Radiologie (Heidelberg, Germany)最新文献

Clinical/methodical issue: Allergic bronchopulmonary aspergillosis (ABPA) is a rare but potentially severe hypersensitivity reaction to Aspergillus fumigatus, primarily affecting patients with asthma or cystic fibrosis. Early diagnosis is crucial to prevent irreversible lung damage.

Standard radiological methods: High-resolution computed tomography (HRCT) is the standard imaging method for detecting bronchiectasis and other typical findings. Common features include central, saccular bronchiectasis, mucus impaction, and centrilobular micronodules. Radiological assessment must be closely integrated with clinical and laboratory parameters.

Methodical innovations: The revised 2024 International Society for Human and Animal Mycology (ISHAM) criteria further emphasize the diagnostic importance of radiological features. High-attenuation mucus (HAM) is considered a highly specific finding and may confirm the diagnosis. Modern classification systems allow more precise disease staging.

Performance: HRCT provides extremely high sensitivity for the radiological hallmarks of ABPA. Detection of HAM is regarded as nearly pathognomonic. Fleeting infiltrates and reversible changes are reliably visualized. Correlating radiological findings with laboratory parameters significantly improves diagnostic accuracy.

Achievements: HRCT remains the indispensable imaging modality for diagnosing and monitoring ABPA.

Practical recommendations: In cases of clinical suspicion, early HRCT of the thorax should be performed. A combination of radiological findings and serological criteria is recommended to confirm the diagnosis. HRCT can be used to detect reversible infiltrates and assess response to treatment.

Background: Osteochondrosis in children and adolescents is a group of diseases and not a variant of growth. They often occur during periods of rapid growth, with predilection sites at many epiphyses and apophyses as well as along the growth plates. There is a classic age of onset for each of the many different diseases.

Objectives: Presentation of the most important entities (Perthes disease, Köhler I disease, Sever's disease, Osgood-Schlatter disease, Sinding-Larsen-Johansen disease, Scheuermann's disease).

Materials and methods: Presentation of the entities mentioned with the clinical presentation and a brief overview of the therapy; radiological changes are illustrated.

Results: In various cases, the diagnosis can be made solely on clinical grounds. If imaging is necessary, conventional X‑rays are usually taken. In Perthes disease, a magnetic resonance imaging scan is indicated in the early stages of the disease.

Conclusion: It is important to be aware of the predilection sites and the age of manifestation of the respective disease. If treatment is necessary, it will be based on the radiological changes, among other things. Correct implementation and diagnosis (in close cooperation with the clinical colleagues) are therefore essential.

Clinical problem: In children and adolescents, osteochondritis dissecans (OCD) represents an important differential diagnosis of chronic joint pain. Because the disease typically begins with nonspecific symptoms, imaging plays a pivotal role in establishing the diagnosis. Early-stage lesions, if identified correctly, can heal completely, whereas unstable lesions usually require surgical treatment.

Radiological standard techniques: Conventional radiography remains the cornerstone of initial diagnostic evaluation.

Methodological innovation: Magnetic resonance imaging (MRI) is currently the most important imaging technique for evaluating OCD lesions. It enables early detection of subchondral signal alterations, detailed morphological assessment of the lesion, evaluation of stability through direct and indirect signs of instability, and follow-up under conservative or postoperative treatment.

Assessment: Radiologists play a central role in the early detection and characterization of OCD, providing clinicians with critical information for further management.

Recommendation for clinical practice: OCD should always be considered in cases of unexplained joint pain in children, adolescents, and young adults. Conventional radiographs should be performed as the initial diagnostic evaluation. However, only MRI enables reliable early detection and accurately differentiates stable and unstable disease. In children, both sides should be examined when appropriate, since OCD frequently affects both joints.

Background: Osteochondrosis and osteonecrosis affect epiphyseal and apophyseal ossification centres and lead to structural changes in bone and cartilage. They differ in terms of aetiology, age and prognosis. Osteochondrosis dissecans and Osgood-Schlatter disease primarily affect adolescents, while spontaneous osteonecrosis of the knee (SONK/Ahlbäck's disease) predominantly occurs in older adults.

Objective: This article presents four clinical cases to illustrate typical manifestations, imaging diagnostics, and therapeutic strategies for osteochondronecrosis in children, adolescents and adults.

Conclusion: Magnetic resonance imaging plays a key role in staging and guiding treatment decisions. While lesions in juveniles may resolve spontaneously, unstable or progressive cases often require surgical intervention. Ahlbäck's disease is associated with a poor prognosis and frequently necessitates joint replacement.

Background: Bone infarctions are a relatively understudied subgroup of osteonecroses in the literature. As frequently incidental, yet distinct imaging findings, they must be interpreted in the context of predisposed patient groups, relevant risk factors, differential diagnoses, and potential complications.

Objective: To present the interrelationship of pathophysiology with imaging, as well as the clinical courses, histopathological correlates, and diagnostic challenges.

Materials and methods: Literature research over the past three decades on epidemiology, pathophysiology, risk factors, and the clinical spectrum with pertinent implications for imaging (plain radiography, computed tomography [CT], magnetic resonance imaging [MRI]).

Results: Bone infarctions manifest in the meta-/diaphyses of long bones and are frequently multifocal. Robust epidemiological data are lacking. Clinically, they present with acute, painful courses in systemic diseases or as oligosymptomatic incidental imaging findings. Imaging reflects the pathophysiology. Plain radiography is in general sufficient for diagnosis in late stages, whereas MRI provides the highest diagnostic accuracy.

Conclusion: Although often an "Aunt Minnie" in imaging, bone infarctions should be understood as a systemic condition. Differentiation from acute osteomyelitis and the rare risk of malignant transformation represent major clinical and diagnostic challenges.

Avascular necrosis of the femoral head (AVN) describes an ischemia-induced necrosis of the subchondral bone of the femoral head. Early diagnosis is crucial to initiate appropriate treatment and achieve the longest possible preservation of the native joint. Pathophysiologically, AVN results from impaired blood supply to the subchondral bone, promoted by various risk factors or underlying pathologies. The most relevant include prolonged or high-dose corticosteroid therapy and chronic alcohol abuse. Magnetic resonance imaging (MRI) is regarded as the key modality for early detection, enabling identification of characteristic changes before radiographic abnormalities become apparent. The earliest MRI finding is a band-like, T1-hypointense line demarcating the necrotic area from surrounding viable bone. The characteristic double-line sign-comprising an outer hypointense and an inner hyperintense rim-reflects reparative processes at the necrosis margin. Bone marrow edema occurs only after the development of a subchondral fracture and thus indicates an advanced stage, rather than, as previously assumed, an early manifestation of AVN. Differential diagnosis should primarily include transient bone marrow edema syndrome and subchondral insufficiency fracture. The Association Research Circulation Osseous (ARCO) classification provides a multimodal, internationally established system for standardized staging. It distinguishes four clinically relevant stages: isolated MRI detection (stage I), radiographic changes without fracture (stage II), subchondral fracture (stage III), and secondary osteoarthritis (stage IV). This system allows reproducible stage-based assessment, supports therapeutic planning, and facilitates interdisciplinary communication. Consequently, radiologic imaging plays a pivotal role in diagnosis, disease monitoring, and treatment decision-making for patients with AVN.

Clinical/methodical issue: Subchondral insufficiency fractures (SIF) occur without adequate trauma to the weight-bearing joint surfaces due to repeated physiological loading and occur predominantly in older people.

Standard radiological methods: Magnetic resonance imaging (MRI). Radiographs.

Methodological innovations: MRI is the best method for the detection, follow-up, and assessment of the prognosis of subchondral insufficiency fractures.

Performance: The typical MRI findings of SIF are bone marrow edema, a subchondral hypointense fracture line, and possibly a subchondral hypointense area on T2-weighted sequences. Subchondral cortical deformity and a fluid-filled cleft indicate advanced SIF with a poor prognosis.

Achievements and practical recommendations: Subchondral insufficiency fractures can heal spontaneously or progress to collapse. The task of radiology is to distinguish between lesions that heal (simple subchondral insufficiency fractures) and lesions that progress unfavorably (subchondral insufficiency fractures with osteonecrosis).

Cross-sectional imaging procedures play a pivotal role in the assessment of the jejunum and ileum as these segments of the small intestine are less easily accessible to endoscopic evaluation compared to the stomach, duodenum and colon. The radiological diagnostics of the small bowel are, however, a special challenge as many small bowel diseases show similar imaging patterns making a differentiation difficult. Technical advances in imaging now enable a more precise characterization of the bowel wall, thereby providing the basis for increasingly more personalized medicine. An imaging pattern-based diagnostic approach can be helpful in narrowing down the spectrum of potential differential diagnoses and increasing the accuracy of radiological interpretation. The aim of this review article is to present the current diagnostic techniques, recent technological developments and characteristic radiological imaging features of small bowel diseases.

Alzheimer's disease is one of the most common causes of dementia in older adults. Since 2024, monoclonal antibody therapy has been available, which can slow disease progression at certain stages. During therapy, magnetic resonance imaging changes called amyloid-related imaging abnormalities (ARIA)-edema (ARIA-E) and hemorrhage (ARIA-H)-must be monitored at specific points during treatment; depending on severity, therapy may need to be paused. Cerebral amyloid angiopathy (CAA) and its inflammatory form (CAA-I) should be considered in the differential diagnosis.