Radiologe最新文献

Background: There are a multitude of application possibilities of artificial intelligence (AI) and structured reporting (SR) in radiology. The number of scientific publications have continuously increased for many years. There is an extensive portfolio of available AI algorithms for, e.g. automatic detection and preselection of pathologic patterns in images or for facilitating the reporting workflows. Even machines already use AI algorithms for improvement of operating comfort.

Method: The use of SR is essential especially for the extraction of automatically evaluable semantic data from radiology results reports. Regarding eligibility in certification processes, the use of SR is mandatory for the accreditation of the German Cancer Society as an oncological center or outside Germany, such as the European Cancer Center.

Results: The data from SR can be automatically evaluated for the purpose of patient care, research and educational purposes and quality assurance. Lack of information and a high degree of variability often hamper the extraction of valid information from free-text reports using neurolinguistic programming (NLP). Against the background of supervised training, AI algorithms or k‑nearest neighbors (KNN) require a considerable amount of validated data. The semantic data from SR can also be processed by AI and used for training.

Conclusion: The AI and SR are separate entities within the field of radiology with mutual dependencies and significant added value. Both have a high potential for profound upcoming changes and further developments in radiology.

Background: Vaccine-induced cerebral venous and sinus thrombosis (VI-CVST) is a rare complication in recipients of the adenovirus-vectored coronavirus disease 2019 (COVID-19) vaccine ChAdOx1 nCov-19 (Vaxzevria®; AstraZeneca).

Objectives: Development of a diagnostic and therapeutic standard.

Materials and methods: Analysis of clinical and basic research findings, expert opinions, and experience with our own cases.

Results: VI-CVST usually manifests on day 4-24 after vaccination, mostly in individuals aged < 60 years, and women. In the majority there is an immune pathogenesis caused by antibodies against platelet factor 4/polyanion complexes, leading to thrombotic thrombocytopenia which can result in severe, sometimes fatal, course. The cardinal symptom is headache worsening within days which, however, also can be of variable intensity. Other possible symptoms are seizures, visual disturbance, focal neurological deficits and signs of increased intracranial pressure. If VI-CVST is suspected, the determination of plasma D‑dimer level, platelet count, and screening for heparin-induced thrombocytopenia (HIT-2) are essential for treatment decision-making. Magnetic resonance imaging (MRI) with venous MR-angiography is the neuroimaging modality of choice to confirm or exclude VI-CVST. On T2* susceptibility-weighted MRI, the clot in the sinuses or veins produces marked susceptibility artifacts ("blooming"), which also enables the detection of isolated cortical venous thromboses. MRI/MR-angiography or computed tomography (CT)/CT-angiography usually allow-in combination with clinical and laboratory findings-reliable diagnosis of VI-CVST.

Conclusions: The clinical suspicion of VI-CVST calls for urgent laboratory and neuroimaging workup. In the presence of thrombocytopenia and/or pathogenic antibodies, specific medications for anticoagulation and immunomodulation are recommended.

Background: Infections with coronavirus disease 2019 (COVID-19) most frequently affect the lungs but may also result in cardiovascular involvement and cardiovascular complications. The heart can either be involved as part of a systemic infection or directly involved due to myocarditis or pericarditis as well as in hypoxia, volume overload, fever or thromboembolic complications. Moreover, pre-existing underlying cardiovascular diseases have a substantial influence on the prognosis of patients with COVID-19 infections.

Method: This review article is based on a comprehensive literature search in the PubMed database on cardiac involvement and cardiac complications of COVID 19 infections, enriched by experiences in dealing with this disorder.

Results and conclusion: Depending on the severity of the infection, cardiac involvement in a COVID 19 infection is observed in up to 50% of the patients. Besides echocardiography as the first-line examination method, cardiac magnetic resonance imaging (MRI) for assessment of the myocardial structure and cardiac computed tomography (CT) for assessment of coronary arteries and to rule out intracardiac thrombus formation represent important imaging modalities. The most important cardiac manifestations in COVID 19 infections are ischemic and inflammatory diseases. The imaging diagnostics play an important role in the acute as well as in the postinfectious phases.

Mutations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can enhance the spread and the infectiousness and decrease the protective effect of antibodies present after infection, vaccination or antibody treatment. The alpha variant (B.1.1.7), first seen in Kent/United Kingdom, has increased the R‑value and therefore the infectiousness by 75%; however, the effectiveness of the vaccines against SARS-CoV‑2 available in Germany seems to be only slightly impaired by these mutations. In the case of the beta variant (B.1.351), first described in South Africa, the neutralization ability of antibodies towards SARS-CoV‑2 is decreased. The monoclonal antibodies bamlanivimab and etesivimab, which are used therapeutically, are ineffective. The AstraZeneca vaccine offers almost no protection against mild or moderate disease caused by the beta variant. The gamma variant (P.1 or B.1.1.28.1), which was first found in Brazil, is probably 1.7-2.6 times more transmissible than previous virus strains circulating in Brazil. In addition to the infectiousness, the mortality risk of the gamma variant also seems to be increased between 1.2 and 1.9-fold in adults and between 5 and 8-fold in young persons. The delta variant (B.1.617), first described in India, is now dominant in most countries. It is 50% more infectious than the alpha variant, and the protective effect of vaccinations against symptomatic disease can be decreased (Biontech: delta variant 88%, alpha variant 93.7%; AstraZeneca: delta variant 67%, alpha variant 74.5%). Furthermore, the course of the disease with the delta variant is often more severe than with the wild type. Disease courses with the delta variant are less severe in vaccinated than in nonvaccinated persons, and fatal outcomes are substantially rarer. A high vaccination rate is essential in order to approach herd immunity and to bring the pandemic under control. Even where the protective effect towards mild or moderate disease is decreased, as a rule, vaccination still offers excellent protection against life-threatening and fatal disease courses.

Background: Following coronavirus disease 2019 (COVID-19), a proportion of patients report prolonged or worsening symptoms and impairments. These symptoms are increasingly referred to as "long COVID" syndrome. They may be associated with radiological changes on computed tomography (CT) and pulmonary function impairment.

Objectives: To discuss the role of long-term assessment of COVID-19 patients to determine which patients may benefit from follow-up.

Materials and methods: This article presents the current results of clinical, radiological, and pulmonary function follow-up tests after COVID-19 pneumonia.

Results: Chronic fatigue and dyspnea are the most common persistent symptoms after COVID-19. Patients also present impaired exercise capacity. On CT, ground-glass opacities and parenchymal bands are the most common residual changes after COVID-19 pneumonia, histologically corresponding to organizing pneumonia. A proportion of patients who had severe COVID-19 pneumonia may show fibrotic-like changes during follow-up. Patients with severe acute infection may present with a restrictive syndrome with lower diffusing capacity for carbon monoxide (DLCO) and total lung capacity (TLC) values. Overall, significant and continuous improvement in all symptoms as well as radiomorphological and functional changes were observed over time.

Conclusions: Patients with persistent symptoms after COVID-19 should be evaluated and treated in specialized post-COVID-19 clinics in a multidisciplinary manner.

Issue: Since the start of the global pandemic, a number of publications have suggested using ionising radiation to diagnose a COVID-19 infection. Some proposals call for the use of computed tomography (CT) to screen for presymptomatic SARS-CoV-2-infections.

Intent of the consultation: With these proposals in mind, the German Commission on Radiological Protection (SSK) agreed during its 307th meeting on 2 and 3 July 2020 to establish a working group aimed at evaluating the use of ionising radiation in connection with a COVID-19 infection. The working group focussed on radiological protection aspects with a view to using computed tomography to diagnose COVID-19. The group started its work on 5 October 2020. Although not commissioned by the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU), representatives of the BMU and the Federal Office for Radiation Protection (BfS) were involved in the consultations.

Statement: The SSK issues the following statement: 1. The use of CT in asymptomatic persons to diagnose COVID-19 outside of approved studies is not evidentially justified. 2. Pursuant to Section 83 (3) of the German Radiation Protection Act, a CT scan for the diagnosis or follow-up of a COVID-19 pneumonia requires the prior justifying indication from a doctor with the requisite specialist knowledge in radiation protection. To this end, specialist medical associations provide recommendations based on up-to-date findings.

Clinical issue: Clinically, COVID-19 (coronavirus disease 2019) is increasingly seen as a systemic disease associated with multiorgan involvement through a hypercoagulatory condition in the sense of vasculopathy.

Standard treatment: Treatment with antiplatelet drugs or heparins appears to be indicated. The current evidence, at least for acetylsalicylic acid (ASA), is lacking.

Diagnostic work-up: Corresponding to the significant proportion of primarily microstructural vascular changes, the radiological diagnosis showed not only macrovascular pathologies, but also diffuse perfusion disorders.

Performance: Regional hypoperfusion in the lungs can be detected with and without pulmonary arterial embolism. Similar findings can be found in almost all organ systems.

Practical recommendations: A therapeutic intervention using low molecular weight heparins in hospitalized patients in situation-adapted dosage is indicated and is discussed in detail. In the detection of micro- and macrovascular thrombosis in the context of COVID-19, extended radiological diagnostics play a central role and are the basis of adapted therapy and secondary prevention.

Background: Diagnostic imaging plays a key role in the evaluation of non-accidental consequences of injuries in childhood. Fractures are the second most common consequence of child abuse, after skin lesions such as abrasions or bleeding. With the evidence of radiological criteria, non-accidental fractures can be differentiated from accidental fractures. Special types of fractures such as the classic metaphyseal lesion can only be differentiated if the image quality is high.

Aim: The goal of this prospective study was to assess adherence to guidelines and quality assurance of radiological diagnostics in the event of suspected abuse in Germany. For this purpose, the quantity and diagnostic quality in university and non-university hospitals as well as the existence of a pediatric radiology department were analyzed.

Materials and methods: In all, 958 X‑ray examinations of 114 suspected abuse cases (46 girls, 68 boys) were evaluated; 42 cases from university, 42 from maximum care and 30 from regular care clinics with a median age of 6 months (3 weeks-3 years of age) were assessed as DICOM data by 3 pediatric radiologists in a consensus procedure with regard to adherence to guidelines and various quality parameters. An accompanying questionnaire was used to compare the theoretical knowledge with the respective practical implementation.

Results: A mean of 8.4 X‑rays (range 1-22) were made per case. In 12 of 114 assessed cases (10%) there was a complete skeletal status according to the S1 guideline. A babygram was performed in 13 cases (10.5%). Departments with focus on pediatric radiology produced significantly more X‑rays per skeletal status than facilities without this specialization (p < 0.04). Significantly higher qualitative implementation was recorded in university hospitals (p < 0.001). Regardless of the type of institution, there was only marginal agreement between the questionnaire response and the available image material.

Conclusion: In Germany, a guideline-compliant procedure in the event of suspected child abuse is largely lacking. It remains to be seen whether this will change in the future with the broader implementation of child protection groups and the S3+ child protection guideline adopted in 2019 (AWMF register 027-069). The establishment of reference centers for a second diagnosis and recommendations for imaging technology can also improve the quality of care over the long term.