Radiologie (Heidelberg, Germany)最新文献

Some diseases, such as neurofibromatosis type 1, Langerhans cell histiocytosis, SAPHO (an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome, chronic nonbacterial osteomyelitis, or psoriatic arthropathy, present with manifestations affecting both the skin and the skeleton. Since these diseases can easily be overlooked in diagnostic radiology, an accurate diagnosis relies on the combined evaluation of bone and skin findings. The bidirectional interaction between cutaneous and skeletal tissues is mediated by genetic predispositions as well as immune-inflammatory mechanisms and is summarized under the term SKIBO ("skin-bone interaction"). This CME overview presents the most important SKIBO disorders-which every radiologist should be familiar with-from both radiological and dermatological perspectives, with the aim of raising radiologists' awareness of relevant skin findings in everyday clinical practice.

Background: After radiological diagnostics, the patient journey does not end with image acquisition and reporting. Patients often face questions regarding report access, image sharing, follow-up, second opinions and care coordination. Digital patient portals may structure this transition, but their functionality varies substantially.

Objectives: To assess the role of digital patient portals after radiological diagnostics and to clinically classify their relevance within the "After the examination: what comes next?" phase.

Materials and methods: Narrative review focusing on radiology patient portals, direct release of imaging results, image access and sharing, patient-controlled image exchange, notification of follow-up recommendations and emergency department contexts.

Results: After imaging, patient portals mainly serve six functions: providing reports and images, contextualizing findings, enabling secure communication, supporting transfer to external physicians, tracking follow-up recommendations and guiding downstream care. Studies indicate that many patients actively access radiology results online, with reports being viewed more frequently than images. Portals create most value when reports, images and clear action options are delivered together.

Conclusion: After radiological diagnostics, the patient portal becomes a digital bridge between imaging and subsequent care. Therefore, radiological quality should not be assessed solely by image acquisition and report quality, but also by whether patients know what to do next after receiving the results.

Clinical issue: Massive hemoptysis is a life-threatening emergency in which the risk of asphyxiation predominates over blood loss. The situation becomes particularly challenging when a patient must be transferred from an external facility and clinically relevant information is incomplete.

Diagnostic work-up: The initial diagnostic workup already begins prior to transfer to a specialized center. Initial priorities are oxygenation, correct patient positioning, and early airway protection. Depending on the local infrastructure, computed tomography (CT) angiography and bronchoscopy are the preferred modes of imaging. Structured, digital transfer of information, results, and imaging data without loss of data is paramount.

Standard treatment: In peripheral or systemic bleeding, bronchial artery embolization is the first-line therapeutic option and should be performed at a specialized center. A superselective technique, strict nontarget prevention, and adherence to established standard operating procedure (SOP) principles are essential. Massive hemoptysis is an example for the digital patient journey in radiological emergencies: when preliminary diagnostics are performed at an external hospital and definitive treatment is provided at a specialized center, the structured and rapid transfer of clinical information to that center is critical for quality of treatment.

Digital infrastructure and interoperability: Emergency datasets on the electronic health card, the electronic patient record, and technical standards (FHIR, DICOM, and DICOMweb) are clinically relevant. European infrastructures (MyHealth@EU, European Health Data Space) may support the future of structured access to key clinical information and direct exchange of imaging data; however, they have not yet been fully integrated into routine emergency radiological practice.

Conclusion: In radiological emergencies, interoperability is not merely a technical feature but a safety-relevant infrastructure component. It improves data triage, reduces media discontinuity, and may help prevent unnecessary repeat imaging.

Practical recommendations: In radiological emergencies, it must be assessed at an early stage whether further treatment in an interventional center is necessary. In these cases, relevant data and clinical information should be transferred in a structured and fully digital manner without loss of information.

Background: The increasing documentation burden in electronic health records makes it difficult to obtain a rapid overview of relevant prior information in complex disease courses. Especially in highly digitized settings such as radiology and interdisciplinary case conferences, large volumes of heterogeneous documents must be reviewed under time pressure.

Objective: The aim was to develop a large language model (LLM)-based patient synopsis to accelerate information retrieval while ensuring transparency, physician oversight, and data protection.

Materials and methods: At the University Medical Center Freiburg, a system was developed for the automated integration of clinical documents from multiple primary systems, including the electronic health record (EHR), picture archiving and communication system (PACS), and other subsystems. It uses retrieval-augmented generation (RAG), metadata harmonization, vector search, and agentic retrieval for the context-sensitive selection of relevant content. The system operates with role-based access control, end-to-end source attribution, and processing in a sovereign cloud without persistent data storage.

Results: The system enables patient-specific queries, structured longitudinal summaries, and automated, source-grounded summaries to support preparation for interdisciplinary case discussions. All statements remain traceable to primary documents, while medical interpretation and decision-making remain the responsibility of the treating physician. Interoperable information systems and a data protection framework in accordance with the General Data Protection Regulation (GDPR), the German Social Code Book V (SGB V), and the EU Artificial Intelligence Act are prerequisites for implementation.

Conclusion: LLM-based patient synopses can support text-intensive clinical workflows, provided that controlled retrieval, clear source attribution, physician validation, and an interoperable, regulation-compliant system architecture are in place. Prospective evaluations are required before routine clinical use.

Background: The check-in before imaging is an often underestimated but clinically critical step in the radiological patient journey. In computed tomography (CT) and magnetic resonance imaging (MRI), the quality of pre-examination information substantially determines whether risks are identified, examinations are adequately planned, and workflows are efficiently managed.

Objective: To describe the clinical and organizational relevance of digital check-in processes in radiology and to assess their potential benefits, limitations, and prerequisites.

Materials and methods: Narrative review focusing on radiology-specific literature on appointment management, digital patient history and informed consent, protocol selection, patient portals, and implementation barriers.

Results: Digital check-in processes can improve the completeness of relevant pre-examination information, facilitate earlier identification of radiological risk constellations, reduce no-shows, focus informed consent discussions, and support protocol planning. However, their benefit depends largely on integration into established systems, as well as on patient-centered design.

Conclusion: The greatest added value arises not from isolated tools, but from a clinically designed, interoperable pre-examination process. Digital solutions should support physicians and improve the patient journey.

Background: Chronic tendinopathies are common causes of persistent musculoskeletal pain. In refractory cases, pathological hypervascularization and neo-innervation play a key role in pain generation. Transarterial microembolization (TAME) aims to reduce this abnormal vascularity using a minimally invasive approach.

Purpose: This review summarizes current evidence regarding the efficacy and safety of TAME in selected tendinopathies.

Materials and methods: A narrative review of recent literature on TAME for adhesive capsulitis, medial and lateral epicondylitis, Achilles tendinopathy, and plantar fasciitis was conducted, focusing on technical aspects, embolic agents, and clinical outcomes.

Results: Available studies consistently demonstrate significant pain reduction and functional improvement following TAME across all indications. The strongest evidence exists for adhesive capsulitis and Achilles tendinopathy, with reported clinical success rates of approximately 80-90%. Procedures are typically performed catheter-guided using a superselective approach and temporary embolic agents, most commonly imipenem/cilastatin. No major complications have been reported.

Conclusion: TAME represents a safe and effective minimally invasive treatment option for selected refractory tendinopathies and may bridge the gap between conservative management and surgery. Further randomized controlled trials are required to define long-term outcomes and optimal patient selection.

Background: Chronic pelvic pain in women is often multifactorial and associated with a marked impairment in quality of life. Among the most common structural causes are symptomatic uterine fibroids and pelvic congestion syndrome.

Objectives: This review provides an overview of interventional radiological treatment options for both conditions, with a focus on pain reduction and clinical effectiveness.

Materials and methods: Current reviews, meta-analyses, and clinical studies on uterine artery embolization (UAE), magnetic resonance (MR-)high-intensity focused ultrasound (HIFU), and radiofrequency and microwave ablation for the treatment of symptomatic uterine fibroids, as well as pelvic vein embolization for pelvic congestion syndrome, were summarized.

Results: In uterine fibroids, UAE, HIFU/MR-HIFU, and thermal ablation techniques improve symptoms and quality of life. UAE is particularly well established for multiple and large fibroids, whereas HIFU and thermal ablation techniques appear especially suitable for selected, more focal lesions. In pelvic congestion syndrome, meta-analyses demonstrate a marked and sustained reduction in pain following pelvic vein embolization.

Conclusion: Interventional radiological procedures represent effective organ-preserving treatment options for both conditions. While the analgesic effect in pelvic congestion syndrome is usually demonstrated directly by pain scales, in fibroid therapies it is generally assessed only indirectly through symptom and quality-of-life parameters. Standardized assessment of pain could help to define patient-relevant benefit more clearly in future studies.

Ligaments and mesenteries divide the peritoneal cavity into interconnected compartments. In addition to the underlying disease, the anatomical conditions of the abdominal cavity and the intraperitoneal distribution of fluid have a decisive influence on the course and spread of the illness. Knowledge of these factors provides insight into clinically relevant disease processes and thus enables systematic diagnosis.