Radiologie (Heidelberg, Germany)最新文献

Renal cell carcinoma is one of the most common cancers and its mortality rate is falling due to continuous advances in diagnostics and treatment. Early detection using imaging techniques enables treatment with curative intent, resulting in a correspondingly favorable prognosis. Classification systems such as the TNM and Bosniak classifications as well as nephrometric scores, particularly the R.E.N.A.L. score, assist in prognosis assessment and support individualized treatment planning. They help to assess tumor complexity and the subsequent risk of postoperative or postinterventional complications; however, other anatomical and clinical factors, apart from nephrometric scores, must also be considered for an optimal individual treatment decision.

Clinical/methodical issue: Bone marrow development is age-dependent. The transformation from red to yellow bone marrow follows a constant pattern and influences the localization and morphology of bone marrow processes.

Standard radiological methods: Magnetic resonance imaging (MRI) is an adequate imaging method to obtain information about the composition of bone marrow.

Methodical innovations: Different MRI sequences allow the differentiation between physiologic, reactive, benign, and pathologic bone marrow changes.

Clinical/methodical issue: Human bone marrow and its metabolism-particularly the composition of bone marrow adipose tissue (BMAT)-are subject to physiological changes throughout the lifespan. However, they are also involved in and altered by pathological processes. Modern techniques of quantitative magnetic resonance imaging (MRI) now enable an objective and quantitative evaluation of such processes.

Standard radiological methods: Standard radiological procedures consist of T1- and T2-weighted MRI of the bone (marrow).

Methodical innovations: Methodological innovations consist of chemical shift encoding-based (CSE) water-fat imaging and proton (¹H) MR spectroscopy (MRS).

Performance: In particular, quantification using the proton density fat fraction (PDFF) is of relevance for both physiological and pathological changes of BMAT.

Achievements: The determination of the PDFF-particularly by means of (¹H)-MRS-is increasingly being used for the evaluation of BMAT, but it remains a non-standard procedure.

Practical recommendations: Knowledge of the typical signal characteristics of BMAT is essential for reliably discriminating physiological from pathological changes-both in terms of visual image reading and quantification.

Background: Bone marrow incidentalomas are being detected with increasing frequency due to the growing use of magnetic resonance imaging (MRI). It is essential to distinguish benign from malignant lesions that require further investigation.

Objectives: The aim is to describe the imaging characteristics to facilitate the practical differentiation between malignant and benign incidental findings in bone marrow.

Methods: A narrative literature review focusing on a pattern-based approach to the spinal and extraspinal skeleton.

Results: The signal characteristics, morphology, and location of the bone marrow incidentaloma are crucial for classifying the lesion. In the spine, classifying the lesion as diffuse, focal, microfocal, or regional helps limit the differential diagnoses. Osteolytic lesions are hypointense on T1w- and hyperintense on T2w-imaging; sclerotic lesions are signal-free on all sequences; and fatty lesions are hyperintense on both T1w- and T2w-imaging. The presence of micro- or macroscopic fat within a lesion is a criterion for benignity.

Conclusion: By using a few MRI sequences and correlating them with X‑ray and computed tomography (CT) images, it is possible to reliably classify incidental bone marrow lesions.

Clinical/methodological issue: Uterine fibroids are the most common benign tumors of the female genital tract. In symptomatic women, uterus-preserving treatment strategies are becoming increasingly more important.

Standard radiological methods: Contrast-enhanced magnetic resonance imaging (MRI) is the imaging standard for preprocedural planning. It accurately enables assessment of the number, size, location and vascularity of fibroids while excluding relevant differential diagnoses.

Methodological innovations: Uterine artery embolization (UAE) is an established minimally invasive uterus-preserving treatment. Recent technical advances include transradial access, optimized angiographic protocols and modern calibrated embolic agents.

Performance: Randomized trials demonstrate sustained symptom relief and improved quality of life with a low complication rate. The use of UAE achieves high fibroid devascularization rates but is associated with higher reintervention rates than myomectomy.

Achievements: The UAE is an evidence-based alternative to surgery in women with symptomatic fibroids seeking uterine preservation. In women wishing to preserve fertility, myomectomy remains the preferred treatment because of the current evidence.

Practical recommendations: Patient selection should be multidisciplinary. Careful patient selection, preprocedural MRI, standardized embolization techniques, and structured periprocedural management are essential for optimal clinical outcomes.

Clinical issue: Intraspinal extradural lesions represent the most frequent group of spinal tumors and comprise a broad spectrum of primary and secondary neoplasms as well as intradural extramedullary tumors with secondary extradural extension. Because even small epidural lesions can cause significant neurological deficits through compression of the spinal cord or cauda equina, a prompt and accurate diagnosis is essential.

Radiological standard procedures: Contrast-enhanced magnetic resonance imaging (MRI) is the imaging modality of first choice as it enables a reliable assessment of the tumor extent, the relationship to the spinal cord, dural sac and nerve roots as well as possible bone marrow infiltration. Characteristic imaging features, such as the origin of the mass, dorsal cortical destruction, neural foraminal widening or a dumbbell-shaped growth pattern, often enable a targeted narrowing down of the underlying tumor entity.

Practical recommendations: In adults secondary epidural tumors should be primarily considered in the differential diagnosis as they account for the majority of intraspinal extradural masses. In particular, metastases, plasma cell neoplasms and lymphomas are of high clinical relevance. A systematic assessment of the anatomical location, growth pattern and possible osseous alterations are essential to narrow down the differential diagnosis and to guide appropriate further diagnostic evaluation and treatment planning.

Background: Spinal space-occupying lesions frequently pose a diagnostic challenge, particularly when distinguishing malignant from nonmalignant abnormalities. The challenge for the radiologist is to reliably differentiate malignant from benign entities.

Objective: To identify imaging features that argue against a neoplastic disease and provide clues to relevant differential diagnoses.

Material and methods: A literature search was conducted in pubmed.gov to identify and characterize tumor-like spinal conditions.

Results: A total of 11 differential diagnoses were selected that can mimic a neoplastic disease, although their etiology fundamentally differs from that of a neoplasm. The key characteristics of each entity are briefly summarized.

Conclusion: As tumor-like spinal lesions comprise a broad spectrum of entities, their differential diagnosis remains challenging.

Spinal tumors are a rare tumor entity in children and adolescents, accounting for approximately 4-10% of all central nervous system (CNS) tumors. Based on their anatomical location, they are classified as intradural or extradural and intradural tumors are further subdivided into intramedullary and extramedullary lesions. The clinical symptoms are often nonspecific, with persistent back pain being the most common initial symptom. Neurological manifestations, including sensory and motor deficits, typically develop later in the course of the disease. The imaging modality of choice is magnetic resonance imaging (MRI) of the entire spinal axis and when indicated the head. The various tumor entities exhibit characteristic imaging features that should be recognized as they are essential for accurate diagnosis and appropriate treatment planning.

In a narrow neuroradiological sense, vascular mass lesions of the spinal cord primarily comprise intramedullary cavernous malformations, spinal arteriovenous malformations (AVMs) with an intramedullary or pial nidus, and hemangioblastomas. Cavernous malformations typically present as small eccentric lesions with a mixed internal signal pattern and a hemosiderin rim; contrast enhancement is usually absent or only minimal. Spinal AVMs are characterized by a nidus with intra- and perimedullary flow voids; hemorrhagic stigmata may be present, and angiography demonstrates early venous drainage. Hemangioblastomas typically appear as avidly enhancing nodules, usually located superficially or subpially, often with a syrinx that is disproportionately large relative to tumor size. Magnetic resonance imaging (MRI) is the first-line imaging modality; when a shunt lesion is suspected, digital subtraction angiography (DSA) remains indispensable. The spinal dural arteriovenous fistula (SDAVF) is presented as the most important differential diagnosis; its appearance of a venous congestive myelopathy distinguishes it from the aforementioned mass lesions.