Radiologie (Heidelberg, Germany)最新文献

Objective: To evaluate the ability of quantitative parameters derived from low-dose dual-respiratory-phase CT to differentiate the severity of chronic obstructive pulmonary disease (COPD).

Materials and methods: We enrolled 100 COPD patients between October 2023 and October 2024. Inspiratory CT scans were performed using a standard-dose protocol, and expiratory scans were performed using a low-dose protocol. Images were reconstructed with 60% adaptive statistical iterative reconstruction (ASIR). Dual-respiratory-phase image registration was performed on a dedicated "Digital Lung" platform to quantify the following parameters: end-expiratory lung volume (LV_EX), end-inspiratory lung volume (LV_IN), mean lung density at end-inspiration (MLD_IN), mean lung density at end-expiration (MLD_EX), and the mean density ratio (MLD_EX/IN). The percentages of low-attenuation areas (LAA-910% and LAA-950%), emphysema (Emph%), and functional small airways disease (fSAD%) were also calculated. Correlations between CT parameters and pulmonary function were assessed. Significant variables were entered into univariate and multivariate logistic regression models, and a combined predictive model was constructed. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis with internal validation by bootstrap resampling.

Results: Quantitative parameters, including LV_EX, LV_IN, LAA-950%, LAA-910%, Emph%, and fSAD%, were significantly correlated with pulmonary function indices (FEV₁%pred and FEV₁/FVC; all P < 0.01). Among these, LAA-910% and Emph% showed the strongest correlations with FEV₁%pred (both r = -0.80). In univariate analysis, LAA-910% demonstrated the highest predictive performance (area under the curve [AUC] = 0.887), followed by Emph% (AUC = 0.884). After adjustment for age and smoking status, multivariate logistic regression identified both Emph% (odds ratio [OR] = 1.298, 95% CI: 1.167-1.488, P < 0.001) and fSAD% (OR = 1.111, 95% CI: 1.040-1.205, P = 0.004) as independent predictors of severe COPD (GOLD 3-4 vs. GOLD 1-2). The combined model incorporating fSAD% and Emph% achieved an AUC of 0.926 (95% CI: 0.883-0.974), with a sensitivity of 80.49% and a specificity of 81.36%. Bootstrap internal validation yielded an optimism-corrected AUC of 0.908, confirming good model generalizability.

Conclusion: Low-dose expiratory CT combined with dual-respiratory-phase quantitative analysis provides reliable imaging biomarkers that correlate strongly with pulmonary function. The predictive model incorporating both fSAD% and Emph% demonstrates excellent diagnostic performance for assessing COPD severity and may serve as a noninvasive adjunct tool for disease stratification.

Background: Enteral contrast media (CM) administration in abdominal computed tomography (CT) is handled inconsistently across Germany.

Objective: To present the current recommendations on enteral CM administration based on the key questions of when, what, and how, and to translate them into radiological practice.

Materials and methods: Synthesis of indication-based recommendations, CM classes and their technical properties, and the practical execution of both routes of administration, based on the German Radiological Society (DRG) recommendations, current guidelines, published evidence, and institutional practice.

Results: Positive oral CM are obsolete for most abdominal indications-including acute abdomen, ileus, and trauma-and are contraindicated when gastrointestinal bleeding or ischemia is suspected. In suspected perforation, routine oral contrast should be omitted and barium sulfate is contraindicated, whereas water-soluble iodinated agents remain an option when a leak has to be demonstrated specifically. Furthermore, enteral contrast with neutral oral CM remains useful for upper gastrointestinal tumor staging and enterography (preferably magnetic resonance enterography).

Conclusion: Indication-appropriate, guideline-based enteral contrast administration reduces unnecessary burden without compromising diagnostic accuracy and should be embedded in standardized workflows.

Background: Varicocele is the most common potentially treatable cause of male subfertility. Endovascular embolization is an established minimally invasive alternative to microsurgical ligation.

Objective: To place the indications, technique, outcomes, and limitations of varicocele embolization in context and to define its role relative to microsurgery.

Materials and methods: Narrative, guideline- and evidence-based review of current WHO, EAU, AUA/ASRM, and CIRSE recommendations, systematic reviews, meta-analyses, and relevant cohort studies published through July 2026.

Results: Treatment is primarily indicated in men with a palpable varicocele, abnormal semen parameters, and otherwise unexplained infertility; subclinical varicoceles and normal semen analyses do not justify intervention. Technical success of embolization is usually above 90% in experienced centers. Pregnancy rates are broadly similar to those after surgery, while overall morbidity tends to be lower. Recurrence may, however, be more frequent than after high ligation. No embolic agent has proved consistently superior.

Conclusion: Varicocele embolization is an evidence-based alternative to surgery, particularly for recurrent disease, bilateral or complex venous anatomy, and when rapid recovery is a priority. Treatment should be selected through multidisciplinary, anatomy-based, and shared decision-making.

Background: Administration of enteral contrast media (CM) in abdominal computed tomography (CT) is handled inconsistently across Germany.

Objective: To present the current recommendations on administration of enteral contrast agents along the guiding questions of when, what and how and to translate them into radiological practice.

Material and methods: Synthesis of indication-based recommendations, CM classes and their technical properties and the practical execution of both routes of administration, based on the recommendations of the German Röntgen Society (DRG), current guidelines, published evidence and institutional practice.

Results: Positive oral CMs are obsolete for most abdominal indications, including acute abdomen, ileus and trauma, and are contraindicated when gastrointestinal bleeding or ischemia is suspected. In cases of suspected perforation, routine oral contrast agents should be omitted and barium sulphate is contraindicated, whereas water-soluble iodinated agents remain an option when a leak has to be specifically demonstrated. Furthermore, enteral contrasting with neutral oral CM remains useful for upper gastrointestinal tumor staging and enterography (preferably magnetic resonance enterography).

Conclusion: An indication-appropriate, guideline-based enteral contrast agent administration reduces unnecessary burden without compromising diagnostic accuracy and should be embedded in standardized workflows.

Curative treatment in oncology requires complete local and systemic tumor control. A special option here is the combination of radiotherapy with systemic therapy. Combining the local effect of radiotherapy with the systemic effect of drug therapy creates synergies that can further increase the resulting control rates. In addition, radiotherapy and systemic therapy primarily reinforce each other in their local effects but also have systemic effects, especially in combination with immunotherapy. The combination of radiotherapy and chemotherapy has long been established and is increasingly being supplemented by immunotherapy or treatment with tyrosine kinase inhibitors. The combination of radiotherapy with antihormonal treatment has also become more important. This leads to higher success rates in both remission and healing.

Computed tomography (CT) and magnetic resonance imaging (MRI) are central to staging, treatment planning and response assessment in oncology. For many tumor entities, clinical guidelines specify the recommended imaging frequency and appropriate modality; however, the practical implementation, including the applied imaging protocols, varies in clinical routine. Intravenous contrast agents are indispensable in oncological imaging for a variety of specific clinical questions, particularly for the detection and characterization of intraparenchymal lesions. In addition to the general indications for contrast administration, the selection of the optimal contrast phase for subsequent imaging is crucial. This article outlines the fundamentals of iodine-based and gadolinium-based contrast agents, their pharmacokinetics and safety aspects that should be considered in the context of a risk-benefit assessment for their use in oncological imaging. Furthermore, typical contrast phases and imaging protocols are presented as representative examples. Future developments in this field include spectral imaging and photon-counting CT, quantitative imaging and artificial intelligence (AI)-based methods as well as contrast agent-free functional MRI techniques. All of these approaches aim to achieve more precise tissue characterization, a potential reduction of radiation dose and/or contrast agent use as well as automated optimization of image acquisition and interpretation and are also discussed in this article.

Clinical/methodical issue: Benign prostatic syndrome is the most common urologic condition in older men and substantially affects quality of life.

Standard radiological methods: Early stage disease is managed with pharmacotherapy. In advanced disease, transurethral resection is the surgical standard.

Methodical innovations: For more than 10 years, prostatic artery embolization has provided a minimally invasive alternative performed under local anesthesia.

Performance: Randomized trials and meta-analyses document a marked improvement in symptom score and quality of life with lower periprocedural morbidity than transurethral resection. Five-year data confirm durable symptom improvement, albeit with a higher reintervention rate than the surgical reference standard. Compared with combined medical therapy, embolization proved superior in a randomized trial. Unlike transurethral resection, there is no upper prostate volume limit.

Achievements: With its inclusion in national and international guidelines, prostatic artery embolization has left the experimental stage.

Practical recommendations: Detailed knowledge of the pelvic vascular anatomy and a clear imaging and navigation strategy are prerequisites. Avoidance of nontarget embolization is the central safety element. Novel embolic agents and potential expansion of indications are undergoing clinical evaluation.

Background: Bone marrow abnormalities are frequent radiological findings with a broad spectrum ranging from physiological conversion/reconversion to malignant infiltration.

Objective: This article summarizes important differential diagnoses of malignant bone marrow lesions and presents a practical diagnostic approach.

Material and methods: Narrative review based on the current literature, focusing on magnetic resonance imaging (MRI), computed tomography (CT) and supplementary techniques, such as chemical-shift imaging (CSI), Dixon sequences, diffusion-weighted imaging (DWI) and positron emission tomography CT (PET/CT).

Results: Non-fat-suppressed T1-weighted MRI is central for bone marrow assessment. A signal intensity lower than skeletal muscle or intervertebral discs argues against simple reconversion and should raise the suspicion of infiltration. The CSI and Dixon techniques help differentiate benign mimics by demonstrating intralesional fat. Important differential diagnoses include metastases, leukemia, lymphomas, myeloproliferative disorders, multiple myeloma, reconversion, bone infarcts, chronic nonbacterial osteitis (CNO)/chronic recurrent multifocal osteomyelitis (CRMO), Langerhans-cell histiocytosis (LCH), enostosis and osteomyelitis.

Conclusion: The diagnosis requires integration of imaging patterns, fat content, mineralization, age, clinical context, tumor history and course. In unclear or aggressive findings, imaging follow-up or biopsy is required.

Background: Imaging has a key diagnostic role in monoclonal plasma cell disorders. It can be used not only to detect osteolytic skeletal lesions but also for the detection of bone marrow involvement, extramedullary manifestations, impending complications, treatment response and the relapse assessment. Whole-body computed tomography (CT) has replaced the conventional skeletal survey, while whole-body magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose positron emission tomography-CT (FDG PET/CT) supplement the morphological skeletal assessment by depicting the bone marrow and functional-metabolic disease activity.

Objective: This article provides a practical, guideline-based overview of imaging in monoclonal gammopathy of undetermined significance (MGUS), smouldering multiple myeloma (SMM) and active (requiring treatment) multiple myeloma (MM), focusing on the indications, technical implementation, interpretation of results, structured reporting and clinical consequences.

Material and methods: Narrative synthesis of relevant publications and guidelines, including literature available through June 2026.

Results: In cases of active MM, whole-body CT is recommended at the time of making the diagnosis to assess skeletal damage. Whole-body MRI or 18F-FDG PET/CT can be additionally used to evaluate bone marrow involvement, metabolic activity and paraskeletal or extramedullary disease manifestations. In selected non-IgM MGUS with a high risk of progression according to the German S3 algorithm and in SMM, whole-body CT is primarily used to differentiate from MM. If osteolysis is not detected, whole-body MRI or alternatively 18F-FDG PET/CT is performed. More than one focal MRI lesion typical for myeloma each measuring ≥ 5 mm is a myeloma-defining event. Follow-up and response to treatment should preferentially use the modality that best depicted the baseline disease. In serologically measurable disease, follow-up is predominantly clinical and laboratory-based. Imaging follow-up is required in hyposecretory or nonsecretory MM, in patients with new clinical symptoms, or in the presence of soft-tissue involvement.

Conclusion: Radiological imaging reports of plasma cell disorders should be standardized in a way specific for the modality and directed at the clinical issue. Decisive is the distinction between mineralized bone and bone marrow, the assessment of instability risk, the separate description of paraskeletal and true extramedullary manifestations as well as the transparent classification of the response, stable findings or progression. A structured whole-body reporting facilitates interdisciplinary treatment planning in the myeloma board.