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BACKGROUND/OBJECTIVE: Oral malformations of the tongue are exceedingly rare. The aim of this study was to evaluate the effectiveness of individualized treatment for patients with vascular malformations of the tongue. METHODS: This retrospective study is based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with vascular malformations of the tongue were included. Indications for therapy of the vascular malformation were macroglossia with the impossibility to close the mouth, bleeding, recurrent infection and dysphagia. Size regression of the malformation (volume measurement) and symptom improvement were investigated. RESULTS: Out of 971 consecutive patients with vascular malformations, 16 patients suffered from a vascular malformation of the tongue. Twelve patients had slow-flow malformations and 4 fast-flow malformations. Indications for interventions were bleeding (4/16, 25%), macroglossia (6/16, 37.5%), and recurrent infections (4/16, 25%). For two patients (2/16, 12.5%), there was no indication for intervention due to absence of symptoms. Four patients received sclerotherapy, 7 patients Bleomycin-electrosclerotherapy (BEST) and 3 patients embolization. Median follow-up was 16 months (IQR 7–35.5). In all patients, symptoms had decreased after two interventions at a median (IQR 1–3.75). Volume reduction of the malformation of the tongue was 13.3% (from median 27.9 cm3 to median 24.2 cm3, p = 0.0039), and even more pronounced when considering only patients with BEST (from 86 cm3 to 59.1 cm3, p = 0.001). CONCLUSION: Symptoms of vascular malformations of the tongue are improved after a median of two interventions with significantly increased volume reduction after Bleomycin-electrosclerotherapy.

To investigate whether a humanoid robot in a clinical radiological setting is accepted as a source of information in conversations before MRI examinations of patients. In addition, the usability and the information transfer were compared with a tablet. Patients were randomly assigned to a robot or tablet group with their consent prior to MRI. The usability of both devices was compared with the extended System Usability Scale (SUS) and the information transfer with a knowledge query. Reasons for refusal were collected by a non-responder questionnaire. At the University Hospital Halle 117 patients were included for participation. There was no statistically significant difference in gender and age. Of 18 non-responders, 4 refused to participate partly because of the robot; for another 3 the reason could not be clarified. The usability according to SUS score was different with statistical significance between the groups in the mean comparison and was one step higher for the tablet on the adjective scale. There was no statistically significant difference in knowledge transfer. On average, 8.41 of 9 questions were answered correctly. This study is the first application, in a clinical radiological setting, of a humanoid robot interacting with patients. Tablet and robot are suitable for information transfer in the context of MRI. In comparison to studies in which the willingness to interact with a robot in the health care sector was investigated, the willingness is significantly higher in the present study. This could be explained by the fact that it was a concrete use case that was understandable to the participants and not a hypothetical scenario. Thus, potentially high acceptance for further specific areas of application of robots in radiology can be assumed. The higher level of usability perceived in the tablet group can be explained by the fact that here the interface represents a form of operation that has been established for years in all population groups. More frequent exposure to robots could also improve the response in the future.· patients accept humanoid robots in clinical radiologic situations. · at present they can only convey information as well as an inexpensive tablet. · future systems can relieve the burden on personnel..· Stoevesandt D, Jahn P, Watzke S et al. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. Fortschr Röntgenstr 2021; 193: 947 - 954.ZIEL: Untersucht wurde, ob ein humanoider Roboter im klinisch-radiologischen Setting als Informationsgeber im Gespräch vor MRT-Untersuchungen von Patienten akzeptiert wird. Ergänzend wurden die Benutzerfreundlichkeit und die Informationsvermittlung mit einem Tablet verglichen. Patienten wurden bei Einwilligung vor einem MRT randomisiert einer Roboter- oder Tablet-Gruppe zugeteilt. Die Handhabbarkeit beider Geräte wurde mit der erweiterten System Usability Scale (SUS) und die Informationsvermittlung mit einer Wissensabfrage verglichen. Ablehnungsgründe wurden per Non-Responder-Fragebogen erhoben. Im Universitätsklinikum Halle wurden 117 Patienten zur Teilnahme eingeschlossen. Bei Geschlecht und Alter gab es keinen statistisch signifikanten Unterschied. Von 18 Non-Respondern lehnten 4 die Teilnahme teilweise wegen des Roboters ab; bei weiteren 3 konnte der Grund nicht geklärt werden. Die Handhabbarkeit nach SUS-Score war zwischen den Gruppen im Mittelwertvergleich statistisch signifikant unterschiedlich und war für das Tablet um eine Stufe auf der Adjektiv-Skala höher. Bei der Wissensvermittlung gab es keinen statistisch signifikanten Unterschied; im Mittel wurden 8,41 von 9 Fragen korrekt beantwortet. Diese Studie ist der erster Anwendungsfall im klinisch-radiologischen Setting eines humanoiden Roboters, der mit Patienten interagierte. Tablet und Roboter sind zur Informationsvermittlung im Kontext eines MRT geeignet. Im Vergleich zu Studien, in denen nach der Bereitschaft zur Interaktion mit einem Roboter im Gesundheitswesen gefragt wurde, ist diese Bereitschaft in der hier vorliegenden Studie deutlich höher. Dies könnte dadurch erklärt werden, dass es sich um einen konkreten, für die Teilnehmer begreiflichen Anwendungsfall handelte und nicht um ein hypothetisches Szenario. Damit ist von einer potenziell hohen Akzeptanz für weitere spezifische Einsatzgebiete von Robotern in der Radiologie auszugehen. Der in der Tablet-Gruppe wahrgenommene höhere Bedienkomfort lässt sich dadurch erklären, dass hier das Interface eine seit Jahren in allen Bevölkerungsgruppen etablierte Bedienform darstellt. Eine häufigere Exposition mit einem Roboter könnte auch hier die Response zukünftig verbessern.· humanoide Roboter werden von Patienten in klinisch radiologischen Situationen akzeptiert. · aktuell können sie Informationen dabei jedoch nur so gut wie ein preisgünstiges Tablet vermitteln. · zukünftige Systeme können das Personal entlasten..· Stoevesandt D, Jahn P, Watzke S et al. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. Fortschr Röntgenstr 2021; 193: 947 – 954.

Arteriovenous malformations (AVMs) as rare diseases are diagnostically and therapeutically challenging. Due to the limited evidence regarding treatment outcome, prospective data are needed on how different treatment regimens affect outcome. The aims of this prospective trial are to determine effectiveness, safety, and clinical outcome of multimodal treatment in patients with extracranial AVMs.After clinical and magnetic resonance imaging (MRI)-based diagnosis and informed consent, 146 patients ( 4 years and 70 years) undergoing multimodal therapy in tertiary care vascular anomalies centers will be included in this prospective observational trial. Treatment options include conservative management, medical therapy, minimally invasive image-guided procedures (embolization, sclerotherapy) and surgery as well as combinations of the latter. The primary outcome is the patient-reported QoL 6 months after completion of treatment using the short form-36 health survey version 2 (SF-36v2) and the corresponding short form-10 health survey (SF-10) for children. In addition, clinical presentation (physician-reported signs), MRI imaging (radiological assessment of devascularization), recurrence rate, and therapeutic safety will be analyzed. Further follow-up will be performed after 12, 24, and 36 months. Moreover, liquid biopsies are being obtained from peripheral blood at multiple time points to investigate potential biomarkers for therapy response and disease progression.The APOLLON trial is a prospective, multicenter, observational open-label trial with unequal study groups to generate prospective evidence for multimodal treatment of AVMs. A multicenter design with the potential to assess larger populations will provide an increased understanding of multimodal therapy outcome in this orphan disease.German Clinical Trials Register (identification number: DRKS00021019) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTMLTRIAL_ID=DRKS00021019 .

Objective Bleomycin is one of the most commonly used agents in sclerotherapy for slow-flow vascular malformations worldwide. However, its efficiency remains unknown. The objective of the present study was to assess whether reversible electroporation combined with bleomycin would increase the sclerotherapy effect in patients with previously unsuccessfully treated venous malformations (VMs). Methods We performed, to the best of our knowledge, the first retrospective observational case series from January 2019 to January 2020 of 17 patients (20 lesions) with symptomatic VMs, who had previously undergone at least two unsuccessful invasive treatments. Reversible electroporation was performed with various electrodes and directly injected bleomycin. All patient records, magnetic resonance imaging data, documentation of previous treatments, and data regarding the intervention, complications, and clinical symptoms were analyzed. Results The 17 VM patients (mean age, 20.8 ± 8.2 years; 9 females) had previously undergone an average of 4.2 invasive treatments. These patients had subsequently undergone 22 electrosclerotherapy sessions of 20 lesions. The median dose of bleomycin was 3 mg. The median magnetic resonance imaging-derived lesion volume before treatment was 24.9 cm3, which had decreased by 86% to 3.5 cm3 after treatment. After 3.7 months, eight patients were asymptomatic without residual symptoms and nine patients showed improvement. Conclusions Bleomycin electrosclerotherapy appears to be an effective therapy for patients with VMs resistive to previous invasive therapy. Because of the small sample size and short follow-up period, our results should be examined further using a larger patient population.

Background and Aims Recommendations for the treatment of lower GI bleeding do not include bleeding from venous malformations (VMs). The aim of this study was to delineate the usefulness of a novel hybrid intervention (fluoroscopy-guided endoscopic sclerotherapy) for the treatment of symptomatic VMs in the rectosigmoidal colon with bleeding. Methods The magnetic resonance images of 421 patients with VM, referred to multicenter vascular anomaly centers from 2009 to 2017, were analyzed retrospectively. Treatment was performed for all patients who experienced bleeding from rectosigmoidal VMs using fluoroscopy-guided endoscopic sclerotherapy with polidocanol foam as a novel approach. Results A total of 27 patients displayed VM in the rectosigmoidal area. Eleven of these presented with acute or previous bleeding and received treatment. Active bleeding was observed in 8 patients (72.7%), whereas 3 patients (27.3%) had signs of previous bleeding. Six of the 11 patients had anemia (54.5%). There were no adverse events within 24 hours of the intervention. In a 2-year follow-up period, only 1 patient (9.1%) presented with recurrent bleeding after 13 months and was successfully treated again with fluoroscopy-guided endoscopic sclerotherapy. Conclusions Fluoroscopy-guided endoscopic sclerotherapy was shown to be a safe and effective treatment of symptomatic VMs of the rectosigmoidal area. Thus, fluoroscopy-guided endoscopic sclerotherapy should be considered for patients with bleeding from VMs of the rectosigmoid after a comprehensive workup and interdisciplinary case discussion.

Investigation of functional outcome and patient`s satisfaction after implantation of a customized versus conventional TKA. In 31 consecutively enrolled patients with primary gonarthrosis, 33 customized TKA (custTKA) and in 31 patients, a conventional TKA (convTKA) was implanted. Perioperative and postoperative management were identical. Radio- graphic evaluation, ROM, KSS (Knee society score) and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) were performed and patients satisfaction was evaluated after 3 and 12 months. Groups were comparable for age, sex, body mass index and extension/flexion. After 92 days average flexion in the convTKA group was significantly higher (119 vs. 113 degrees; unpaired t-test). At 375 days, mean flexion in both groups was 120 degrees. There was a significant higher number of outliers of neutral mechanical axis for convTKA patients (11 vs. 3; Chi-squared test). After 92 days there was no difference for KSS (convTKA: 160, custTKA: 167) but significant better results for WOMAC (19 vs. 40) in the custTKA group (unpaired t-test, p= 0.02). In addition, significantly better KSS (181 vs. 156) and WOMAC (99 vs. 42) were found for the custTKA group at 375 days (unpaired t-test, p= 0.002 and 0.001). Patients with the custTKA implant reported significant higher fulfillment of their ex- pectations regarding function and knee strength. In the present study, the patients with a custTKA implant showed significantly superior short-term clinical results and fulfillment of their expectations regarding knee function.

Purpose To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face. Materials and Methods A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene–vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76–99%; partial, 51–75%; failure, n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy. Results The median number of embolotherapy sessions was 2.0 (range, 1–4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76–99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51–75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006). Conclusion Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients’ clinical outcome, emphasizing the need for multimodal therapeutic concepts. Level of Evidence Level 4, Retrospective study.

BackgroundRespiratory failure worsens the outcome of acute pancreatitis (AP) and underlying factors might be early detectable.AimsTo evaluate the prevalence and prognostic relevance of early pleuropulmonary pathologies and pre-existing chronic lung diseases (CLD) in AP patients.MethodsMulticentre retrospective cohort study. Caudal sections of the thorax derived from abdominal contrast enhanced computed tomography (CECT) performed in the early phase of AP were assessed. Independent predictors of severe AP were identified by binary logistic regression analysis. A one-year survival analysis using Kaplan-Meier curves and log rank test was performed.Results358 patients were analysed, finding pleuropulmonary pathologies in 81%. CECTs were performed with a median of 2 days (IQR 1-3) after admission. Multivariable analysis identified moderate to severe or bilateral pleural effusions (PEs) (OR = 4.16, 95%CI 2.05-8.45, pConclusionsIncreasing awareness of the prognostic impact of large and bilateral PEs and pre-existing CLD could facilitate the identification of patients at high risk for severe AP in the early phase and thus improve their prognosis.

Background: Treatment of cerebral aneurysms using hemodynamic implants such as endosaccular flow disruptors and endoluminal flow diverters has gained significant momentum during recent years. The intended target zone of those devices is the immediate interface between aneurysm and parent vessel. The therapeutic success is based on the reduction of aneurysmal perfusion and the subsequent formation of a neointima along the surface of the implant. However, a subset of aneurysms–off-centered bifurcation aneurysms involving the origin of efferent branches and aneurysms arising from peripheral segments of small cerebral vessels–oftentimes cannot be treated via coiling or implanting a hemodynamic implant at the neck level for technical reasons. In those cases, indirect flow diversion–a flow diverter deployed in the main artery proximal to the parent vessel of the aneurysm–can be a viable treatment strategy, but clinical evidence is lacking in this regard. Materials and Methods: Five neurovascular centers contributed to this retrospective analysis of patients who were treated with indirect flow diversion. Clinical data, aneurysm characteristics, anti-platelet medication, and follow-up results, including procedural and post-procedural complications, were recorded. Results: Seventeen patients (mean age: 60.5 years, range: 35–77 years) with 17 target aneurysms (vertebrobasilar: n = 9) were treated with indirect flow diversion. The average distance between the flow-diverting stent and the aneurysm was 1.65 mm (range: 0.4–2.4 mm). In 15/17 patients (88.2%), perfusion of the aneurysm was reduced immediately after implantation. Follow-ups were available for 12 cases. Delayed opacification (OKM A3: 11.8%), reduction in size (OKM B1-3: 29.4%) and occlusion (D1: 47.1%) were observable at the latest investigation. Clinically relevant procedural complications and adverse events in the early phase and in the late subacute phase were not observed in any case. Conclusion: Our preliminary data suggest that indirect flow diversion is a safe, feasible, and effective approach to off-centered bifurcation aneurysms and distant small-vessel aneurysms. However, validation with larger studies, including long-term outcomes and optimized imaging, is warranted.

Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.

Purpose To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand. Materials and Methods A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig’s classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments. Results The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig’s classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients. Conclusion Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients. Level of Evidence Level 4, Retrospective study.

Purpose To prospectively evaluate the efficacy and safety of a new ethylene vinyl alcohol (EVOH) copolymer–based embolic agent in the treatment of symptomatic peripheral arteriovenous malformations (AVMs). Materials and Methods This prospective single-center study evaluated EVOH embolization with 3 different formulations of EVOH (Squid Peri 12 cP, 18 cP, and 34 cP; BALT Germany GmbH, Dusseldorf, Germany) in patients with symptomatic AVMs. Between April 2018 and October 2019, 36 embolization procedures in 21 patients (3 males and 18 females; mean age, 34.7 years) were performed (inclusion criteria: symptomatic peripheral AVM, ≥14 years of age, and elective embolization). Symptoms, technical aspects (transarterial, transvenous, or percutaneous approach; plug or balloon occlusion), clinical and technical success (defined as the improvement of symptoms and complete angiographic eradication of the AVM nidus), adverse events, and short-term outcomes were assessed. Results The mean volume of the embolic agent used per session was 3.4 mL of EVOH 34 cP (standard deviation [SD], ± 5.4), 6.2 mL ± 8.1 of EVOH 18 cP, and 4.6 mL ± 10.1 of EVOH 12 cP. Angiographic success was achieved in 18 patients (85.7%). The mean follow-up was 190 days (range, 90–538 days; median, 182 days). In the follow-up assessment, findings of magnetic resonance imaging showed that 19 patients (90.5%) had a persistent state of devascularization compared with postinterventional angiography. Amelioration or complete elimination of pain was achieved in 90.0% of the patients. One patient experienced a major adverse event; minor adverse events developed in 2 patients. Conclusions In this study, EVOH appeared to be a safe and effective embolic agent in peripheral AVMs and had a low rate of adverse events in a limited number of patients.

This prospective study aimed to validate the IHCT using a match performance score (MPS). Seventeen 3rd league male professional ice hockey field players (mean ± SD, age: 28.0 ± 6.95 years, 10 forwards, 7 defenders) completed the IHCT and were observed in the subsequent competitive match period. Match performance data were collected over 2 months (number of matches: 13-15). Based on these evaluated matches, the MPS consisting of goals, assists, penalty time, plus-minus, and number of matches was calculated for each player. The IHCT contains load parameters (e.g., 10 m and 30 m skate times, transition/weave agility times with and without a puck, slap and wrist shot puck velocities on goal) and stress parameters (e.g., lactate, heart rate). The 30 m sprint skate without puck (r2 = 0.41) and the maximum wrist shot velocity before test (r2 = 0.36) were the test performance parameters with the highest relevance for match performance. The velocity of shots on goal (SOG) displayed the highest correlation for any on-ice performance parameter (30 m sprint without puck: r = 0.76). These results provide evidence of the validity of the IHCT and the usefulness of the MPS to quantify match performance. Obviously, sprint and shot velocities are important parameters to be a successful ice hockey player. Based on these findings, IHCT and MPS are valuable assessments for coaches to evaluate the individual match performance and the effectiveness of training programs. Further research is needed to extend the scope of the IHCT and MPS for 1st and 2nd league players and for a stronger differentiation between forwards and defenders.

The aim of this study was to investigate position-specific (forwards, defenders) reference data for a scientifically evaluated (validity, reliability) ice hockey-specific complex test (IHCT). One hundred and four 3rd league professional ice hockey field players (mean &plusmn, standard deviations (SD), age: 26.4 &plusmn, 5.62 years) volunteered for the investigation. Players were categorized as forwards (n = 64) and defenders (n = 40). Data from the IHCT were collected over six seasons from three 3rd league teams. The IHCT included parameters for load (e.g., 10 m and 30 m skate times, transition and weave agility times with and without a puck, slap and wrist shots on goal) and stress (e.g., lactate, heart rate). The only significant (p &lt, 0.002) difference between forwards and defenders for performance were found for weave agility with puck (p &lt, 0.001). Forwards showed a higher average performance in this parameter than defenders. Differences were also found in weave agility without a puck (p = 0.008), 30 m backward sprinting without puck (p = 0.012) and goals after test (p = 0.030). This study provides position-specific reference data for a valid and reliable ice hockey-specific complex test for the 3rd league. These results may be used by coaches to judge player performance based on position (forwards vs. defenders). Moreover, coaches may use these data to evaluate the effectiveness of the most recent training period. Further research should extend this database to 1st and 2nd league players in order to enhance the scope of the test.

Purpose: Kaposiform Hemangioendothelioma (KHE) is a rare vascular tumor in children, which can be accompanied by life-threatening thrombocytopenia, referred to as Kasabach-Merritt Phenomenon (KMP). The mTOR inhibitor sirolimus is emerging as targeted therapy in KHE. As the sirolimus effect on KHE occurs only after several weeks we aimed to evaluate if additional transarterial embolization is of benefit for children with KHE and KMP. Methods: 17 patients with KHE and KMP acquired from 11 hospitals in Germany were retrospectively divided into two cohorts. Children being treated with adjunct transarterial embolization and systemic sirolimus, and those being treated with sirolimus without additional embolization. Bleeding rate as defined by WHO was determined for all patients. Response of the primary tumor at 6 and 12 months assessed by Magnetic Resonance Imaging (MRI), time to response of KMP defined as thrombocyte increase >150 x 103/µl, as well as rebound rates of both after cessation of sirolimus were compared. Results: N= 8 patients had undergone additive embolization to systemic sirolimus therapy, sirolimus in this group was started after a mean of 6.5 ± 3 days following embolization. N=9 patients were identified who had received sirolimus without additional embolization. Adjunct embolization induced a more rapid resolution of KMP within a median of 7 days vs 3 months, however tumor response as well as rebound rates were similar between both groups. Conclusion: Additive embolization may be of value for a more rapid rescue of consumptive coagulopathy in children with KHE and KMP compared to systemic sirolimus only.

To assess morphological and hemodynamic characteristics of peripheral vascular malformations on 3 T magnetic resonance imaging (MRI) including qualitative comparison of two fat-saturated sequences: short tau inversion recovery (STIR) and three-dimensional high-resolution volume interpolated gradient recalled echo (GRE). During 9 months, 100 patients with suspected or known vascular malformations were prospectively assessed on a 3 T scanner using T2-weighted STIR and turbo spin echo (TSE), T1-weighted TSE, time-resolved contrast-enhanced magnetic resonance angiography (MRA) with interleaved stochastic trajectories (TWIST) and T1-weighted volume interpolated breath-hold examination (VIBE) after contrast enhancement. The analysis included signal behavior and morphologic and hemodynamic characteristics. Additionally, the image quality of the fat-saturated sequences was evaluated by 2 radiologists. 86 patients (14 dropouts; 57 female, 29 male; mean age 26.8 years, age range 1-56) were analyzed. 22 had high-flow and 64 low-flow malformations, including 14 with a lymphatic component. In 21 of 22 patients with high-flow malformations, typical characteristics (flow voids, hyperdynamic arteriovenous fistula, dilated main/feeder-arteries and draining veins) were documented. Patients with low-flow malformations had phleboliths in 35 cases, fluid-fluid levels in 47 and dilated draining veins in 23. Lymphatic malformations showed peripheral contrast enhancement of cyst walls in the volume interpolated GRE. The comparison of fat-saturated sequences showed significantly better results of the volume interpolated GRE in all categories except the presence of artifacts which were significantly reduced in the STIR (p 0.05). 3 T MRI with MRA provides detailed morphological and hemodynamic information of different types of peripheral vascular malformations. Contrast-enhanced high-resolution volume interpolated GRE proved superior to STIR in differentiating morphologic features and to be diagnostic in the differentiation of lymphatic parts and joint involvement. · 3 T MRI with MRA offers detailed information about vascular malformations.. · Fat-saturated MRI provides especially information about morphological characteristics, extent and tissue involvement.. · Volume interpolated GRE proved superior in almost all categories compared to STIR.. · Volume interpolated GRE showed more artifacts.. · Volume interpolated GRE additionally allows differentiation of lymphatic parts and evaluation of joint involvement..· Höhn F, Hammer S, Fellner C et al. 3T MRI of Peripheral Vascular Malformations: Characteristics and Comparison of Two Fat-Saturated sequences: Short Tau Inversion Recovery Versus Three-Dimensional High-Resolution Volume Interpolated Gradient Recalled Echo. Fortschr Röntgenstr 2021; 193: 446 - 458.ZIEL: Studienziel war es, morphologische und hämodynamische Charakteristiken peripherer vaskulärer Malformationen mittels 3T-Magnetresonanz-Bildgebung prospektiv zu untersuchen und 2 fettgesättigte Sequenzen qualitativ zu vergleichen: die Short Tau Inversion Recovery (STIR) und die 3-dimensionale hochauflösende Volume Interpolated Gradient Recalled Echo (GRE) Sequenz. In 9 Monaten wurden 100 Patienten mit V. a. oder mit gesicherter vaskulärer Malformation prospektiv unter Verwendung eines 3T-Scanners mittels einer T2-gewichteten STIR und Turbo-Spin-Echo (TSE), T1-gewichteten TSE und T1-gewichteten, kontrastmittelunterstützten Volume Interpolated Breath-hold Examination (VIBE) untersucht. Zudem wurde eine zeitaufgelöste Magnetresonanzangiografie mit interleaved stochastic trajectories (TWIST-MRA) durchgeführt. Analysiert wurden Signalverhalten, morphologische und hämodynamische Charakteristiken sowie die Bildqualität der 2 fettgesättigten Sequenzen im Vergleich. Bei 14 Drop-outs wurden die Daten von 86 Patienten (57 Frauen, 29 Männer; Durchschnittsalter 26,8 Jahre; Altersgruppe 1–56 Jahre) analysiert. Es lagen 22 High-flow- und 64 Low-flow-Malformationen (davon 14 mit lymphatischem Anteil) vor. In 21 der 22 High-flow-Malformationen wurden typische Charakteristiken detektiert (flow-voids, hyperdynamische arteriovenöse Fisteln, dilatierte Haupt-/zuführende Arterien und dilatierte ableitende Venen). Bei den Low-flow-Malformationen kamen in 35 Fällen Phlebolithen, in 47 Flüssigkeits-Flüssigkeitsspiegel und in 23 dilatierte Venen zur Darstellung. Bei den lymphatischen Malformationen zeigte sich eine wandständige Kontrastmittelaufnahme der Zysten. Der Vergleich der fettgesättigten Sequenzen ergab signifikant bessere Ergebnisse der Volume Interpolated GRE in allen untersuchten Kategorien mit Ausnahme der Artefakte, welche in der STIR signifikant geringer ausfielen (p 0,05). 3T-MR-Bildgebung mit MRA liefert detaillierte morphologische und hämodynamische Informationen zu allen peripheren Malformationstypen. Von den fettgesättigten Sequenzen erwies sich die kontrastmittelgestützte hochauflösende Volume Interpolated GRE bezüglich der Differenzierung morphologischer Charakteristiken der STIR überlegen und diagnostisch aussagekräftig zur Differenzierung lymphatischer Anteile und Gelenkbeteiligungen. · 3T-MR-Bildgebung mit MRA liefert detaillierte Informationen über alle Malformationstypen.. · Fettgesättigte MR-Sequenzen bilden insbesondere morphologische Charakteristiken, Ausdehnung und Umgebungsinfiltration exakt ab.. · Die Volume Interpolated GRE erwies sich in nahezu allen Kriterien der STIR überlegen.. · Einzige Einschränkung war die höhere Artefaktanfälligkeit der Volume Interpolated GRE.. · Die Volume Interpolated GRE ermöglicht zusätzlich die Differenzierung von lymphatischen Malformationsanteilen sowie Gelenkbeteiligungen..

The aim of this retrospective cross-sectional study was to provide an MRI-based examination framework of venous malformations (VMs) infiltrating the sciatic nerve and determine the frequency of nerve infiltration patterns and muscle involvement in correlation to the patients’ quality of life. Pelvic and lower limb MR images of 378 patients with vascular malformations were examined retrospectively. Pain levels and restriction of motion were evaluated with a questionnaire. Cross-sectional areas of affected nerves were compared at standardized anatomical landmarks. Intraneural infiltration patterns and involvement of muscles surrounding the sciatic nerve were documented. Sciatic nerve infiltration occurred in 23/299 patients (7.7%) with VM. In all cases (23/23; 100%), gluteal or hamstring muscles surrounding the nerve were affected by the VM. Infiltrated nerves were enlarged and showed signal alterations (T2-hyperintensity) compared to the unaffected side. Enlarged nerve cross-sectional areas were associated with elevated pain levels. Three nerve infiltration patterns were observed: subepineurial (12/23; 52.2%), subparaneurial (6/23; 26.1%) and combined (5/23; 21.7%) infiltration. This study provides a clinically relevant assessment for sciatic nerve infiltration patterns and muscle involvement of VMs, while suggesting that VMs in gluteal and hamstring muscles require closer investigation of the sciatic nerve by the radiologist.

The aim of this study was to identify the frequency of rectosigmoidal involvement in patients with venous malformations (VM) of the lower extremities and to demonstrate multidisciplinary therapeutic options. The medical records and magnetic resonance images (MRI) of patients with VM of the lower extremities, over a six-year period, were reviewed retrospectively in order to determine the occurrence of rectosigmoidal involvement. Vascular interventions, surgical treatments, percutaneous and hybrid (endoscopy-guided angiography) sclerotherapy and procedural complications (according to Clavien-Dindo classification) were also noted. Of the 378 patients with vascular malformation of the lower limbs, 19 patients (5%) had documented venous rectosigmoidal malformation. All of these 19 patients reported episodes of rectal bleeding, while seven patients (36.8%) also had anemia. All patients underwent endoscopy. By endoscopy, seven patients (36.8%) showed discreet changes, and 12 patients (63.2%) showed pronounced signs of submucosal VM with active (47.3%) or previous (15.7%) bleeding. Treatment was performed in all patients with pronounced findings. Six patients underwent endoscopy-guided hybrid sclerotherapy, one patient underwent endoscopic tissue removal, one patient received percutaneous sclerotherapy and one patient received a combination of transvenous embolization and hybrid sclerotherapy. Three patients required open surgery. No complications occurred after conservative treatments; however, one complication was reported after open surgery. None of the treated patients reported further bleeding and anemia at the end of the follow-up period. In this cohort, rectosigmoidal VM occurred in 5% of patients presenting with a high incidence of rectal bleeding. Percutaneous or endoscopy-guided hybrid sclerotherapy appeared to be a safe and effective alternative to surgery.

Background: Acute pancreatitis (AP) is a frequent disorder with considerable morbidity and mortality. Obesity has previously been reported to influence disease severity. Objective The aim of this study was to investigate the association of adipose and muscle parameters with the severity grade of AP. Methods: In total 454 patients were recruited. The first contrast-enhanced computed tomography of each patient was reviewed for adipose and muscle tissue parameters at L3 level. Associations with disease severity were analysed through logistic regression analysis. The predictive capacity of the parameters was investigated using receiver operating characteristic (ROC) curves. Results: No distinct variation was found between the AP severity groups in either adipose tissue parameters (visceral adipose tissue and subcutaneous adipose tissue) or visceral muscle ratio. However, muscle mass and mean muscle attenuation differed significantly with p-values of 0.037 and 0.003 respectively. In multivariate analysis, low muscle attenuation was associated with severe AP with an odds ratio of 4.09 (95% confidence intervals: 1.61-10.36, p-value 0.003). No body parameter presented sufficient predictive capability in ROC-curve analysis. Conclusions: Our results demonstrate that a low muscle attenuation level is associated with an increased risk of severe AP. Future prospective studies will help identify the underlying mechanisms and characterise the influence of body composition parameters on AP.

Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge especially in younger patients. The aim of this review article is to provide up-to-date information about the different kinds of LM manifestations. In addition, related syndromes and typical imaging features to facilitate the diagnosis are discussed. The clinical presentation of abdominal LM is unspecific, whereby most are asymptomatic and comprise incidental findings of thin-walled cystic masses anywhere in the abdomen. The fluid in the cystic masses may be proteinaceous, contain blood, or be infected. Radiological imaging features overlap with other cystic diseases; hallmark in LM is a lack of a solid component and exclusive enhancement of the walls and septa. In cystic abdominal masses in early childhood or young adults, abdominal LM must be taken into account by the radiologist. Newly defined entities in this spectrum of diseases are central conducting lymphatic anomaly (CCLA) and generalized lymphatic anomaly (GLA).

Purpose To evaluate the effects of lowering the detector entrance exposure in children undergoing interventional radiology procedures. Materials and Methods The study retrospectively investigated radiation dose levels in pediatric patients aged 0–18 years before (n = 39) and after (n = 26) lowering detector entrance dose, undergoing embolization of peripheral Arteriovenous malformations, Portal Vein Interventions or Percutaneous Transhepatic Cholangio Drainage (PTCD) between 2014 and 2017. Patient characteristics, fluoroscopy time, protocols used as well as resulting Skin Dose and Dose Area Product (DAP) were compared in each cohort. Image quality was assessed by two independent readers. Results The two patient cohorts did not differ in terms of patient demographics. Similarly, fluoroscopy time did not differ before and after implementation of the low dose settings. An overall reduction of skin dose of 75.1% for AVM embolizations, 80.5% for Portal Vein Interventions and 85.3% for PTCD placement was observed. The DAP decrease was 82.5% for AVM embolizations, 72.2% for Portal Vein Interventions and 79.8% for PTCD placement. Image quality was generally considered to be good with an insignificant difference between pre and post implementation of the low dose approach and good agreement between the two readers. Manual inroom-switching to higher dose levels was possible, however this was not performed more frequently after implementation of the low dose settings. Conclusion Lowering the detector entrance dose in pediatric interventional radiology procedures results in a significant decrease of the radiation dose burden.

Abdominelle lymphatische Malformationen (LM) stellen relativ seltene Befunde in der Differenzialdiagnose fokaler abdomineller Lasionen dar. Dennoch sind sie gerade bei Patienten in einer jungen Altersgruppe diagnostisch eine Herausforderung. Das Ziel dieses Ubersichtsartikels ist es, aktuellste Informationen uber die unterschiedlichen Arten der Manifestation von LM zu geben. Daruber hinaus werden die in diesem Zusammenhang auftretenden Syndrome sowie typischen Merkmale der Bildgebung behandelt. Klinisch treten abdominelle LM meist asymptomatisch auf. In der Bildgebung werden haufig Zufallsbefunde von dunnwandig begrenzten zystischen Raumforderungen im gesamten Abdomen auffallig. Die Flussigkeit in den zystischen Raumforderungen kann proteinreich sein, Blut enthalten oder Zeichen der Infektion aufweisen. Die radiologische Prasentation uberschneidet sich dabei haufig mit anderen zystischen Erkrankungen. Das typische Zeichen der LM ist das Fehlen von soliden Anteilen und die ausschliesliche Kontrastmittelaufnahme der zystischen Wande und Septen. Differenzialdiagnostisch mussen Radiologen bei zystischen abdominellen Raumforderungen v. a. bei Kindern und jungen Erwachsenen eine LM in Betracht ziehen. Die kurzlich neu definierten Entitaten dieses Krankheitsspektrums sind die sog. „central conducting lymphatic anomaly“ (CCLA) und die generalisierte lymphatische Anomalie (GLA).

The aim of this investigation was to quantify the acute effects of the execution of the physical performance tests within the ice hockey-specific complex test (IHCT) on shooting performance. Thirty-four professional male ice hockey players with an average of 6.9 years of playing experience were recruited. The slap shot (SS) was found to accelerate the puck with a higher speed and greater precision. After the IHCT, the maximum puck speed of successful goal shots decreased considerably (p &lt, 0.001, d &gt, 1.5). The puck speed percentage decrement after the IHCT did not differ between the SS (6.1, SD = 4.4, −5.5–17.9) and the wrist shot (WS, 6.0, SD = 3.5, −0.9–12.2, p = 0.86, d = 0.03). The magnitude of puck speed reduction in the WS was inversely related to the functional heart rate reserve (r = −0.44, p = 0.02) and the blood lactate elimination rate (r = −0.43, p &lt, 0.02). The linear and COD speed tests on-ice resulted in a higher amount of successful goal shots. These findings highlight the interaction of intense on-ice testing and goal-shooting performance.

Objective The aim of this study was to evaluate the safety and clinical outcomes of percutaneous sclerotherapy of venous disorders of the labia majora in patients with vascular malformations of the lower limbs. Methods Thirty percutaneous sclerotherapy treatments were performed over a 6-year period among 17 female patients with symptomatic venous malformation (VM) or secondary varicosis of the labia majora. Four patients were treated with sclerotherapy alone, 13 patients had additional procedures to control the VM before sclerotherapy. Polidocanol was used as sclerosant. Indications for sclerotherapy included pain, bleeding, thrombophlebitis, and swelling. Genitourinary symptoms were recorded. The number of treatments and procedure-related complications were registered. Complications were classified according to the Society of Interventional Radiology (SIR) classification system (grade A-E). The 3-month postintervention follow-up included magnetic resonance imaging, clinical examination, and a symptom-related questionnaire. If no reintervention was necessary, consultation was scheduled biannually. Results All patients had local swelling and pain; only a fraction of the patients had further symptoms with bleeding or thrombophlebitis (47% each). Eight patients required reintervention. No major complications were observed; minor complications such as postprocedural swelling occurred in 29% (SIR grade A), pain occurred in 17% (SIR grade B), and skin blistering developed in 5% (SIR grade B). Upon follow-up examination after a median of 40 months, 76% showed complete relief of symptoms, and 23% reported partial relief. All patients reported a substantial reduction in pain (75% >5 points in visual analogue scale) and swelling (88% complete cessation). Conclusions Percutaneous sclerotherapy is a safe and effective treatment option of VM and secondary varicosis of the labia majora.

Purpose: Regarding genital lesions, the incidence of male external genitalia vascular anomalies is circa 3%, thereof one-tenth tumors and nine-tenth malformations according to the International Society for the Study of Vascular Anomalies classification. Image-guided percutaneous sclerotherapy in male external genitalia vascular malformations has rarely been described. Therefore, a retrospective analysis of sclerotherapy in a series of eight patients was conducted. Materials and Methods: The study was IRB approved. Two radiologists reviewed angiographic reports and analyzed interventionally treated male patients with external genitalia vascular malformations between February 2, 2014, and November 11, 2017, at an interdisciplinary tertiary care Vascular Anomalies Center. Inclusion criteria were a slow-flow malformation of the male external genitalia and no interventional treatment before. Operations longer than 1-year past were no exclusion criteria. Patients suffered from lymphatic and/or venous malformations and received percutaneous sclerotherapy. Malformations were treated with polidocanol, ethanol in gel form or OK-432. Patients answered a questionnaire regarding symptoms with repeat after follow-up. The initial state and post-treatment results were compared. Magnetic resonance imaging pre- and post-intervention was assessed. Complications were reported standardized. Results: Eight patients with a mean age of 21.6 years suffered from genital swelling, bleeding, thrombophlebitis, lymphorrhea, skin changes, pain, and functional genitourinary symptoms and were treated with sclerotherapy. All patients reported clinical improvement of symptoms during the average follow-up period of 30 months. No complications ensued. Conclusion: Sclerotherapy seems to be a safe and effective treatment of slow-flow malformations of the male external genitalia. Due to the low incidence of the disease, multicenter studies are necessary to assess a larger number of cases.

No systematic, histologically confirmed data are available concerning the association between magnitude of direct dynamic impact caused by vertical impact trauma and the resulting injury to cartilage and subchondral bone. The aim of this study was to investigate the association between dynamic impact and the resulting patterns of osteochondral injury in an ex-vivo model. A mechanical apparatus was employed to perform ex-vivo controlled dynamic vertical impact experiments in 110 pig knees with the femur positioned in a holding fixture. A falling body with a thrust plate and photo sensor was applied. The direct impact to the trochlear articular surface was registered and the resulting osteochondral injuries macroscopically and histologically correlated and categorized. The relationship between magnitude of direct impact and injury severity could be classified as stage I injuries (impact7.3MPa): elastic deformation, no histological injury; stage II injuries (impact 7.3-9.6MPa): viscoelastic imprint of the cartilaginous surface, subchondral microfractures; stage III injuries (impact 9.6-12.7MPa): disrupted cartilage surface, chondral fissures and subchondral microfractures; stage IV injuries (impact12.7MPa): osteochondral impression, histologically imprint and osteochondral macrofractures. The impact ranges and histologic injury stages determined from this vertical dynamic impact experiment allowed for a biomechanical classification of direct, acute osteochondral injury. In contrast to static load commonly applied in ex-vivo experiments, dynamic impact more realistically represents actual trauma to the knee joint.

The oral sodium tolbutamide test (OSTT) for diabetes was significantly different in 102 normal, twenty-one borderline, and twenty-nine diabetic subjects as classified by the oral glucose tolerance test (OGTT). Mean thirty-minute values, in per cent of FBS, were 57.0, 72.3, and 86.2, and mean forty-minute values were 44.1, 60.3, and 79.4 in the three groups, respectively. Individual agreement between the OSTT and OGTT was generally good, though with some conflicts. Effective blood levels were attained ten minutes after oral administration of sodium tolbutamide, 2.0 gm., and at twenty minutes and beyond levels exceeded those after intravenous administration of 1.0 gram. Hypoglycemic response to the intravenous and oral tests appeared comparable except for a lag of about ten minutes and attainment of lower blood sugar levels at forty and sixty minutes after oral administration. Reproducibility was good, except in those subjects with initial conflict between the OSTT and OGTT.