Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren最新文献

Online survey about the current status of CT protocols in hepatocellular carcinoma (HCC) in the year 2023/2024. Moreover, the usage of structured reporting using LI-RADS and mRECIST was surveyed and the results were compared with a survey from 2020.Radiologists working in outpatient or inpatient care in Germany were invited. The survey was conducted between 10/2022 and 06/2023 and between 06/2024 and 08/2024. HCC-related questions were asked regarding the commonly used imaging modalities, body coverage, and contrast phases in CT, as well as the usage of structured assessment and treatment response using mRECIST and LI-RADS.More than half of the participants stated that they "frequently" perform imaging of HCC. In the CT protocol, acquisition of a pre-contrast phase was widespread. While a late arterial and a portal venous contrast phase was acquired in most cases, a delayed phase was used much less frequently (at small and medium-sized hospitals only in 26.5%). For staging, LI-RADS was used in structured reports in only 13%; for response monitoring mRECIST was used at university hospitals in only 26.5% and LI-RADS in 14.7%, whereas these have been almost never used in routine practice at all other sites. The main reasons given for the lack of application were the expenditure of time, the lack of reporting templates, problems with integration into the IT infrastructure and a lack of reimbursement.The recommendation of a three phase CT examination in late arterial, portal venous, and delayed phase for HCC diagnostics according to LI-RADS is only partially implemented in Germany. Structured reporting for staging and response monitoring using LI-RADS and mRECIST was at a similarly low level in Germany in 2023 compared to 2020. Possible solutions include the development and distribution of online educational resources, structured reporting templates, and inexpensive IT solutions. · The CT protocols in HCC diagnostics in Germany differ considerably with regard to the contrast phases acquired.. · Definition of a late arterial (approx. 15-20s p.i.; 5-15s after aortic peak), portal venous (approx. 60-80s p.i.) and delayed phase (2-5min p.i.) as well as a pre-contrast phase only after TACE may improve quality of CT diagnostics of HCC.. · The use of structured reporting using LI-RADS, LR-TR and mRECIST in HCC remained low in 2023/2024, similar to 2020.. · The use of LI-RADS and mRECIST could be improved by providing online educational resources, structured reporting templates, and inexpensive IT solutions.. · Nelles C, Ristow I, Juchems MS et al. Standardized Reporting of HCC with LI-RADS and mRECIST: Update on the Situation in Germany. Rofo 2025; DOI 10.1055/a-2438-1670.

The need for effective early detection and optimal therapy monitoring of cardiovascular diseases as the leading cause of death has led to an adaptation of the guidelines with a focus on cardiac computed tomography (CCTA) in patients with a low to intermediate risk of coronary heart disease (CHD). In particular, the introduction of photon-counting computed tomography (PCCT) in CT diagnostics promises significant advances through higher temporal and spatial resolution, and also enables advanced texture analysis, known as radiomics analysis. Originally developed in oncological imaging, radiomics analysis is increasingly being used in cardiac imaging and research. The aim is to generate imaging biomarkers that improve the early detection of cardiovascular diseases and therapy monitoring.The present study summarizes the current developments in cardiac CT texture analysis with a particular focus on evaluations of PCCT data sets in different regions, including the myocardium, coronary plaques, and pericoronary/epicardial fat tissue.These developments could revolutionize the diagnosis and treatment of cardiovascular diseases and significantly improve patient prognoses worldwide. The aim of this review article is to shed light on the current state of radiomics research in cardiovascular imaging and to identify opportunities for establishing it in clinical routine in the future. · Radiomics: Enables deeper, objective analysis of cardiovascular structures via feature quantification.. · PCCT: Provides a higher quality image, improving stability and reproducibility in cardiac CT.. · Early detection: PCCT and radiomics enhance cardiovascular disease detection and management.. · Challenges: Technical and standardization issues hinder widespread clinical application.. · Future: Advancing PCCT technologies could soon integrate radiomics in routine practice.. · Ayx I, Bauer R, Schönberg SO et al. Cardiac Radiomics Analyses in Times of Photon-counting Computed Tomography for Personalized Risk Stratification in the Present and in the Future. Rofo 2025; DOI 10.1055/a-2499-3122.

Theranostics in nuclear oncology combines diagnostic and therapeutic procedures using radiotracers to target tumor cells. Prostate-specific membrane antigen (PSMA) is a key target in metastatic prostate cancer, and the radioligand [177Lu]Lu-PSMA-617, which binds to PSMA, has shown promising results in treating metastatic castration-resistant prostate cancer (mCRPC), leading to its approval by the European Medicines Agency in 2022.In this narrative review, the current evidence of [177Lu]Lu-PSMA-617 in mCRPC was discussed in the context of selected studies and the joint EANM/SNMMI guidelines for Lutetium-177-labeled PSMA-targeted radioligand therapy.The use of [177Lu]Lu-PSMA-617 for post-chemotherapy mCRPC is supported by substantial evidence from the phase II TheraP and the phase III VISION trials, demonstrating its safety and efficacy. The theranostic approach identifies patients likely to benefit from [177Lu]Lu-PSMA-617, which is effective only in tumors with sufficient PSMA expression, as detected by PSMA-ligand PET/CT, which is also used for response assessment.The success of [177Lu]Lu-PSMA-617 in post-chemotherapy mCRPC patients has led to further ongoing studies evaluating its use earlier in the treatment sequence, prior to chemotherapy. To ensure beneficial treatment outcome, adequate patient selection and evaluation of imaging-based response through PSMA-ligand PET/CT is necessary. · Indications for [177Lu]Lu-PSMA-617 are based on the TheraP and VISION clinical trials.. · Adequate patient selection using PSMA-ligand PET/CT is essential for beneficial outcomes.. · Response evaluation is based on imaging, PSA levels, and the patient's clinical condition.. · Karimzadeh A, Lehnert W, Koehler D et al. Overview of selected completed prospective studies on PSMA-targeted radioligand therapy with [177Lu]Lu-PSMA-617 in metastatic castration-resistant prostate cancer. Rofo 2025; DOI 10.1055/a-2514-4523.

Before any medical procedure, including computed tomography (CT), it is crucial to ensure patients are fully informed about the risks and alternative options. Video-based informed consent offers an increased transfer of information in less time.In a monocentric, prospective, questionnaire-based study, video-based informed consent, which included a digital medical history form, was compared to the traditional paper-based consent form. Two groups (doctors and patients) were divided into a control group (traditional informed consent) and one study group (video-based informed consent). Participants rated their satisfaction and acceptance on a scale of 1 to 6 (1: very good). Additionally, patients' understanding of the information provided was evaluated, and the duration of informed consents process was measured.A total of 205 patients in the control group and 150 in the study group were surveyed. Satisfaction ratings of "very good" or "good" were similar for both methods (91% control group, 94% study group). The patients' study group showed a higher recall of the information provided in all six areas, e.g. radiation exposure (73% control group; 86% study group).Among the doctors, 20 from the control group and 11 from the study group were interviewed. Satisfaction was significantly higher in the study group (30% control group, 72% study group).The duration of the traditional informed consent process averaged 270.2 seconds, compared to 228.7 seconds for the video-based informed consent.Satisfaction with video-based information is high among both patients and doctors. Patients retain the content more effectively with video-based informed consent, which also saves time. · Video-based informed consent shows high levels of satisfaction and acceptance among patients and doctors.. · After a video-based informed consent consultation, patients were better able to remember the information provided.. · Compared to conventional informed consent consultations, video-based consultations save time.. · Vogele D, Nedelcu A, Beer M et al. Video-based Informed Consent in Radiology - Acceptance, Satisfaction, and Effectiveness. Rofo 2025; DOI 10.1055/a-2490-1472.

To evaluate the feasibility of liver tract embolization after transhepatic biliary drainage using a biodegradable polymer plug (IMPEDE-FX, Shape Memorial Medical, Santa Clara, CA, USA).In a retrospective observational study, 15 plug embolizations were performed in 13 patients at risk for tract-related adverse events (AEs). Risk factors included coagulopathy, cirrhosis, central bile duct puncture, previous drain-related bleeding, malignant obstruction, large tract diameter, or multilevel strictures. Clinical and imaging follow-up was performed at 24 hours, 3 months, and 6 months. Primary endpoints were technical and clinical success. Technical success was defined as plug deployment in the intended position. Clinical success was defined as the absence of biliary, infectious, or bleeding AEs. To assess clinically occult bleeding or biliary obstruction, periprocedural hemoglobin, hematocrit, and bilirubin levels were compared. Secondary endpoints were plug migration, plug oversizing, and plug visibility on imaging.The technical success rate was 100%. The clinical success rate was 84.6%. There were no infectious or bleeding AEs. In 2 cases where the persistence of biliary congestion was clinically underestimated prior to drain removal, 2 biliary AEs occurred (2 biliocutaneous fistulas including 1 plug migration within 24 hours; 15.4% SIR grade 3 AEs). The median plug oversizing relative to the diameter of the hepatic tract was substantially lower in unsuccessful cases than in successful cases (27% vs. 86%). The plug was visible on ultrasound and CT. On MRI, no plug-related artifacts occurred.The plug could be an option when a non-permanent, precisely deployable device is desired for tract embolization. Adequate plug-to-tract oversizing and biliary decongestion are essential to achieve durable tract closure. Therefore, the plug seems unsuitable for patients with multilevel strictures where complete drainage of the biliary system is not feasible. · The polymer plug can be precisely delivered within the liver tract.. · Plug-to-tract oversizing and biliary decongestion are essential for durable tract closure.. · The plug appears unsuitable for endoscopically incompletely relievable multilevel biliary strictures.. · Thurner A, Giulia Dalla G, Hartung V et al. A biodegradable polymer plug for liver tract embolization after percutaneous or surgical placement of transhepatic biliary drainage tubes: a feasibility study. Rofo 2025; DOI 10.1055/a-2509-5189.