Radiologie (Heidelberg, Germany)最新文献

Clinical/methodical issue: Chronic pain syndromes represent a major medical and socioeconomic burden. In both cancer-related and noncancer pain, pharmacological treatment alone is often insufficient or limited by adverse effects, particularly during long-term opioid therapy. Image-guided interventional procedures are therefore increasingly relevant as targeted, opioid-sparing components of multimodal pain management.

Imaging guidance and interventional techniques: This narrative review summarizes diagnostic blocks, therapeutic injections, and neurolytic procedures targeting sympathetic plexuses and peripheral nerves. It outlines the principal imaging modalities (computed tomography, fluoroscopy, ultrasound), common indications, and the distinction between diagnostic/prognostic, pharmacological, and definitive neurolytic techniques.

Evidence: Available evidence demonstrates clinically meaningful pain reduction, functional improvement, and opioid-sparing effects in selected indications. The strongest evidence exists for visceral cancer pain, particularly for celiac plexus and splanchnic nerve interventions, and for chronic musculoskeletal pain such as genicular nerve procedures.

Conclusion: Image-guided nerve and plexus interventions are effective components of multimodal pain management and can be integrated into interdisciplinary care pathways. Their clinical value depends on careful patient selection, precise anatomical targeting, standardized procedural quality, and structured outcome assessment; they should be considered early rather than only as a last-line option.

Background: Back pain, which has a high prevalence, is associated with substantial individual and socioeconomic burden. Mechanical irritation and local inflammation promote edema, neovascularization, and pain chronification.

Objective: This article aims to provide an overview of the possible indications for and the performance of periradicular therapy (PRT), epidural injection therapy, facet joint infiltration, and facet denervation.

Methods: This clinical narrative review presents workflows of the different techniques, the medications used, and potential complications. This paper does not constitute a systematic scientific review.

Conclusion: Interventional pain therapies are useful after unsuccessful conservative treatment and in the presence of an appropriate clinical-imaging correlation. PRT is used for radicular symptoms. Epidural injection therapy, in contrast, is suitable for bilateral and multisegmental complaints. Facet joint infiltrations are used therapeutically for pain management and may also be employed diagnostically prior to denervation procedures.

Background: Transarterial microembolization (TAME) has become an increasingly established minimally invasive treatment option for chronic joint pain, particularly involving the knee joint. The procedural success of genicular artery embolization (GAE) is largely determined by the complex arterial anatomy, vascular variants and an extensive anastomotic network.

Objective: The aim of this review article is to describe the relevant target vessels for GAE. Special emphasis is placed on anatomical variants and anastomoses that influence target vessel selection, catheterization strategies and procedural safety of GAE.

Material and methods: Narrative literature review based on current angiographic, anatomical and clinical studies on GAE, focusing on arterial anatomy, anatomical variants and the functional relevance of the anastomotic network.

Results: In the knee, the descending genicular artery (GA), superomedial GA, inferomedial GA, superolateral GA, inferolateral GA and the anterior recurrent tibial artery are identified as key target vessels. These arteries show substantial interindividual variability and extensive anastomotic connections. This vascular network explains why embolization of a single genicular artery does not provide a clinical benefit over placebo and why treatment of all GAs is required.

Discussion: The clinical success of GAE greatly depends on a thorough understanding of vascular anatomy. A structured approach to target vessel selection, with detailed knowledge of anatomical variants and anastomoses, is essential for a safe, complete and effective GAE.

Clinical issue: Osteoarthritis-related chronic joint pain substantially impairs function and quality of life. A clinically relevant subgroup of patients remains insufficiently controlled by conservative care and is not yet eligible for, or declines, arthroplasty ("treatment gap").

Standard treatment: First-line management includes weight reduction and physiotherapy, analgesics/nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular injections, and-when indicated-surgical options up to joint replacement.

Treatment innovations: Transarterial periarticular embolization (TAPE) targets abnormal periarticular neovascularity/hypervascularity via superselective, blush-guided devascularization using temporary crystalline agents or resorbable/permanent microspheres.

Diagnostic work-up: Accurate pain localization to the target joint and radiographic osteoarthritis (OA) grading are mandatory. Magnetic resonance imaging (MRI)/ultrasound may support selection by demonstrating inflammatory activity (synovitis/hypervascularity). Angiography identifies the pathological blush as the procedural endpoint.

Evidence: Across studies, technical success is near 100% with clinically meaningful improvements (typically ~30-40 point pain reduction on a 0-100 visual analog scale) and gains in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)/Knee Injury and Osteoarthritis Outcome Score (KOOS); however, sham-controlled randomized controlled trials (RCTs) show mixed results. Adverse events are uncommon and mainly mild/self-limited; major complications are rare.

Conclusion: TAPE is a promising minimally invasive option, but its incremental benefit over placebo and optimal selection criteria require confirmation.

Practical recommendations: Consider TAPE in specialized centers for refractory mild-to-moderate OA (strongest evidence for the knee; emerging data for hip/hand), using standardized protocols, particle sizes ≥ 100 µm when applicable, and strict nontarget prevention (e.g., skin cooling).

Background: Accurate preoperative prediction of isocitrate dehydrogenase (IDH) genotype in gliomas is crucial for treatment planning and prognostic evaluation. However, variability across imaging modalities and centers limits model generalization in clinical practice.

Purpose: We aimed to develop and evaluate a functionally guided fusion Vision Transformer (FGF-ViT) network for IDH genotype prediction in gliomas and to assess its generalization across multicenter datasets and incomplete multimodal inputs.

Methods: This retrospective multicenter study involved glioma patients from multiple institutions. In step 1, four FGF-ViT networks were constructed using different modality combinations (conventional MRI [cMRI]; MRI + diffusion-weighted imaging [DWI]; cMRI + perfusion-weighted imaging [PWI]; cMRI + DWI + PWI), trained on a primary cohort, and tested on an independent external validation set. Step 2 evaluated model generalization on additional multicenter datasets with variable modality availability. Models fused cMRI, DWI, and DSC-PWI features via transformer attention. Performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity.

Results: The FGF-ViT achieved robust IDH prediction with an AUC of 0.822 (95% CI: 0.666-0.977) in the independent external validation cohort. Its performance remained stable even with one missing functional modality.

Conclusion: The proposed FGF-ViT provides a clinically relevant multimodal imaging and generalizable framework for preoperative IDH genotype prediction in gliomas, enabling reliable application across centers and incomplete multimodal conditions.

Objective: The aim of the study was to investigate the use of magnetic resonance diffusion tensor imaging (DTI) in children with neurodevelopmental disorders, particularly the value of fractional anisotropy (FA) in assessing neurological dysfunction.

Materials and methods: In total, 91 children with neurodevelopmental disorders and 21 children without neurodevelopmental disorders were enrolled and underwent DTI.

Results: The FA values were significantly (P < 0.05) decreased in both the globus pallidus and the posterior limb of the internal capsule in the neurodevelopmental disorder groups (193.08 ± 31.10 and 480.02 ± 29.08 in the mild-moderate, 183.26 ± 21.89 and 469.54 ± 27.02 in the severe, and 161.28 ± 16.13 and 407.18 ± 42.27 in the extremely severe subgroups, respectively) compared to the control group (206.12 ± 12.05 for the globus pallidus and 487.12 ± 21.06 for the posterior limb). The FA values were significantly (P < 0.05) decreased in the globus pallidus (165.33 ± 19.02) and the posterior limb of the internal capsule (441.21 ± 51.23) in the neurodevelopmental disorder group compared with the control group (189.05 ± 29.20 for the globus pallidus and 492.57 ± 28.10 for the posterior limb).

Conclusion: The use of DTI provides critical insights into neurodevelopmental disorders in children. Changes in FA in the globus pallidus and posterior limb of the internal capsule are closely associated with the severity of neurological dysfunction and may serve as effective biomarkers for assessment.

Hepatocellular carcinoma (HCC) is a histologically heterogeneous tumor entity. According to the current World Health Organization (WHO) classification in addition to not otherwise specified (NOS) HCCs it is comprised of eight subtypes: steatohepatitic, clear cell, macrotrabecular massive, scirrous, chromophobe, fibrolamellar, granulocyte-rich and lymphocyte-rich. The HCC diagnosis is based on typical contrast agent behavior with arterial hyperenhancement followed by washout; however, HCC subtypes can show additional imaging features related to their histology. In addition, the HCC subtypes can partially differ from NOS HCC in aggressiveness and prognosis. Characterizing the various HCC subtypes could enable individualized treatment in the future and thus potentially influence the prognosis, even though a subtype-specific treatment for HCC subtypes apart from in studies is not currently available.

Particle radiotherapy (RT) offers promising treatment options for sarcomas due to its physical and radiobiological advantages. It enables high doses to be delivered to the tumor while minimizing the impact on surrounding tissue. Additionally, the higher biological effectiveness of carbon ions (C12) helps to overcome the radioresistance of many sarcomas. Although prospective comparative studies are lacking, existing data support the clinical use of particle RT. Future technical and biological optimization of particle RT could further improve the oncological outcome.