Radiologie (Heidelberg, Germany)最新文献

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.

Clinical/methodical issue: Distinguishing pseudoprogression from true progression represents a considerable challenge in both clinical practice and radiological imaging.

Standard radiological methods: Established radiological methods include computed tomography (CT) and magnetic resonance imaging (MRI), complemented by fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT from nuclear medicine.

Methodical innovations: Novel PET/CT tracers, liquid biopsies, and radiomics are considered innovative approaches that may facilitate the detection of pseudoprogression but still need clinical validation.

Performance: CT, MRI, and PET/CT can provide valuable clues for distinguishing pseudoprogression from true progression, but are often inconclusive. Novel imaging approaches are currently under investigation in clinical studies.

Achievements: The use of laboratory markers and radiomics has shown promising improvements in several studies, but has not yet been adopted into clinical routine.

Practical recommendations: In clinically stable patients, suspected pseudoprogression early after start of immunotherapy justifies continuation of therapy with close imaging follow-up (early follow-up after 4-8 weeks).

Clinical issue: In recent decades, oncology has been fundamentally transformed by immune checkpoint inhibitors (ICIs). By blocking inhibitory molecules that normally inhibit T cell activation, they reactivate the body's immune defenses against tumors.

Treatment innovations: ICIs have established themselves in numerous tumor types-from melanomas to lung and kidney carcinomas to tumor entities defined essentially by high mutational burden-they offer significant survival benefits.

Diagnostics: Radiology plays a central role in the management of these therapies, as phenomena such as pseudoprogression challenge the classic RECIST (response evaluation criteria in solid tumors) system, and early detection of immune-mediated side effects often precedes clinical manifestation in imaging.

Assessment: The growing complexity of therapy requires radiologists to possess precise image interpretation, interdisciplinary collaboration, and knowledge of immunological principles, thus, enabling an improved prognosis for many tumor types.

Background: Immune checkpoint inhibitors (ICI) and chimeric antigen receptor T‑cell (CAR-T) therapies have fundamentally transformed oncology. With their increasing use, immune-related adverse events (irAEs) have gained attention, including those affecting the nervous system.

Objectives: To describe the clinical and imaging characteristics of neurological immune-related adverse events (NirAEs) under ICI and CAR‑T therapy, as well as their differential diagnostic and therapeutic implications.

Materials and methods: Review of current literature on the incidence, clinical spectrum, and imaging features of NirAEs.

Results: NirAEs occur in approximately 1-6% of patients treated with ICIs. Common manifestations include myositis, myasthenic syndromes, peripheral neuropathies, and various forms of encephalitis, which may differ clinically and radiologically from their idiopathic or paraneoplastic counterparts. Under CAR‑T therapy, immune effector cell-associated neurotoxicity syndrome (ICANS) represents the most frequent neurotoxic complication and affects about 30% of patients. Magnetic resonance imaging (MRI) is the imaging modality of choice but often reveals nonspecific or initially unremarkable findings. A pretherapeutic baseline MRI and close imaging follow-up improve diagnostic interpretation and prognostic assessment. Findings must always be interpreted within the clinical context and through interdisciplinary collaboration.

Conclusion: NirAEs are rare but potentially life-threatening. Due to unspecific imaging findings and overlapping differential diagnoses, close interdisciplinary cooperation between radiology, neurology, and oncology is essential. Early recognition and imaging follow-up are key to improving prognosis and survival.

Clinical issue: CAR-T cell therapy is complex and is now offered at a growing number of oncology centers in Germany. In addition to the initial CAR-T cell treatment, several advances and complementary therapies are available, which radiologists should be familiar with to properly evaluate treatment response and detect side effects early.

Standard treatment: In hemato-oncologic diseases, combinations of chemotherapy and targeted therapies are usually administered.

Treatment innovations: CAR-T-cell therapy combined with complementary immunotherapies.

Diagnostic work-up: For current indications, cross-sectional imaging-typically positron emission tomography/computed tomography-is used for staging and for evaluating therapy response.

Performance: The response rate is approximately 66.4% (25.5-90.9%).

Achievements: CAR-T cell therapy represents a new era in immunotherapy, and its recent advances mark a significant innovation in oncologic treatment.

Practical recommendations: Radiologists should understand the principles of CAR-T cell therapy in order to accurately assess treatment response and recognize early signs of potential side effects.

Background: Immunotherapies have become an integral part of modern oncology. Despite their therapeutic success, they are associated with cardiotoxic side effects that require early detection. Cardiac magnetic resonance imaging (CMR), as a noninvasive modality, enables precise tissue characterization of immune-mediated myocardial injury.

Objectives: To present cardiotoxic effects of immunotherapies and the role of CMR in diagnosis and risk stratification.

Materials and methods: Current scientific literature and clinical guidelines were reviewed regarding the incidence, pathophysiology, and imaging-based diagnosis of cardiotoxic effects related to immunotherapies.

Results: Myocarditis associated with immune checkpoint inhibitors is rare but linked to high mortality. Chimeric antigen receptor (CAR)-T-related cardiotoxicity often occurs in the context of cytokine release syndrome and can be assessed by CMR with respect to both functional and structural myocardial changes.

Conclusion: CMR plays a central role in the noninvasive diagnosis of immunotherapy-related cardiotoxicity and is essential for clinical decision-making and risk stratification.

The development of immune checkpoint inhibitors (ICI) has revolutionized cancer treatment. ICI enhance antitumor immunity by inhibiting the negative regulatory components of the T cell-mediated immune response against tumor cells. ICI are associated with less toxicity in comparison compared to chemotherapy. However, immune-mediated adverse events (iAEs) may occur during therapy with ICI. This paper focuses on pulmonary iAEs events in therapy with ICI.