retrospective analysis of 81 RE procedures in patients with primary or secondary liver tumors was performed. The quality of angiographic visualization of the hepatic vessels was assessed before the first injection and immediately before the whole dose has been injected. Visualization and flow rate were graded on a 5-point scale: 1 = very good to 5 = not visible/no antegrade flow. Univariate logistic regression models and multiple linear regression models were used to evaluate the prognostic variables associated with visualization and flow scores. Visualization quality was inversely related to flow rate, the lower the flow rate the better the grade of the visualization. Visualization quality was also inversely related to body-mass-index (BMI). Performing RE with the 50/50-CM/G5 mixture resulted in a mean injection time for 1 GBq of 15 min. No clinically significant adverse events, including radiation-induced liver disease were reported. RE with a 50/50-mixture of CM and G5 for administration of 90Y resin microspheres in a modified sandwich technique is a safe administration alternative and provides good visualization of hepatic vessels, which is inversely dependent on flow rate and BMI. Injection time was reduced compared with our experience with the standard sandwich technique.

To find out whether the use of accelerated 2D-selective parallel-transmit excitation MRI for diffusion-weighted EPI (pTX-EPI) offers advantages over conventional single-shot EPI (c-EPI) with respect to different aspects of image quality in the MRI of the pancreas.The MRI examinations of 33 consecutive patients were evaluated in this prospective and IRB-approved study. PTX-EPI was performed with a reduced (zoomed) FOV of 230 × 118 mm(2). The 2D-RF pulse of pTX-EPI was accelerated, i.e. shortened by a factor of 1.7 (pTX-acceleration factor). C-EPI used a full-FOV of 380 × 285 mm(2). In a qualitative analysis, two experienced readers evaluated 3 different aspects of image quality on 3- to 5-point Likert scales. Additionally, apparent diffusion coefficients (ADCs) were determined in both c-EPI and pTX-EPI in normal-appearing pancreatic tissue using regions of interests (ROIs). Mean ADC values and standard deviations were compared between the two techniques.The reduced-FOV pTX-EPI was superior to c-EPI with respect to overall image quality (p0.0001) and identifiability of the pancreatic ducts (p0.01). Artifacts were significantly less severe in pTX-EPI (p0.01). The mean ADC values of c-EPI (1.29 ± 0.19 × 10(-3)mm(2)/s) and pTX-EPI (1.27 ± 0.17 × 10(-3)mm(2)/s) did not differ significantly between the two techniques (p=0.44). The variation within the ROIs as measured by the standard deviation was significantly lower in pTX-EPI (0.095 × 10(-3)mm(2)/s) than in c-EPI (0.135 × 10(-3)mm(2)/s), p0.05.PTX-accelerated EPI with spatially-selective excitation and reduced FOV leads to substantial improvements in DWI of the pancreas with respect to different aspects of image quality without significantly influencing the ADC values.

To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10–20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. We treated 99 consecutive patients (mean age 53.1 ± 21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n = 99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n = 1), hemorrhagic shock (n = 1), or cardiac event (n = 1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv ± 7.25 mSv. Mean procedural time was 72.1 ± 37.4 min. CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose.

Purpose To evaluate the association of therapy-related changes in imaging parameters with progression-free survival (PFS) of patients with unresectable liver metastases from neuroendocrine tumors (NETLMs). Materials and Methods Forty-five radioembolized patients (median age: 62 years; range: 43–75) received a pre- and 3 months posttherapeutic magnetic resonance imaging (MRI) examination. The latter were evaluated for tumor size, arterial enhancement, and necrosis pattern. Influences of therapy-related changes on PFS were analyzed. Statistical analysis included Student's t-test, Wilcoxon test, Cox regression analysis, and Kaplan–Meier curves. Results The median percentage decrease in sum of diameters was 9.7% (range: 43.9% decrease to 15.4% increase). Twenty-one patients (47%) showed increased necrosis. Three parameters were associated with significantly longer PFS: a decrease of diameter (hazard ratio [HR]: 0.206; 95% confidence interval [CI]: 0.058–0.725; P = 0.0139), a decrease in tumor arterial enhancement (HR: 0.143; 95% CI: 0.029–0.696; P = 0.0160), and an increase in necrosis after 3 months (HR: 0.321; 95% CI: 0.104–0.990; P = 0.0480). Multivariate analysis revealed that changes in diameter and arterial enhancement have complementary information and are associated independently with long PFS. Conclusion A decrease both in sum of diameters and arterial enhancement of metastases, as well as an increase in necrosis, are associated with significantly longer PFS after radioembolization. J. Magn. Reson. Imaging 2015;41:361–368.© 2013 Wiley Periodicals, Inc.

PURPOSE To evaluate the ultrasound tissue elasticity imaging by comparison to multimodality imaging using image fusion with Magnetic Resonance Imaging (MRI) and conventional grey scale imaging with additional elasticity-ultrasound in an experimental small-animal-squamous-cell carcinoma-model for the assessment of tissue morphology. METHOD AND MATERIALS Human hypopharynx carcinoma cells were subcutaneously injected into the left flank of 12 female athymic nude rats. After 10 days (SD ± 2) of subcutaneous tumor growth, sonographic grey scale including elasticity imaging and MRI measurements were performed using a high-end ultrasound system and a 3T MR. For image fusion the contrast-enhanced MRI DICOM data set was uploaded in the ultrasonic device which has a magnetic field generator, a linear array transducer (6-15 MHz) and a dedicated software package (GE Logic E9), that can detect transducers by means of a positioning system. Conventional grey scale and elasticity imaging were integrated in the image fusion examination. After successful registration and image fusion the registered MR-images were simultaneously shown with the respective ultrasound sectional plane. Data evaluation was performed using the digitally stored video sequence data sets by two experienced radiologist using a modified Tsukuba Elasticity score. The colors "red and green" are assigned for an area of soft tissue, "blue" indicates hard tissue. RESULTS In all cases a successful image fusion and plan registration with MRI and ultrasound imaging including grey scale and elasticity imaging was possible. The mean tumor volume based on caliper measurements in 3 dimensions was ~323 mm3. 4/12 rats were evaluated with Score I, 5/12 rates were evaluated with Score II, 3/12 rates were evaluated with Score III. There was a close correlation in the fused MRI with existing small necrosis in the tumor. None of the scored II or III lesions was visible by conventional grey scale. CONCLUSION The comparison of ultrasound tissue elasticity imaging enables a secure differentiation between different tumor tissue areas in comparison to image fusion with MRI in our small study group. Therefore ultrasound tissue elasticity imaging might be used for fast detection of tumor response in the future whereas conventional grey scale imaging alone could not provide the additional information. By using standard, contrast-enhanced MRI images for reliable and reproducible slice positioning, the strongly user-dependent limitation of ultrasound tissue elasticity imaging may be overcome, especially for a comparison between baseline and follow-up measurements.

OBJECTIVES The objective of this study was to evaluate the correlation between dynamic gadoxetic acid-enhanced magnetic resonance imaging parameters and specific uptake values (SUVs) derived from ¹⁸fluorodeoxyglucose (¹⁸F-FDG) and ⁶⁸Ga-DOTA-Tyr(3)-octreotate (⁶⁸Ga-DOTATATE) positron emission tomography/computed tomography (PET/CT) in patients with liver metastases of neuroendocrine neoplasms. METHODS A total of 42 patients with hepatic metastases of neuroendocrine neoplasms were prospectively enrolled and underwent both dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and PET/CT, using either ¹⁸F-FDG or ⁶⁸Ga-DOTATATE as tracer. The DCE-MRI was performed at 3 T with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid acquiring 48 slices every 2.2 seconds for 5 minutes. Three regions of interest (ROIs) representing the liver background and up to 3 ROIs representing metastatic liver tissue were coregistered in the PET/CT and in the DCE-MRI data sets. For each patient, a dedicated dual-inlet, 2-compartment uptake model was fitted to the enhancement curves of DCE-MRI ROIs and perfusion parameters were calculated. Lesion-to-background ratios of SUVs were correlated with corresponding lesion-to-background ratios of the perfusion parameters arterial plasma flow, venous plasma flow, total plasma flow, extracellular mean transit time, extracellular volume, arterial flow fraction, intracellular uptake rate, and hepatic uptake fraction using the Spearman coefficient. RESULTS Whereas the lesion-to-background ratios of arterial plasma flow and arterial flow fraction of liver metastases correlated negatively with the lesion-to-background ratios of SUV(mean) derived from ⁶⁸Ga-DOTATATE PET/CT (r = -0.54, P < 0.001; r = -0.39, P < 0.001, respectively), they correlated positively with the lesion-to-background ratios of SUV(mean) derived from ¹⁸F-FDG-PET/CT (r = 0.51, P < 0.05; r = 0.68, P < 0.01, respectively). The lesion-to-background ratios of the DCE-MRI parameters extracellular mean transit time and extracellular volume correlated very weakly with the lesion-to-background ratios of SUV(mean) from ⁶⁸Ga-DOTATATE PET/CT, whereas venous plasma flow, total plasma flow, hepatic uptake fraction, and intracellular uptake rate showed no correlation between DCE-MRI and PET/CT. CONCLUSIONS Both ⁶⁸Ga-DOTATATE and ¹⁸fluorodeoxyglucose PET/CT partially correlate with MRI perfusion parameters from the dual-inlet, 2-compartment uptake model. The results indicate that the paired imaging methods deliver complementary functional information.

Objective: To analyze the clinical efficacy of 90Y radioembolization in liver metastases from pancreatic cancer, to describe treatment toxicities and to identify biomarkers as predictors of outcome. Methods: Data from 19 pancreatic cancer patients (9 females/10 males) who had received 90Y radioembolization for metastatic liver disease between 06/2004 and 01/2011 were analyzed retrospectively. Results: The median age at 90Y radioembolization was 63 years (range 43-77). In 16 patients, previous palliative gemcitabine-based chemotherapy was given for metastatic disease. Objective response in the liver after 90Y radioembolization was 47%. Median local progression-free survival in the liver was 3.4 months (range 0.9-45.0). Median overall survival (OS) was 9.0 months (range 0.9-53.0) and 1-year survival was 24%. Cox regression models for baseline biomarkers at 90Y radioembolization revealed correlations of increased carbohydrate antigen 19-9 (p = 0.02) and C-reactive protein (p = 0.03) with shorter OS. Short-term adverse events (nausea, vomiting, fatigue, fever and abdominal pain) did not exceed grade 3. As long-term adverse events, liver abscesses, gastroduodenal ulceration, cholestasis and cholangitis, ascites and spleen infarction were observed. Conclusion:90Y radioembolization is able to induce an encouraging local response rate of liver metastases of pancreatic cancer patients. Most short-term toxicities are manageable; however, patients should be followed up carefully for severe long-term toxicities.

Ultrasound examination is the imaging procedure with the best predictive diagnostic capability for the salivary glands. Due to the salivary glands' relatively superficial anatomical location, clear boundary from surrounding tissue and comparatively typical echogenicity, therefore sonography is ideal for diagnosis. In addition, the technical advances in recent years, including higher resolution, color Doppler sonography, contrast-enhanced ultrasound, elastography, and tissue harmonic have lead to an improvement in diagnostic accuracy of sonography further resulting in an expansion of the range of indications. Sonography allows detection of obstructive salivary gland diseases such as stenosis or sialolithiasis, as well as sialadenosis such as Sjögren syndrome. Ultrasound examination alone is sufficient to diagnose benign tumors. However, in the case of malignant tumors, computer tomography or MRI may be also required, especially to determine the question of infiltration of the skull base.

Currently methods to reduce radiation and contrast media application in endovascular repair of aortic aneurysms (EVAR) are investigated. First positive results for real-time contrast medium- enhanced ultrasonography (CEUS) guided endovascular aortic repair have been reported. A combination with image fusion of CEUS and preoperative multi-slice computed tomography (MS-CT) might offer added safety regarding stent-graft positioning and sealing of the landing zones. EVAR was performed in a patient with an asymptomatic infrarenal aortic aneurysm and a penetrating aortic ulcer in the neck region. The precise placement of the stent-graftwas performed with CEUS using image fusion and native intraprocedural angiographic fluoroscopy and confirmed with digital subtraction angiography (DSA) using iondinated contrast media. At follow-up, CEUS was used to exclude endoleaks and stent-graft failure or malposition. The precise CEUS-guided placement of the stent-graft was technically successful. No artifacts due to electrical noise and metallic parts of the operating table and surgical instruments occurred. The amount of iodinated contrast media was reduced as intraoperative follow-up was performed using CEUS. CEUS with image fusion combined with intraprocedural angiographic fluoroscopy enables accurate stent-graft placement without use of any nephrotoxic contrast media. This allows EVAR in patients with renal insufficiency or allergic reactions to contrast media.

OBJECTIVE: To evaluate various embolization particles on their physical properties with special regard on morphological variability and elasticity. METHODS: 8 embolization particles (EmboCept (R), Contour SE (R) Microspheres, Embosphere (R) Micorspheres 400 mu m, 500 mu m, 1300 mu m, Embozene (R) Microspheres, DC Beads (R), Embozene Tandem (R)) were evaluated and graduated from 1- 6 microscopically due to morphologic changes in vitro before, during and after their catheter passage by 4 blinded reviewers. To facilitate comparison, microscopic images were provided with a scale. RESULTS: All tested particles showed a homogenous shape and morphology before passage through the simulation catheter. During the passage all particles were elastically deformable, where necessary. After the catheter passage no loss of basic shape was seen. Changes in size were found in 5/8 particles. Grading of morphologic changes varied between mean value of 1.0 and 3.0. No complete destruction or loss of function was seen. CONCLUSION: All tested embolization particles are, regarding their morphological properties in sense of homogenous shape and deformation after catheter passage, a safe treatment option. Tested in vitro no less of functionality regarding physical properties should be expected.

To determine pre-therapeutic predictive factors for overall survival (OS) after yttrium (Y)-90 radioembolization (RE).We retrospectively analyzed the pre-therapeutic characteristics (sex, age, tumor entity, hepatic tumor burden, extrahepatic disease [EHD] and liver function [with focus on bilirubin and cholinesterase level]) of 389 consecutive patients with various refractory liver-dominant tumors (hepatocellular carcinoma [HCC], cholangiocarcinoma [CCC], neuroendocrine tumor [NET], colorectal cancer [CRC] and metastatic breast cancer [MBC]), who received Y-90 radioembolization for predicting survival. Predictive factors were selected by univariate Cox regression analysis and subsequently tested by multivariate analysis for predicting patient survival.The median OS was 356 days (95% CI 285-427 days). Stable disease was observed in 132 patients, an objective response in 71 (one of which was complete remission) and progressive disease in 122. The best survival rate was observed in patients with NET, and the worst in patients with MBC. In the univariate analyses, extrahepatic disease (P 0.001), large tumor burden (P = 0.001), high bilirubin levels (1.9 mg/dL, P 0.001) and low cholinesterase levels (CHE4.62 U/I, P 0.001) at baseline were significantly associated with poor survival. Tumor entity, tumor burden, extrahepatic disease and CHE were confirmed in the multivariate analysis as independent predictors of survival. Sex, applied RE dose and age had no significant influence on OS.Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.

Calcified nodules (“CN”) are responsible for up to 5% of coronary-infarcts and, therefore, classified as minor criteria of “vulnerable” atherosclerotic plaque. We sought to evaluate prevalence and distribution of CN in carotid arteries in correlation with clinical symptoms. 178 consecutive patients with unilateral ischemic stroke and carotid plaques ≥2 mm by duplex ultrasound underwent a carotid-black-blood-3T-MRI with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using dedicated surface-coils. CN were defined as distinct calcification with an irregular, protruding, and convex luminal surface. Prevalence of CN was determined in common carotid artery (“CCA”) and internal carotid artery (“ICA”) in consensus by two reviewers blinded to clinical information. Thirty seven CN in 28 arteries of 26 patients were identified. Prevalence of CN in CCA compared to ICA was slightly higher (59 vs. 41%), but nearly similar in 66 arteries with ≥30% compared to 290 arteries with

Purpose: The aim of this study was to evaluate the clinical and functional outcomes in patients who underwent selective interventional embolization of renal pseudoaneurysms or arteriovenous fistulas at our center. Materials and Methods: Our retrospective analysis included all consecutive patients who received selective transcatheter embolization of renal pseudoaneurysms or arteriovenous fistulas after partial nephrectomy in our department from January, 2003 to September, 2013. The technical and clinical success rate and functional outcome of every procedure was collected and analyzed. Furthermore, the change in renal parenchymal volume before and after embolization was determined in a subgroup. Results: A total of 1425 patients underwent partial nephrectomy at our hospital. Of these, 39 (2.7 %) were identified with a pseudoaneurysm or an arteriovenous fistula after partial nephrectomy. The diagnosis of the vascular lesions was made by means of biphasic CT or CEUS. Technical success by means of selective microcoil embolization was achieved in all 39 patients (100 %). Clinical success, defined as no need for further operation or nephrectomy during follow-up, was achieved in 35 of 39 patients (85.7 %). Renal function, as measured by eGFR before and after the intervention, did not change significantly. However, a mean loss of parenchymal volume of 25.2 % was observed in a subgroup. No major or minor complications were attributable to the embolization procedure. Conclusion: Transcatheter embolization is a promising method for treating vascular complications which may occur after partial nephrectomy. We confirm the high success rate of this technique while discussing renal functional outcomes and potential safety aspects. Key points: • Arterial pseudoaneurysms and arteriovenous fistulas are rare but severe complications after partial nephrectomy • Selective microcoil embolization is a safe and effective kidney-preserving procedure for treating these complications • Embolization leads to a significant loss of renal parenchymal volume but not to a loss of renal function Citation Format: • Strobl FF, D'Anastasi M, Hinzpeter R et al. Renal Pseudoaneurysms and Arteriovenous Fistulas as a Complication of Nephron-Sparing Partial Nephrectomy: Technical and Functional Outcomes of Patients Treated With Selective Microcoil Embolization During a Ten-Year Period. Fortschr Rontgenstr 2016; 188: 188 – 194

The aim of this study is to determine MRI characteristics which indicate liver metastases of neuroendocrine tumors (NET) rather than metastases of other origin (non-NET).Sixty-nine patients with histopathologically proven liver metastases from NET and 69 patients with known liver metastases of other origin underwent MRI of the liver using a 1.5 T MR-scanner. Two board certified radiologists assessed presence of fluid-fluid-levels, number and distribution pattern, signal intensity (SI) characteristics, lesion homogeneity, presence of central necrosis and intratumoral hemorrhage in T2w and T1w non-contrast imaging. A multivariate logistic regression analysis was performed to determine the independent association of image findings and occurrence of NET.Fluid-fluid-levels were identified in 19/69 of patients with NET-metastases, and in none of the patients in the control group (p0.0001). Hyperintense SI in T1w imaging, markedly hyperintense SI in T2w imaging, a disseminated distribution pattern and intratumoral hemorrhage were indicative of NET metastases (p0.05). After statistical adjustment for all significant MRI findings, fluid-fluid-levels (OR: 17.6, 95% CI: 1.9-166.5), strongly hyperintense SI in T2w (OR: 4.7, 95% CI: 1.8-12.7) and a disseminated distribution pattern (OR: 2.9, 95% CI: 1.1-7.4) were independent predictors for NET metastases.The presence of fluid-fluid-levels is highly indicative of NET liver metastases and can be used as an independent predictor to distinguish them from metastases of other origin.