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Background Abdominal sarcomas are a heterogeneous group of rare soft tissue tumors and can be localized intraperitoneally or retroperitoneally. A pretherapeutic differentiated subtyping is essential for planning an individual, multimodal treatment concept in an interdisciplinary team of experts. Objective The central aspects of histology acquisition, imaging diagnostics and (molecular) pathological subtyping of abdominal soft tissue sarcomas are described in detail. Material and methods Imaging and pathological diagnostics are depicted based on the German S3 guidelines on adult soft tissue sarcomas, a current literature search and personal experiences at the Sarcoma Center at the National Center for Tumor Diseases in Dresden (NCT/UCC). Results Preoperative imaging and (molecular) pathological subtyping of abdominal soft tissue sarcomas place high demands on surgeons, radiologists and pathologists. Genome analyses of sarcomas have the potential to identify points of attack for individualized treatment options. The limitations of resectability can only be assessed by experienced sarcoma surgeons at specialized centers. Conclusion The treatment of abdominal soft tissue sarcomas at an experienced center is associated with a better prognosis. Even at the first suspicion of an abdominal sarcoma, a referral to an experienced center should be made in order to guarantee optimal expertise in diagnostics and treatment.

Aortoiliac stenosis is common cause of peripheral arterial disease (PAD), which is particularly prevalent in older age ( 60 years) with a prevalence of 20%. In early stages (TASC [Trans-Atlantic Inter-Society Consensus] II A/B), these stenoses can be successfully treated by endovascular procedures. For more complex aortoiliac stenoses (TASC II C/D), open surgical treatment was the primary treatment in the past.Because of the advanced age and multiple comorbidities of PAD patients with complex aortoiliac stenoses, open surgical treatment is usually associated with high risk, and therefore endovascular procedures are an alternative despite their poorer outcome. Covered endovascular reconstruction of the aortic bifurcation (CERAB) aims to improve the primary patency rate compared with the usual endovascular implantation of kissing stents.With regard to the primary patency rate, open surgical treatment remains superior to both endovascular procedures; however, the CERAB technique shows a better 5‑year outcome than the kissing stent technique. No differences are found in the secondary patency rate for any of the three procedures. The morbidity and mortality of the CERAB and kissing stent techniques are comparably low, and both procedures are superior to open surgical treatment.Because of the better long-term outcome of the CERAB versus the kissing stent technique, it should be used in patients with complex aortoiliac stenoses with increased risk of complications expected with open surgical treatment.HINTERGRUND: Die aortoiliakalen Stenosen sind eine häufige Ursache für die periphere arterielle Verschlusskrankheit (PAVK), welche insbesondere im höheren Alter ( 60 Jahre) mit einer Prävalenz von 20 % gehäuft auftritt. In frühen Stadien (TASC [Trans-Atlantic Inter-Society Consensus] II A/B) lassen sich diese Stenosen mittels endovaskulärer Therapieverfahren erfolgreich behandeln. Bei den komplexeren aortoiliaklen Stenosen (TASC II C/D) wurden in der Vergangenheit vornehmlich die offen-chirurgischen Therapieverfahren durchgeführt.Aufgrund des hohen Alters und den multiplen Komorbiditäten der PAVK-Patienten mit komplexen aortoiliaklen Stenosen stellt die offen-chirurgische Therapie meist ein hohes Risiko dar, weshalb die endovaskulären Verfahren trotz ihres schlechteren Outcomes eine Alternative darstellen. Durch die Methode der gecoverten endovaskulären Rekonstruktion der Aortenbifurkation (CERAB) soll die primäre Offenheitsrate gegenüber der üblichen endovaskulären Implantation von Kissing-Stents verbessert werden.Hinsichtlich der primären Offenheitsrate ist die offen-chirurgische Therapie den beiden endovaskulären Verfahren weiterhin überlegen, allerdings zeigt die CERAB-Technik ein besseres 5‑Jahres-Outcome als die Kissing-Stent-Technik. Bei der sekundären Offenheitsrate finden sich bei keinem der 3 Verfahren Unterschiede. Die Morbidität und Mortalität der CERAB- und Kissing-Stent-Technik sind vergleichbar niedrig, beide Verfahren sind der offen-chirurgischen Therapie überlegen.Aufgrund des besseren Langzeit-Outcomes der CERAB- gegenüber der Kissing-Stent-Technik sollte diese bei Patienten mit komplexen aortoiliakalen Stenosen mit einem erhöhten Komplikationsrisiko bei der offenen chirurgischen Versorgung angewandt werden.

Abdominal sarcomas are a heterogeneous group of rare soft tissue tumors and can be localized intraperitoneally or retroperitoneally. A pretherapeutic differentiated subtyping is essential for planning an individual, multimodal treatment concept in an interdisciplinary team of experts.The central aspects of histology acquisition, imaging diagnostics and (molecular) pathological subtyping of abdominal soft tissue sarcomas are described in detail.Imaging and pathological diagnostics are depicted based on the German S3 guidelines on adult soft tissue sarcomas, a current literature search and personal experiences at the Sarcoma Center at the National Center for Tumor Diseases in Dresden (NCT/UCC).Preoperative imaging and (molecular) pathological subtyping of abdominal soft tissue sarcomas place high demands on surgeons, radiologists and pathologists. Genome analyses of sarcomas have the potential to identify points of attack for individualized treatment options. The limitations of resectability can only be assessed by experienced sarcoma surgeons at specialized centers.The treatment of abdominal soft tissue sarcomas at an experienced center is associated with a better prognosis. Even at the first suspicion of an abdominal sarcoma, a referral to an experienced center should be made in order to guarantee optimal expertise in diagnostics and treatment.HINTERGRUND: Abdominelle Sarkome sind eine heterogene Gruppe seltener Weichteiltumoren und können intraperitoneal oder retroperitoneal lokalisiert sein. Eine prätherapeutische, differenzierte Subtypisierung ist zur Planung eines individuellen, multimodalen Therapiekonzeptes im interdisziplinären Expertenteam unabdingbar.Der vorliegende Artikel stellt die zentralen Aspekte der Histologiegewinnung, bildgebenden Diagnostik und (molekular-)pathologischen Typisierung abdomineller Weichteilsarkome dar.Die Darstellung erfolgt orientiert an der deutschen S3-Leitlinie „Adulte Weichgewebesarkome“, einer aktuellen Literaturrecherche und eigener Erfahrungen am Sarkomzentrum am Nationalen Centrum für Tumorerkrankungen Dresden (NCT/UCC) Dresden.Die präoperative bildgebende und (molekular-)pathologische Typisierung abdomineller Weichteilsarkome stellt hohe Ansprüche an Chirurgen, Radiologen und Pathologen. Genomanalysen von Sarkomen haben das Potenzial, Angriffspunkte für individualisierte Therapieoptionen zu identifizieren. Die Grenzen der Resektabilität können nur von erfahrenen Sarkomchirurgen am Zentrum beurteilt werden.Die Behandlung abdomineller Weichteilsarkome am erfahrenen Zentrum geht mit einer besseren Prognose einher. Schon bei Verdachtsdiagnose eines abdominellen Sarkoms sollte eine Überweisung an ein erfahrenes Zentrum erfolgen, um der Komplexität in Diagnostik und Therapie gerecht zu werden.

Die interventionelle Radiologie ist ein noch junges, aber rasant wachsendes und zunehmend differenziertes Teilgebiet der Radiologie. Ihre Methoden finden Eingang in die Therapieoptionen und -leitlinien zahlreicher Tumorerkrankungen. In diesem Ubersichtsartikel werden sowohl diagnostisch-interventionelle Verfahren, wie die bildgesteuerte Biopsie; kurative Methoden, wie die thermoablativen Verfahren der Mikrowellenablation (MWA), Radiofrequenzablation (RFA), der laserinduzierten Thermotherapie (LITT); als auch palliative Interventionen, wie die transarterielle Chemoembolisation (TACE) oder die selektive interne Radiotherapie (SIRT) jeweils mit ihren Indikationen und Komplikationen vorgestellt. Selektive Literaturrecherche in der Datenbank PubMed sowie in wissenschaftlichen Leitlinien unter Einbezug eigener Fallbeispiele und Erfahrungen aus dem eigenen Behandlungskollektiv. Die in der Zielsetzung genannten Verfahren werden methodisch vorgestellt und ihrem aktuellen klinischen Stellenwert zugeordnet. Das Angebot interventionsradiologischer Verfahren in der onkologischen Therapie wird sich aller Voraussicht nach in Zukunft noch mehr erweitern und die bereits etablierten Methoden flachendeckender verfugbar werden.

Aortenerkrankungen konnen je nach Krankheitsbild und Akuitat mit unterschiedlichen bildgebenden Verfahren untersucht werden. Modalitaten und Qualitat der Bildgebung haben sich in den vergangenen Jahren rasant weiterentwickelt. Gemeinsam mit der klinischen Einschatzung eines betroffenen Patienten ist sie wegweisend fur das weitere Management. Neben der eigentlichen Diagnosestellung sind die erhobenen Befunde auch Basis fur die weitere Indikationsstellung, Therapieplanung, Therapiekontrolle und Verlaufsbeurteilung. Wahrend die Katheterangiographie und der intravaskulare Ultraschall nur noch in Ausnahmefallen und dann in Kombination mit einer interventionellen Therapie zur Anwendung kommen, stehen heute Schnittbildverfahren wie die kontrastverstarkte computertomographische Angiographie und die Magnetresonanztomographie im Zentrum der diagnostischen Abklarung. Den sich stetig verbessernden sonographischen Verfahren kommt vor allem im Rahmen von Screeninguntersuchungen, aber auch in der pra- und posttherapeutischen Verlaufsbeobachtung eine immer wichtigere Rolle zu. Therapeutisch relevante Zusatzinformationen konnen mithilfe der molekularen Bildgebung in der Positronenemissionstomographie/Computertomographie gewonnen werden.

Percutaneous transhepatic biliary and gall bladder interventions play an important role in the diagnosis and therapy of biliary tract diseases.With technical success rates up to 99% as well as complications rates up to a maximum of 26% they showed good results. Indications were opacification of the biliary tree as well as treatment of biliary system pathologies, such as drainage and stents.Interventions were used if endoscopic approaches are not possible or exploited. We describe the current state of knowledge and the range for percutaneous biliary/gall bladder interventions and give an overview of technical approaches for fundamental interventional procedures, including percutaneous transhepatic biliary drainage.Percutaneous transhepatic biliary and gall bladder interventions are safe and effective treatments for benign and malignant stenosis, postoperative complications and risk patients with cholecystitis.

Depending on the type and acuteness, diseases of the aorta can be imaged by a variety of techniques. Modalities and quality of imaging have developed rapidly in recent years. In combination with the clinical assessment of patients, the results obtained by imaging determine the further management. They not only establish the underlying diagnosis but provide the information essential for indications, planning and reassessment of therapy, as well as for evaluation of the clinical course and surveillance. Whereas conventional catheter-guided angiography and intravascular ultrasound are only used in exceptional cases and then in conjunction with interventional therapy, cross-sectional imaging modalities, such as contrast-enhanced computed tomography (CT) angiography and magnetic resonance imaging (MRI) are nowadays the mainstay of diagnostics. Ultrasound techniques are improving steadily and are gaining increasing importance, e. g. for screening purposes and for pretherapeutic and posttherapeutic surveillance. Additional information of therapeutic relevance may be acquired by means of molecular imaging with positron emission tomography (PET) CT.

Liver metastases are the most common cause of death in colorectal cancer patients. Nowadays, complete resection is considered to be the only curative treatment but only approximately 25% of patients are suitable candidates for surgery; therefore, many different interventional oncology techniques have been developed in recent years for the treatment of secondary liver metastases. The aim of interventional oncological procedures is either to provide a potentially curative treatment option for locally limited metastases with local ablative techniques, to enable nonresectable tumors to become accessible to surgical or local ablative techniques using transarterial procedures or to achieve improved survival in a palliative setting. These interventional therapies include transarterial approaches, such as chemoembolization and radioembolization as well as a multitude of different ablative techniques, such as radiofrequency and microwave ablation as well as irreversible electroporation (IRE). This article describes the indications for the various procedures and the clinical results of each of these techniques are reviewed based on the currently available literature.

Hintergrund Bei Patienten mit nichtresektablen Lebermetastasen ist ein Ansprechen auf eine Chemotherapie notwendig, um eine Resektion erreichen zu konnen. In Studien korreliert die Ansprechrate wahrend einer neoadjuvanten/Konversionschemotherapie eng mit der Haufigkeit von Metastasenresektionen.

Selective internal radiotherapy (SIRT) is a method for local treatment of primary liver tumors and metastatic liver disease. SIRT is based on the delivery of radioactive labeled microspheres into the vascular bed of the liver via angiographically placed catheters in branches of the hepatic artery. Currently this therapeutic approach is predominantly applied, if surgical resection or other local forms of ablative therapies are not indicated and commonly applied chemotherapy regimen have failed to prevent progression of liver involvement. This article briefly summarizes the pathophysiologic principle of SIRT, addresses the criteria for patient selection, describes how to perform the therapeutic procedure in combination with adjuvant actions and reports on side effects and possible complications. Finally, the results obtained with this therapy are summarized for the most relevant tumor entities and some future perspectives are discussed.

ZusammenfassungFokale Leberläsionen sind unabhängig vom Vorhandensein eines Malignoms ein häufiger Befund. Für ein eventuelles therapeutisches Management ist es dabei erforderlich, die Läsionen eindeutig zu identifizieren und zu charakterisieren. Zur nicht-invasiven Diagnostik stehen die Sonographie, Computertomographie (CT), Magnetresonanztomographie (MRT) und nuklearmedizinische Verfahren zur Verfügung. Die modernen chirurgischen wie auch minimalinvasiven ablativen Verfahren erfordern eine hohe diagnostische Präzision, die insbesondere von der CT und MRT gewährleistet wird. Darüber hinaus gewinnt die Positronenemissionstomographie (PET) gerade beim Staging und der Therapiekontrolle zunehmend an Bedeutung, was umso mehr für die kombinierten PET-CT Scanner gilt, die die hohe Sensitivität der PET mit der Ortsauflösung der CT vereinen.Bei der Abklärung fokaler Leberläsionen müssen neben der Leistungsfähigkeit der einzelnen Untersuchungsmethoden das Spektrum möglicher Läsionen im Kontext der jeweiligen Grunderkrankung des Patienten berücksichtigt werden.

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies worldwide. Besides liver transplantation, which is only feasible in few patients and surgical resection, the scope of potential treatment options has considerably expanded in recent years. Thermoablative therapies are now well established in early HCC due to the low rate of complications and short hospital stay. The disadvantage of higher relapse rates compared to surgical resection will be further diminished through technical advances regarding radiofrequency ablation and microwave ablation, as well as growing experience of users and thorough multidisciplinary selection of potential candidates for thermoablative therapy.

For patients with non-resectable liver metastases a response to chemotherapy is necessary in order to be able to achieve resection. Studies have shown that the response rate during neoadjuvant conversion chemotherapy is closely correlated with the frequency of resection of metastases.Assessment of the response in clinical studies is based on the RECIST criteria. These criteria are supplemented by questions on the prognosis, tumor symptoms and toxicity for decisions on therapy. For assessment of resectability, the functional residual liver tissue and prognostic factors are important.Regular imaging controls are necessary for guiding therapy in order to avoid a continuation of chemotherapy in cases of tumor progression. Chemotherapy is normally terminated when resectability has been achieved in order to avoid additional (liver) toxicity. Morphological criteria for response to therapy (e.g. mRECIST) can be more sensitive for assessing the effects of individual therapeutic procedures but are not established for guiding systemic therapy or for comparison with other therapeutic procedures.

The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.

CLINICAL ISSUE OF THORACIC ANEURYSMS: Aneurysms are among the most common diseases affecting the thoracic aorta, with a continuous increase in incidence over the recent decades. The main cause of thoracic aneurysms is atherosclerosis, which, due to the frequent lack of major symptoms and the potentially lethal complications such as ruptured aortic aneurysm, remains a challenge in clinical practice.CT angiography remains the imaging method of choice for acute aortic aneurysms, with MR angiography being increasingly used for follow-up imaging. THRESHOLD FOR TREATMENT: In the ascending aorta a diameter larger than 5-5.5 cm (descending aorta 6.5 cm) is regarded as the threshold for treatment. THORACIC ENDOVASCULAR AORTIC REPAIR: The continuous evolution of aortic stent grafting (i.e., thoracic endovascular aortic repair [TEVAR]) since Parodi, Palmaz and Dake has led to a steep rise in stent grafting procedures in recent years.Particularly in elderly patients with multiple comorbidities, TEVAR is a valuable, less invasive option compared to open surgical repair.

Die interdisziplinare Leitlinie der Qualitat S3 zur Diagnose und Therapie des hepatozellularen Karzinoms (HCC) ist ein evidenz- und konsensbasiertes Instrument, um die Diagnostik und Therapie des HCC zu verbessern, da die Diagnostik und Therapie des HCC ein auserst diffiziles Vorgehen erfordert. Es ist die Aufgabe der Leitlinie, dem Patienten (mit Verdacht auf HCC oder nachgewiesenem HCC) angemessene, wissenschaftlich begrundete und aktuelle Verfahren in der Diagnostik, Therapie und Rehabilitation anzubieten. Dies gilt sowohl fur die lokal begrenzte oder lokal fortgeschrittene Erkrankung als auch bei Vorliegen eines Rezidivs oder von Fernmetastasen. Die Leitlinie soll neben dem Beitrag fur eine angemessene Gesundheitsversorgung auch die Basis fur eine individuell zugeschnittene, qualitativ hochwertige Therapie bieten. Mit den erklarenden Hintergrundtexten ist es auch nicht spezialisierten, mitbehandelnden Kollegen moglich, den Patienten uber das Vorgehen der Spezialisten, Nebenwirkungen und Ergebnisse gut zu beraten. Mittel- und langfristig sollen so die Morbiditat und Mortalitat von Patienten mit HCC gesenkt und die Lebensqualitat erhoht werden.

In patients with acute thrombo-embolic occlusion of the superior mesenteric artery, catheter-assisted thrombolytic therapy represents a procedure of increasing importance in addition to surgery and intensive care treatment. The thrombolytic drugs utilized for this purpose are urokinase, streptokinase and recombinant tissue plasminogen activator (rtPA).Therapeutic embolization is predominantly used in the treatment of arterial bleeding from the gastro-intestinal tract, the liver, the intestines (due to an aneurysm or vascular malformation) and in bleeding from intestinal anastomoses. Polyvinyl alcohol particles, embospheres, gelfoam and microcoils can be utilized as embolic agents. Percutaneous transhepatic cholangiodrainage and stent implantation are applied in patients with biliary obstructions caused by inoperable tumors of the gall bladder or bile ducts, of the pancreatic head or duodenum and by metastases located in the liver parenchyma or hepatic hilum.Image-guided percutaneous drainage is a valuable option in the management of abscesses in the peritoneal cavity; less common indications are lymphoceles, biliomas, urinomas, hematomas, necrosis and pseudocysts.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in the world. The majority of HCCs develops on the basis of a chronic liver disease. This often complicates diagnosis and therapy. Non-invasive diagnostic criteria are based on dynamic imaging techniques and the serum level of AFP (alpha-fetoprotein). When evaluating HCC patients for therapy, besides tumor burden and localisation, the therapeutic evaluation must also consider the general condition of the patient and his/her liver function. For this purpose, the BCLC algorithm of the Barcelona Clinic for Liver Disease has proven helpful. Only one-third of the patients can be cured by resection, transplantation or local tumour ablation. In locally advanced cases transarterial procedures including transarterial chemoembolisation and radioembolisation are applied. HCC is a chemo-resistant tumour and chemotherapy is not accepted as standard of care in HCC. Sorafenib is the first systemic treatment with proven efficacy approved for the treatment of advanced and metastatic HCC. Interdisciplinary management of HCC patients is essential in order to provide every patient with the optimal therapy at his specific stage of disease.

Die Selektive Interne Radiotherapie ( SIRT) wird zur Behandlung von primarem Leberkrebs und Lebermetastasen verschiedener Primartumoren eingesetzt. Es liegt noch keine nennenswerte Erfahrung bei der Behandlung von cholangiolaren Karzinomen vor. Die SIRT ist vor allem dann indiziert, wenn chirurgisches Vorgehen, lokal ablative Masnahmen (Radiofrequenzablation, RFA) nicht indiziert sind oder wenn Chemotherapien keinen Erfolg mehr zeigen oder kontraindiziert sind.

Selective internal radiation therapy (SIRT) is used for the treatment of patients with liver tumors, especially for those with hepatocellular carcinoma (HCC) or liver metastases from various primary tumors. Currently this innovative treatment concept is recommended when established state-of-the-art treatment regimes have failed and tumor progression is noted or if the treatment has to be abandoned because of intolerable toxic effects. For SIRT small biocompatible microspheres (SIR-Spheres(R)) are labelled with the radioactive isotope 90Yttrium, a pure beta emitter, and are superselectively infused into the hepatic arteries. The microspheres are collected in the precapillary vessels in and surrounding the tumor. The beta radiation of 90Yttrium has an average penetration in tissue of approximately 2.5 mm and results in very high doses of radiation being selectively targeted to metastases providing protection to the surrounding healthy liver tissue. In this paper we review the results of SIRT in patients with hepatic metastases from colorectal cancer, breast cancer, neuroendocrine tumors and primary liver cancer (HCC).

In the last two decades image-guided interventional catheterizations and percutaneous ablative regional treatment procedures have revolutionized the therapy of nonresectable primary and secondary liver tumours. A distinction is made between chemoablative procedures and thermo- and radioablative procedures. The main chemoablative interventions are transarterial infusion chemotherapy (HAIC; hepatic arterial infusion chemotherapy) and transarterial (chemo-)embolization (TACE/TAE). The object of the transarterial treatment procedures is to deliver the highest possible concentration of a chemotherapy agent or combination of chemotherapy agents directly into the tumour by way of the blood vessels supplying it, while at the same time keeping the systemic effects of the drugs as small as possible. Transarterial chemoperfusion to the liver can be applied in the treatment of all primary and secondary hepatic tumours, but the main indications are hepatocellular carcinoma (HCC) and metastases from colorectal primary tumours.

Lung tumors and pulmonary metastases together are the most common cause of cancer-related death in men and the second most frequent in women. Up to now, surgical resection has remained the gold standard in the treatment of pulmonary tumors, being the only treatment option that was potentially curative and offered the possibility of a significant increase in life expectancy after successful therapy. Over the past decade, percutaneous radiofrequency ablation (RFA) has gained worldwide acceptance in the treatment of primary and secondary tumors of the liver with curative intent, so that indications for RFA have been extended to embrace tumors in other organs, e.g. the lung. Since the first case results were described, the number of publications dealing with the treatment of lung tumors using thermal ablative therapies has increased significantly. The aims of the present article are to give a short overview of emerging therapies such as cyberknife surgery and also, especially, to describe the indications for and technique of RFA, to discuss the ideal method of follow-up, and to highlight possible complications of the therapy and the current results of RFA of primary and secondary lung tumors. In addition, the value of combining RFA with other therapy modes (especially chemotherapy and radiation therapy)is briefly treated.

The encouraging preliminary results of radioembolization therapy in hepatocellular carcinoma and liver metastases from colorectal cancer have suggested that this mode of therapy could also be successful in breast and neuroendocrine metastases from colorectal cancer. (90)Yttrium microspheres in combination with radiosensitizing agents and growth factor inhibitors present opportunities to evaluate its application in combinatorial treatment paradigms with modern chemotherapy regimens. Other randomized trials are needed in hepatocellular carcinoma, to compare radioembolization with (90)yttrium against transarterial chemoembolization, bland embolization, drug-eluting beads, and best supportive care. A further potential research area besides the application of radioembolization for extrahepatic tumors is the determination of quality of life in randomized studies comparing radioembolization with systemic chemotherapy regimens with or without percutaneous radiation therapies.

Percutaneous vertebroplasty (PVP) represents a minimally invasive option which is gaining in importance for the treatment of vertebral compression fractures (VCF) and osteolysis of the spine. This article describes the indications for its use, peri-interventional imaging, technique, and results of PVP.The current guidelines for performance of PVP are explained in accordance with the "Interdisciplinary Consensus Paper on Vertebroplasty and Kyphoplasty" of the German Professional Associations and the 2005 CIRSE Guidelines. The results of our own study carried out in 2002 are compared to the complication rates and clinical outcomes reported in the literature.Painful osteoporotic VCF and osteolysis within the vertebral body due to metastases and multiple myeloma are indications for PVP. Absolute contraindications are, in particular, asymptomatic VCF, alleviation of pain by drug treatment, therapy-refractory coagulopathies, allergies to cement components, and active infections. MRI or CT is indicated before undertaking PVP to assess the fracture age, to exclude other causes of pain, and to evaluate the posterior edge of the vertebral body. High-quality mono- or biplanar fluoroscopy--preferably in combination with CT (fluoroscopy)--is necessary for PVP to minimize the risk of cement leakage. A clear reduction in pain [mean reduction of 6.1 points (VAS)] is achieved in 86-92% of the patients with PVP. Our own study treating 58 patients (mean follow-up 323+/-99 days) revealed a clear alleviation of pain in 77% [-5.7 points (VAS)].PVP constitutes a safe and effective minimally invasive treatment approach to stabilize and reduce acute and chronic back pain due to osteoporotic VCF and tumor-associated osteolysis.

Percutaneous catheter interventions are performed increasingly often for the purposes of both diagnosis and therapy. The incidence of local complications reported after transfemoral catheterization in the literature is 0.1-9%. Such complications should be detected as early and reliably as possible, and sonography is a good means of finding them during follow-up, not least because it is suitable for use in examinations at the bedside. The clinical value of sonography compared with other examination techniques is made clear with reference to specimen cases.

Reimbursement for inpatient services rendered based on comparable daily care rates, case-based flat rates, and special fees as practiced until now has been replaced by the system of diagnosis-related groups. Up until 2004, operation and procedure system (OPS 301) codes could be processed completely automatically by appropriate adaptation of the radiology information system (RIS). Because of further differentiation of OPS codes in the 2005 version, it is no longer possible to unambiguously determine OPS codes automatically. Our goal was to fulfill these additional requirements with as little extra effort as possible. In 36 of 2138 procedures during an observation period of 12 days, i.e., 4/day, manual input on the part of the radiology technical assistant and quality assurance by the diagnosing physician were necessary. This is only needed in complicated procedures for which the minor added effort is negligible in comparison to the entire effort expended for the procedure. We were thus able to achieve the goal of near automation of ascertaining OPS codes.

The accurate evaluation of carotid artery stenoses is important for therapeutic decision making. Catheter digital subtraction angiography (DSA) still represents the gold standard, while the advent of multislice CT (MSCT) has led to improved temporal and spatial resolutions of CTA.In a pilot study, we investigated 14 diseased vessels in 9 symptomatic patients (7m, 2f; mean age 60.7+/-10,9 years) comparing biplanar DSA with standardized 16-slice MS-CTA. The degree of stenosis was evaluated in a consensus reading following modified NASCET criteria.DSA demonstrated 4 occlusions, 5 high-grade stenoses (70%) and 5 lower-grade stenoses (70%). One dissecting, infrapetrous stenosis was not adequately quantified by CTA due to a close topographic relation to the skull base. In the carotid bifurcation (n=13), an excellent correlation was demonstrated between DSA and CTA with a correlation coefficient of 0.99.MS-CTA has a good diagnostic potential in the evaluation of carotid artery stenoses. Larger studies will need to demonstrate the relative diagnostic value for different subtypes of stenosis and for different reader experience levels.

Radiofrequency ablation (RFA) of primary and secondary liver malignancies is a promising and rapidly evolving technique, which increasingly gains importance. A new field of RFA is the minimal invasive therapy of osseous and soft tissue tumors. In the management of osteoid-osteoma, RFA is a well established treatment option. Basic principles, indications, complications and results of RFA will be presented. A careful evaluation of indications for RFA in osseous or soft tissue neoplasms is mandatory. In patients who are neither candidates for surgical tumor resection nor respond to chemotherapy, there is a need for alternative treatment options. In these preselected patients a substantial improvement in quality of life with low associated morbidity can be provided by RFA. In malignancies of bone and soft-tissue tumors, RFA is a palliative treatment option. Therefore, the results can not be compared to those of surgical resection or chemotherapy which essentially are employed with curative intention. Our own experiences as well as data published in the literature indicate that RFA is a helpful tool in preserving patient's quality of life. The high technical and clinical success together with a low complication rate makes RFA of osseous and soft tissue neoplasms a valuable supportive tool for patients not referable for surgery or systemic therapy.

Radiofrequency ablation is increasingly used to treat tumors "beyond the liver". The aim of this article is to perform a structured and critical review of the current literature concerning RFA of the lung and to compare these results with our own experience.16 patients with tumors or metastases of the lung were treated in our institution within 18 months. 8 of these 16 patients were treated in a multicenter trial. For this article we compared our results to the results of all publications concerning RFA of the lung since 1995.8 of our 16 patients were not included in the international multicenter trial and were followed-up at least 15 months. Within this observation period, 2 of 8 patients had recurrence of the tumors while in 6 patients no recurrence was detected. Lee et al. published a study with 30 patients. In 10 of these 30 patients RFA was performed in a curative intention with a therapeutical success in 8 of 10 patients after one year.Radiofrequency ablation of lung tumors smaller than 3 cm appears to be an alternative to surgical removal. Moreover, RFA offers a higher quality of life for the patients due to a low morbidity and mortality. However, more studies with longer observation periods are necessary for a definite conclusions.

Osteoporotic vertebral compression fractures are a frequently encountered clinical problem. We aimed to perform a critical, structured review of the current literature and to compare the results with our own experiences.A structured review of 7 studies about vertebroplasty in osteoporotic compression fractures was performed; each study assessed at least 16 patients and was published in English since 1997. The results were compared to our own experience in 22 patients treated in 2002.Over the past decade, vertebroplasty has increasingly been performed for the treatment of painful osteoporotic vertebral body compression fractures. In good correlation with our own results, all authors reported a significant improvement of pain immediately after treatment and a reduction of pain of up to 90% within 24 h after vertebroplasty. Furthermore, a significant reduction in the use of analgetics and a substantial improvement of functional status has been described in recent studies. In our own evaluation, we were also able to demonstrate a significant improvement of pain after vertebroplasty in 17 of 22 (77%) of our patients. 18 of 22 (82%) patients were able to diminish or even discontinue their analgesic medication.Reported results for vertebroplasty have demonstrated a rapid improvement in pain and physical functioning in patients with osteoporotic vertebral compression fractures. Percutaneous vertebroplasty has proven to provide a valuable treatment option for osteoporotic vertebral compression fractures.

Percutaneous vertebroplasty (pv) is a worldwide increasingly performed interventional therapeutic procedure. This article addresses indications, patient preparation, technical requirements and approach as well as possible complications of percutaneous vertebroplasty.Percutaneous vertebroplasty is a technique consisting in an injection of bone cement into a vertebral body under imaging guidance. This procedure is performed to relief pain and support the mechanical stability in partially collapsed vertebral bodies.In the management of spinal compression fractures secondary to osteoporosis, myeloma, osteolytic metastases and aggressive hemangiomas, percutaneous vertebroplasty yields analgesic effect, and provides additional fortification in weakened segments of the vertebral column. Contraindications include major bleeding disorders, radicular pain and pain caused by compression of the myelon.Percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, using correct technique, pv is a safe and effective procedure for treating pain, caused either by osteoporotic or malignant vertebral compression fractures.

Intracranial aneurysms are a common pathology faced by the diagnostic radiologist in daily practice. They can present as symptomatic aneurysms with a subarachnoid hemorrhage or as an incidental finding in another radiological study. Moreover, clipped or coiled aneurysms sometimes require a postinterventional work-up to exclude residual perfusion. Previous studies assessing the value of CT angiography in the diagnosis of intracranial aneurysms have been conducted using single slice spiral CT-scanners. They have shown a limited sensitivity in the diagnosis of small aneuryms with a diameter of equal to or smaller than 3 mm.Presently, there is only limited experience regarding the use of multi-detector row CT (MDCT) in the diagnosis of intracranial aneurysms. We have examined eight patients with a total of eleven aneurysms with MDCT technology, five patients with a 4-slice MDCT and three with a 16-slice MDCT. Of these, five were untreated aneurysms and six posttherapeutic with a status post surgical clipping. The mean diameter of the aneurysms was 5 mm (range 2 to 13 mm, median 3 mm). Of the treated aneuryms, two showed residual perfusion of the aneurysmal neck with a diameter of 2 and 6 mm respectively. In all cases, MDCT-angiography was in full agreement with the DSA diagnosis. Studies on larger patient populations will need to demonstrate the value of CTA in the diagnosis of intracranial aneurysms compared to the reference standard DSA.

The newly developed 16-slice multi detector row computed tomography (MDCT) allows for isotropic imaging at rotation times under 500 ms. We aim to describe our first experiences with this novel technology in the diagnostic imaging of the craniocervical vascular system.The craniocervical vascular system of 8 consecutive patients was examined with a standardized protocol with the new 16-slice MDCT. The volume covered included the carotid arteries from their origin at the aortic arch and the intracranial arterial and venous vessels in their entirety. Homogeneity of contrast, contrast-to-parenchyma ratios, image quality and radiation doses were assessed.A homogeneous vessel-to-parenchyma ratio was reached in the carotids as well as in the intracranial arterial and venous vessels. Image quality was rated as excellent in all patients. The estimated mean effective radiation dose amounted to 2.31 mSv +/-0.57, the mean dose length product to 608 mGy*cm +/-151.The newly developed 16-slice MDCT technology appears to be a promising tool in the diagnostic assessment of the cervicocranial vessels.