Radiologie (Heidelberg, Germany)最新文献

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.

Background: Bone marrow reconversion is a physiological response to increased hematopoietic demand and is common in chronic anemia. Magnetic resonance imaging (MRI) enables noninvasive assessment of marrow composition; however, visual evaluation remains subjective. Because the psoas signal is largely unaffected by hematologic status, it can serve as a stable internal reference.

Objectives: To quantify lumbar vertebral marrow signal alterations in women with iron deficiency anemia (IDA) and evaluate the diagnostic performance of the T1-weighted signal ratio between the lumbar vertebrae and the psoas muscle as a predictor of anemia.

Materials and methods: This retrospective study analyzed lumbar spine MRIs and laboratory data of 141 women (83 IDA, 58 controls). On sagittal T1-weighted images, circular regions of interest were placed in the L1 vertebral body and adjacent psoas muscle to calculate the vertebra/psoas signal ratio. Group comparisons, correlation, and receiver operating characteristic (ROC) analysis with 95% confidence intervals were performed.

Results: The mean vertebra/psoas ratio was significantly lower in IDA (1.63 ± 0.34) than in controls (2.19 ± 0.71; p < 0.001). Hemoglobin levels correlated positively with the ratio (β = 0.11; R² = 0.16; p < 0.05). The ROC analysis results demonstrated good discrimination (AUC = 0.81; 95% CI 0.73-0.88); an optimal cut-off of 1.93 yielded 85.5% sensitivity and 63.8% specificity.

Conclusion: The lumbar vertebra/psoas T1-weighted signal ratio is significantly reduced in IDA and correlates with hemoglobin levels. It represents a simple and reproducible quantitative MRI biomarker that may aid in the screening and diagnostic evaluation of anemia on routine spine imaging.

Objective: This study aimed to explore the anatomy and injury patterns of trapeziometacarpal (TMC) joint ligaments by using magnetic resonance imaging (MRI).

Materials and methods: In total, 32 asymptomatic healthy volunteers (16 women, 16 men; mean age, 34.5 ± 5.4 years) and 18 patients (12 women, 6 men; mean age, 43.6 ± 10.4 years) were recruited between January 2019 and November 2024. All participants underwent MRI of the TMC joint using T1-weighted imaging and proton density-weighted imaging with fat suppression. Two musculoskeletal radiologists independently analyzed the MRI features of the TMC joint ligaments in volunteers and patients.

Results: In asymptomatic volunteers, the normal anterior oblique ligament (AOL), dorsal radial ligament (DRL), and posterior oblique ligament appeared as slender, low-signal fibrous structures on MRI, whereas the normal intermetacarpal ligament exhibited a striated signal. The AOL was significantly thinner in women than in men, and there were no significant sex differences for other ligaments. Ligament injuries were characterized by changes in MRI signal: Sprains showed high-signal alterations, partial tears displayed thickening and partially discontinuous fibers with disrupted signals, and complete ruptures were characterized by ligament retraction and fluid-filled gaps. Among the ligaments, the AOL was most susceptible to injury, followed by the DRL.

Conclusion: Magnetic resonance imaging is an accurate method for assessing the anatomy and pathological conditions of the TMC joint ligaments, thus aiding in the accurate diagnosis and management of ligament injuries.

Background: Osteoporosis is frequently underdiagnosed in trauma patients. However, contrast-enhanced whole-body computed tomography (WBCT) in polytrauma care enables opportunistic assessment of bone status without additional radiation exposure. The aim of this study was to investigate whether vertebral, femoral, and dentomaxillofacial CT parameters can identify patients with documented osteopenia or osteoporosis and whether a combined score improves classification.

Materials and methods: This retrospective, single-center study included 60 WBCT cases. Twenty patients with osteopenia or osteoporosis documented in their initial trauma report were compared with 20 age- and sex-matched reference patients and 20 younger patients. The final classification of bone status was based on an evaluation of patient records, including dual-energy X‑ray absorptiometry (DXA) data (where available), and medical history. Trabecular density was measured in the lumbar spine (L1-L3), femoral neck, and maxillary alveolar ridge. Hard palate cortical thickness (HPT) was measured in millimeters. The whole-body osteoporosis screening score was defined as WBOS = ƒ(HPT, hip HU, lumbar HU).

Results: Measurements of HPT, maxilla, hip, and lumbar spine decreased significantly in patients with osteopenia/osteoporosis patients. The combined WBOS score demonstrated the best exploratory performance, with a sensitivity of 100.0%, a specificity of 97.1%, an accuracy of 98.3%, and an AUC of 0.994 at a preliminary threshold of 361.

Conclusion: Opportunistic multisite assessment of bone status using WBCT in polytrauma appears feasible. The WBOS showed the best exploratory discrimination but requires further validation against DXA or quantitative CT before clinical implementation.

Background: We aimed to explore the use of deep learning image reconstruction (DLIR) to improve virtual non-contrast (VNC) images from enhanced dual-energy computed tomography (DECT).

Materials and methods: A total of 91 patients undergoing treatment for liver lesions from September to December 2024 were analyzed. All patients underwent true non-contrast (TNC) and dual-phase enhanced DECT with medium-level DLIR (DLIR-M). The VNC images were generated from arterial phase (VNC_A) and venous phase (VNC_V) scans. The CT values and standard deviations of liver, spleen, bilateral erector spinae, and liver lesions were measured across the three image groups, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists subjectively scored the image quality. Measurements and quality scores were statistically compared among the groups.

Results: There was no difference in CT values among the three groups (P > 0.05); VNC_A and VNC_V images did not alter the primary imaging characteristics of hypervascular liver lesions. The VNC_A and VNC_V images had lower image noise than the TNC images, with VNC_V images having the lowest noise. Except for the spleen, VNC_A and VNC_V images had higher SNR than TNC images, with VNC_V images having the best SNR. The subjective scores of the TNC, VNC_A, and VNC_V images were all greater than 3, showing good consistency between the two observers (kappa = 0.78, 0.76, and 0.83, respectively).There was no difference between the subjective evaluation of VNC_A and TNC (P > 0.05), while VNC_V had better image quality than TNC (P < 0.05). The total effective radiation dose was 8.55 ± 0.38 mSv; thus, replacing TNC with VNC would reduce the dose by 33.4%.

Conclusion: Virtual non-contrast images generated in liver DECT with DLIR provide similar CT values to TNC images. The VNC_V images provide lower image noise as well as higher SNR and subjective scores than TNC and are recommended for clinical use.

Advances in knowledge: Virtual non-contrast images with DLIR generated from DECT can improve image quality and reduce radiation dose.

Guidelines and directives are instruments with varying legal effects that are relevant to liability and cost law. While guidelines primarily gain legal relevance in the question of how standard-compliant diagnostics and therapy can be expected under a physician contract, directives, with their cost sensitivity (which does not apply in liability law!), play a central role in the question of benefits and reimbursement in the statutory health insurance system. In borderline areas, it should be noted that both instruments can also become significant in the other sector.

Background: Teleradiology has evolved into an integral component of radiological care. Among approximately 1900 hospitals in Germany, only around 650 maintain their own radiological departments; patient care is increasingly provided through cooperative arrangements incorporating teleradiological expertise. However, the spatial separation between image acquisition and diagnostic interpretation presents specific liability-related challenges.

Objective: This article examines the central liability risks in teleradiology and provides concrete recommendations for everyday radiological practice. The aim is to protect physicians from legal consequences and to guarantee the quality of patient care.

Results: The legal foundations are based on §§ 630a et seq. of the German Civil Code (BGB). Teleradiologists are subject to the same specialist standard as colleagues working on-site. Specific risks include technical transmission problems, time-critical emergencies, and organizational liability issues. Recommendations include adherence to technical standards (Digital Imaging and Communications in Medicine, DICOM), virtual private network (VPN) encryption, quality assurance prior to interpretation, redundant data transmission pathways, written cooperation agreements, and emergency protocols. Professional liability insurance must explicitly cover teleradiological activities.

Conclusion: Legal jurisprudence has not yet provided definitive answers, particularly regarding technical transmission errors. Quality assurance, documentation, and clear allocation of responsibilities are central to avoiding liability. For cross-border activities, the territorial scope of insurance coverage must be verified. Furthermore, regular review of insurance coverage is recommended.