Homeostasis of the sebaceous gland and mechanisms of acne pathogenesis.

BACKGROUND: Sebaceous glands (SGs) are appendages of mammalian skin that produce a mixture of lipids known as sebum. Acne vulgaris is an exceptionally common skin condition, characterized by elevated sebum production, altered sebum composition, and the formation of infundibular cysts, called comedones. Comedo-associated SGs are atrophic, suggesting that comedo formation involves abnormal differentiation of progenitor cells that generate the SG and infundibulum: the 'comedo switch'. Understanding the biological processes that govern SG homeostasis promises to highlight potential aetiological mechanisms underlying acne and other SG-associated skin disorders. RESULTS: In this review, we discuss the clinical data, genetic mouse models and in vitro research that have highlighted major hormones, paracrine factors, transcription factors and signalling pathways that control SG homeostasis. These include, but are not limited to androgens, progestogens and oestrogens; retinoids; receptor tyrosine kinases such as ErbB family receptors, fibroblast growth factor receptor 2 and insulin/insulin-like growth factor 1 receptors; peroxisome proliferator-activated receptor γ; aryl hydrocarbon receptor; and the Wnt signalling pathway. Where possible, the cellular and molecular mechanisms by which these regulatory factors control SG biology are indicated, along with considerations as to how they might contribute to acne pathogenesis. CONCLUSIONS: Future research should seek to establish the relative importance, and causative relationships, of altered sebum production, sebum composition, inflammation and abnormal differentiation of sebaceous progenitors to the process of comedo formation in acne. Such an understanding will allow for therapeutic targeting of regulatory factors that control SG homeostasis, with the aim of treating acne.

Intestinal insulin/IGF1 signalling through FoxO1 regulates epithelial integrity and susceptibility to colon cancer.

Obesity promotes the development of insulin resistance and increases the incidence of colitis-associated cancer (CAC), but whether a blunted insulin action specifically in intestinal epithelial cells (IECs) affects CAC is unknown. Here, we show that obesity impairs insulin sensitivity in IECs and that mice with IEC-specific inactivation of the insulin and IGF1 receptors exhibit enhanced CAC development as a consequence of impaired restoration of gut barrier function. Blunted insulin signalling retains the transcription factor FOXO1 in the nucleus to inhibit expression of Dsc3, thereby impairing desmosome formation and epithelial integrity. Both IEC-specific nuclear FoxO1ADA expression and IEC-specific Dsc3 inactivation recapitulate the impaired intestinal integrity and increased CAC burden. Spontaneous colonic tumour formation and compromised intestinal integrity are also observed upon IEC-specific coexpression of FoxO1ADA and a stable Myc variant, thus suggesting a molecular mechanism through which impaired insulin action and nuclear FOXO1 in IECs promotes CAC.

Percutaneous irreversible electroporation of hepatocellular carcinoma: Contrast-enhanced ultrasound-findings during 1-year follow-up.

PURPOSE: To assess the postprocedure findings after percutaneous irreversible electroporation (IRE) of hepatocellular carcinoma (HCC) in contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS: Percutaneous IRE was performed in a total of 22 patients with 24 HCC tumours following interdisciplinary tumour board review. The lesions were documented using CEUS before, immediately and within 24 hours after IRE. During follow-up CEUS was performed at 6 weeks and 3, 9, and 12 months after ablation. Two experienced radiologists evaluated the acquired CEUS image date in a consensus reading. RESULTS: Median tumour size before treatment was 13.7±4.8 mm (short axis) and 16.0±5.2 mm (long axis). All HCC lesions showed arterial hyperenhancement in CEUS. Median size of the ablation defect after ablation was 29.3±5.2 mm (short axis) and 31.6±5.6 mm (long axis). After IRE all tumours showed complete devascularization. The size of the ablation defects showed significant shrinkage and reduced peripheral enhancement in the course of follow-up. At 12 months follow-up the ablation defect size decreased to 16.7±4.3 mm (short axis) and 18.3±4.1 mm (long axis). CONCLUSION: CEUS showed a complete devascularization of HCC tumours after IRE. Post-intervetional peripheral enhancement returned to normal during follow-up and may represent zones of reversible damage of cellular integrity through electroporation. A significant shrinkage of the ablation defects during 12 month of follow-up was seen in all cases.

Low Tube Voltage Liver MDCT with Sinogram-Affirmed Iterative Reconstructions for the Detection of Hepatocellular Carcinoma.

Aim of this study was to compare low tube voltage computed tomography (80 kV) of the liver using iterative image reconstruction (SAFIRE) with standard computed tomography (120 kV) using filtered back-projection (FBP) for the detection of hepatocellular carcinoma (HCC). 46 patients (43 men) with 93 HCC confirmed by 3 T MRI with Gd-EOB-DPTA, in inconclusive cases combined with contrast-enhanced ultrasound, underwent dual-energy CT. The raw data of the 80 kV tube was reconstructed using the iterative reconstruction algorithm SAFIRE with two strengths (I3 and I5). The virtual 120 kV image data set was reconstructed using FBP. The CT images were reviewed to determine the lesion-to-liver contrast (LLC), the lesion contrast-to-noise ratio (CNR) and the sensitivity. The LLC (57.1/54.3 [I3/I5] vs. 34.9 [FBP]; p ≤ 0.01), CNR (3.67/4.45 [I3/I5] vs. 2.48 [FBP]; p < 0.01) and sensitivity (91.4%/88.2% [I3/I5] vs. 72.0% [FBP]; p ≤ 0.01) were significantly higher in the low-voltage protocol using SAFIRE. Therefore, low tube voltage CT using SAFIRE results in an increased lesion-to-liver contrast as well as an improved lesion contrast-to-noise ratio compared to FBP at 120 kV which results in a higher sensitivity for the detection of HCC.

[Acceptance of medical apps and e­books among German radiologists]. / Akzeptanz von Medizin-Apps und E­Books unter deutschen Radiologen.

PURPOSE: Smartphones, tablet PCs, mobile applications (apps) and electronic book files (e-books) affect our lives in private and job-related settings. The aim of this study was to analyze the behavior of radiologists on smartphones, tablet PCs and e­books and to investigate its effect on their daily work. MATERIALS AND METHODS: An online survey containing of 23 questions was conducted using Survey Monkey© ( www.surveymonkey.com ). The invitation to the survey was done using the newsletter of the German Radiological Society (DRG). The acquired data was automatically stored by the software and then analyzed using descriptive statistics. RESULTS: In total, 104 radiologists (29% female) participated in the online survey. Of these, 93% and 96.5% owned a smartphone or a tablet PC, respectively, and 72% and 67% used medical apps and e­books, respectively. Through their use, 31% found moderate and 41% found enormous improvement in their daily work. A majority of participating radiologists would be willing to pay an increased user fee for optimized apps or e­books. CONCLUSION: With currently only moderate individual benefit of mobile medical apps and e­books, there is a widespread need for optimally configured apps and e­books with a correspondingly high market potential. KEY POINTS: (1) Radiologists use smartphones (93%) or tablet PCs (96.5%); (2) 72% of radiologists use a smartphone or tablet PC for medical material; (3) 53% of radiologists report significant assistance from or a high value of the mobile medical applications used; (4) There is a willingness to pay a license fee for optimized mobile applications or e­books.

Percutaneous Irreversible Electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors.

Aim of this retrospective analysis was to evaluate the survival times after percutaneous irreversible electroporation (IRE) in inoperable liver tumors not amenable to thermal ablation. 71 patients (14 females, 57 males, median age 63.5 ± 10.8 years) with 103 liver tumors were treated in 83 interventions using IRE (NanoKnife® system). The median tumor short-axis diameter was 1.9 cm (minimum 0.4 cm, maximum 4.5 cm). 35 patients had primary liver tumors and 36 patients had liver metastases. The Kaplan-Meier method was employed to calculate the survival rates, and the different groups were compared using multivariate log-rank and Wilcoxon tests. The overall median survival time was 26.3 months; the median survival of patients with primary land secondary liver cancer did not significantly differ (26.8 vs. 19.9 months; p = 0.41). Patients with a tumor diameter >3 cm (p < 0.001) or more than 2 lesions (p < 0.005) died significantly earlier than patients with smaller or fewer tumors. Patients with hepatocellular carcinoma and Child-Pugh class B or C cirrhosis died significantly earlier than patients with Child-Pugh class A (p < 0.05). Patients with very early stage HCC survived significantly longer than patients with early stage HCC with a median survival of 22.3 vs. 13.7 months (p < 0.05).

Evaluation of a robotic system for irreversible electroporation (IRE) of malignant liver tumors: initial results.

OBJECTIVE: Comparison of conventional CT-guided manual irreversible electroporation (IRE) of malignant liver tumors and a robot-assisted approach regarding procedural accuracy, intervention time, dose, complications, and treatment success. METHODS: A retrospective single-center analysis of 40 cases of irreversible electroporation of malignant liver tumors in 35 patients (6 females, 29 males, average age 60.3 years). Nineteen of these ablation procedures were performed manually and 21 with robotic assistance. A follow-up (ultrasound, CT, and MRI) was performed after 6 weeks in all patients. RESULTS: The time from the planning CT scan to the start of the ablation as well as the dose-length product were significantly lower under robotic assistance (63.5 vs. 87.4 min, [Formula: see text]; 2132 vs. 4714 mGy cm, [Formula: see text]). The procedural accuracy, measured as the deviation of the IRE probes with respect to a defined reference probe, was significantly higher using robotic guidance (2.2 vs. 3.1 mm, [Formula: see text]). There were no complications. There was one incomplete ablation in the manual group. CONCLUSION: Robotic assistance for IRE of liver tumors allows for faster procedure times with higher accuracy while reducing radiation dose as compared to the manual placement of IRE probes.

Microwave ablation of large HCC lesions: Added value of CEUS examinations for ablation success control.

PURPOSE: To assess the value of dynamic contrast enhanced ultrasound (CEUS) for the detection of residual tumor tissue day 1 after microwave ablation (MWA) of large hepatocellular carcinoma (HCC) compared to MRI. MATERIAL AND METHODS: 30 consecutive patients (5 females, 25 males, mean age 64 years, age range 54-73 years) with an untreated HCC lesion larger than or equal to 3 cm underwent percutaneous MWA between 03/2014 and 04/2016. 1 patient was excluded because of an artificial pacemaker. All remaining 29 patients underwent 3-T MRI with liver-specific contrast agent and CEUS 1 day after ablation to detect residual tumor tissue. The 6-week follow-up including CEUS and MRI was defined as the reference standard. RESULTS: Complete ablation was achieved in 23 of 29 treated lesions (79%). The sensitivities and specificities for the detection of residual tumor tissue on day 1 were 100% and 83% for CEUS and 87% and 67% for MRI resp. without the differences being statistically significant. CONCLUSION: CEUS allows a reliable assessment of therapeutic success of percutaneous ablation of large HCC lesions one day after the ablation. Its ability to visualize reactive periablation perfusion changes in real-time might be of advantage in the depiction of residual tumor tissue when compared to MRI imaging alone.

Percutaneous irreversible electroporation (IRE) of prostate cancer: Contrast-enhanced ultrasound (CEUS) findings during follow up.

PURPOSE: Irreversible electroporation (IRE) is a focal non-thermal ablation technique that can be used to treat prostate cancer (Pca). The objective was to document the evolution of the volume of the prostate gland and the ablation zone after IRE of Pca. MATERIAL AND METHODS: A retrospective analysis of the image findings of CEUS 1 day, 6 weeks, 3 months and 6 months after IRE of 25 patients was conducted. The prostate gland volumes and the size of the ablation zones were documented. Changes in volume and size over time were calculated. RESULTS: There was a significant volume reduction of the prostate gland in the first 3 months after ablation. The mean percentage change after 6 weeks was 34.3% with another decrease of 35.0% after 3 months. Volume did not change between month 3 and 6. Size of ablation zone measured in short- and long-axis significantly diminished until 6 months after ablation. CONCLUSION: CEUS showed a significant involution of the prostate gland during the first 3 months and a significant decrease of the ablation zone during the first 6 months after IRE of prostate cancer.

Chronic liver disease: Quantitative MRI vs CEUS-based microperfusion.

PURPOSE: To compare the diagnostic performance of MRI-based T1 relaxometry with dynamic contrast-enhanced ultrasound (CEUS)-based liver microcirculation for evaluation of liver function. MATERIALS AND METHODS: 22 patients underwent Gd-EOB-DTPA-enhanced MRI with T1 relaxometry and previous or consecutive CEUS examinations. A transverse 3D VIBE sequence with an inline T1 calculation was acquired and the reduction rate of T1 relaxation time (rrT1) was evaluated. For CEUS measurements (1-6 MHz), a bolus injection of 1.4 ml sulfur hexafluoride microbubbles were administered and both cine loops and single images from arterial phase up to late phase were stored.Quantification of time to peak (TTP), rise time (RT), Wash- In Area Under the Curve (WiAUC), mean transit time (mTTI), the wash- in rate (WiR) and Wash-in perfusion index (WIPI)) was performed using a novel quantification software (VueBoxTM). To compare quantification parameters, patients were classified in patients representing a healthy population (rrT1 > 50%, n = 8) and those representing patients with liver disease (rrT1 < 50%, n = 14). RESULTS: Comparing perfusion parameters TTP, mTTI, and WiR were higher in patients without liver disease compared to patients with impaired liver function (p = 0.10-0.21). RT, WiAUC and WIPI were significantly lower in patients with impaired liver function (RT, 14.8±1.5 s; WiAUC, 17288±6179 a.u., WIPI, 1243±423) compared to patients without liver disease (RT, 21.2±2.6 s, p = 0.032; WiAUC, 71534±25600, p = 0.034; WIPI, 4286±1748, p = 0.04). In a simple linear regression model, none of the perfusion parameters correlated significantly with rrT1 (p = 0.08-0.63). CONCLUSION: Within the framework of this study, CEUS-based perfusion parameters were not able to assess severity of liver disease, however, WiAUC, RT and WIPI were significant perfusion parameters to make a rough assessment of liver function.

Robot-assisted microwave thermoablation of liver tumors: a single-center experience.

PURPOSE: To evaluate and compare the needle placement accuracy, patient dose, procedural time, complication rate and ablation success of microwave thermoablation using a novel robotic guidance approach and a manual approach. METHODS: We performed a retrospective single-center evaluation of 64 microwave thermoablations of liver tumors in 46 patients (10 female, 36 male, mean age 66 years) between June 2014 and February 2015. Thirty ablations were carried out with manual guidance, while 34 ablations were performed using robotic guidance. A 6-week follow-up (ultrasound, computed tomography and MRI) was performed on all patients. RESULTS: The total procedure time and dose-length product were significantly reduced under robotic guidance (18.3 vs. 21.7 min, [Formula: see text]; 2216 vs. 2881 mGy[Formula: see text]cm, [Formula: see text]). The position of the percutaneous needle was more accurate using robotic guidance (needle deviation 1.6 vs. 3.3 mm, [Formula: see text]). There was no significant difference between both groups regarding the complication rate and the ablation success. CONCLUSION: Robotic assistance for liver tumor ablation reduces patient dose and allows for fast positioning of the microwave applicator with high accuracy. The complication rate and ablation success of percutaneous microwave thermoablation of malignant liver tumors using either CT fluoroscopy or robotic guidance for needle positioning showed no significant differences in the 6-week follow-up.

Percutaneous irreversible electroporation (IRE) of prostate cancer: Contrast-enhanced ultrasound (CEUS) findings.

PURPOSE: To evaluate the use of contrast-enhanced ultrasound (CEUS) after irreversible electroporation (IRE) of prostatic cancer tissue to assess the ablation status by depicting microvascularisation in the ablation area. MATERIALS AND METHODS: Retrospective evaluation of CEUS of 13 patients (mean age: 61.4 ± 7.5 years) with histologically confirmed prostatic cancer who underwent percutaneous IRE. In the course of clinical routine, the tumor lesions were documented before, immediately after, and 1 day after the ablationusing color-coded transabdominal and transrectal CEUS. The obtained image data (DICOM loops and images) were subsequently evaluated by 2 experienced radiologists and assessed with regard to micro vascularisation by means of a 5-point scale. RESULTS: CEUS images showed significantly reduced microcirculation of the lesions (mean 0.9 ± 0.6 cm (0.5-1.5 cm) after IRE. Microcirculation was reduced from 2.15 ± 0.56 prior to ablation to 0.65 ± 0.63 (p <  0.001) immediately after the ablation and to 0.27 ± 0.44 one day after IRE (p <  0.001). CONCLUSION: This study showed rapid and significant reduction of the microcirculation in the ablation area afterpercutaneous IRE of prostatic cancer tissue.

Chronic liver disease: Correlation of CEUS-based microperfusion and indocyanine green clearance.

PURPOSE: To evaluate whether changes of dynamic contrast-enhanced ultrasound (CEUS)-based liver microcirculation during chronic liver disease are correlated with the extent of impaired liver function, expressed by the indocyanine green (ICG) clearance. MATERIALS AND METHODS: 19 patients underwent CEUS examinations with previous or consecutive ICG clearance test. The ICG plasma disappearance rate (ICG-PDR) was determined using the noninvasive pulse-densitometric LiMON system. Quantification of peak enhancement (PE), rise time (RT) and the wash-in rate (WiR) was performed in the liver parenchyma (ROIliver) as well as in the portal vein (ROIportal vein) using a novel quantification software (VueBoxTM). To compare quantification parameters, patients were classified in patients representing a healthy population (ICG-PDR >16, n = 8) and those representing patients with liver disease (ICG-PDR ≤16, n = 11). RESULTS: ROIportal vein showed significant differences comparing healthy patients and patients with liver disease for all perfusion parameters: PE and WiR were significantly higher in patients without liver disease (p = 0.048; p = 0.039). RT was significantly lower in healthy population (p = 0.039). Comparing perfusion parameters for ROIliver, PE was significantly higher in patients without liver disease (p = 0.039). There was no significant difference for RT (p = 0.804) and WiR (p = 0.058), respectively. CONCLUSION: Within the framework of this study CEUS derived estimation of microcirculation did not prove to be a reliable estimator of liver function. RT, PE and WiR measured in the portal vein were significant perfusion factors in predicting liver function.

Percutaneous treatment of symptomatic superior mesenteric vein stenosis using self-expanding nitinol stents.

PURPOSE: To evaluate the technical and clinical success of percutaneous superior mesenteric vein (SMV) stenting in symptomatic patients using self-expanding nitinol stents. METHODS: We retrospectively analyzed the technical and clinical success of percutaneous SMV stenting of 6 symptomatic patients (3 men, mean age 67 years, range 48-81 years). Stenosis of the SMV was caused by postoperative stricture (n=3), pancreas carcinoma (n=1) and pancreatitis (n=2). As a result of the stenosis, 3 patients had symptomatic ascites, 2 patients showed signs of mesenteric ischemia and 1 patient had recurrent gastrointestinal bleeding. Stenting was performed by a percutaneous transhepatic approach using self-expanding nitinol stents. RESULTS: Stenting of the SMV was technically and clinically successful in all patients. No peri-interventional complications occurred. The stent diameters ranged from 6 to 14 mm. During the mean follow-up of 6 months (range, 2-10 months) 1 patient presented early stent occlusion 2 weeks after placement. CONCLUSION: Stenting of a symptomatic SMV stenosis using self-expanding nitinol stents is feasible and clinically effective.

Magnetic resonance imaging of the sacroiliac joints in patients with suspected spondyloarthritis--comparison of turbo spin-echo and gradient-echo sequences for the detection of structural alterations.

PURPOSE: Magnetic resonance imaging (MRI) is the method of choice for the evaluation of spondyloarthritis (SpA). According to the guidelines of the Assessment of Spondyloarthritis International Society (ASAS) and Outcome Measures in Rheumatology (OMERACT), MRI findings in SpA of the spine and the sacroiliac joints (SIJ) are classified as inflammatory and structural alterations. Modern gradient-echo sequences (GRE) are recommended for optimized detection of structural alterations of the SIJ. We assess the benefit of GRE in the detection of structural alterations of the SIJ in comparison to conventional turbo spin-echo sequences (TSE). MATERIAL AND METHODS: Retrospective study of 114 patients who received MRI of the SIJ for the evaluation of SpA. Structural alterations of the SIJ were assessed by two blinded readers separately for T1 TSE and T2* GRE. The findings were classified according to a previously published chronicity score separately for both sides and sequences. Interobserver reliability was calculated with Cohen's Kappa, and the significance of findings was assessed with the Wilcoxon test. P-values <0.05 were required for statistical significance. RESULTS: 68 of 114 (60%) patients showed SpA-typical findings of the SIJ. The average chronicity score for GRE (score 3.3) was significantly higher than for TSE (score 2.6), p=0.001. The Kappa-values for the interobserver reliability were 0.86-0.90 without any statistically significant differences between both sides and sequences. CONCLUSION: Both T1 TSE and T2* GRE showed a high interobserver reliability in the detection of structural alterations in patients with SpA. However, T2* GRE detected significantly more structural alterations than T1 TSE and should be an integral part of a modern MRI protocol for the diagnostic workup of patients with suspected SpA. KEY POINTS: T2* gradient-echo sequences are superior to T1 turbo spin-echo sequences in the detection of structural SI-joint alterations.

Magnetic resonance imaging of the sacroiliac joints in patients with suspected spondyloarthritis - comparison of turbo spin-echo and gradient-echo sequences for the detection of structural alterations.

PURPOSE: Magnetic resonance imaging (MRI) is the method of choice for the evaluation of spondyloarthritis (SpA). According to the guidelines of the Assessment of Spondyloarthritis International Society (ASAS) and Outcome Measures in Rheumatology (OMERACT), MRI findings in SpA of the spine and the sacroiliac joints (SIJ) are classified as inflammatory and structural alterations. Modern gradient-echo sequences (GRE) are recommended for optimized detection of structural alterations of the SIJ. We assess the benefit of GRE in the detection of structural alterations of the SIJ in comparison to conventional turbo spin-echo sequences (TSE). MATERIAL AND METHODS: Retrospective study of 114 patients who received MRI of the SIJ for the evaluation of SpA. Structural alterations of the SIJ were assessed by two blinded readers separately for T1 TSE and T2* GRE. The findings were classified according to a previously published chronicity score separately for both sides and sequences. Interobserver reliability was calculated with Cohen's Kappa, and the significance of findings was assessed with the Wilcoxon test. P-values < 0.05 were required for statistical significance. RESULTS: 68 of 114 (60 %) patients showed SpA-typical findings of the SIJ. The average chronicity score for GRE (score 3.3) was significantly higher than for TSE (score 2.6), p = 0.001. The Kappa-values for the interobserver reliability were 0.86 - 0.90 without any statistically significant differences between both sides and sequences. CONCLUSION: Both T1 TSE and T2* GRE showed a high interobserver reliability in the detection of structural alterations in patients with SpA. However, T2* GRE detected significantly more structural alterations than T1 TSE and should be an integral part of a modern MRI protocol for the diagnostic workup of patients with suspected SpA.

S3 guideline for chronic pancreatitis - diagnosis, classification and therapy for the radiologist.

UNLABELLED: Chronic pancreatitis shows an increasing prevalence and incidence mainly in the Western Hemisphere. Early diagnosis and therapy are frequently delayed because of non-specific symptoms as well as non-specific blood values. The German Society of Digestive and Metabolic Diseases (DGVS) organized the preparation and publication of an interdisciplinary S3 level guideline with the support of the German Radiological Society (DRG) as 1 of 11 contributing societies. In this article we present and discuss the main topics of the guideline regarding the diagnosis, differential diagnosis and therapy of complications of this complex chronic disease with a focus on clinical and scientific radiologists. KEY POINTS: • Ultarsound represents the perfect first line imaging modality • For further diagnostic werk up MRI with MRCP are recommended for the differential diagnosis of pancreatic cancer • For clinical studies the modified (CT, MRI) Cambridge classification is recommended.

Clinical significance of conventional rib series in patients with minor thoracic trauma.

BACKGROUND: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. METHODS: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. RESULTS: We included 669 patients (61.4 % men, 38.6 % women, median age: 51 years, range: 13 - 92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5 %) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5 %) patients. Considering the 157 patients with fractured ribs, 73 (46.8 %) had a single fracture, 38 (24.4 %) and two fractures and 45 (28.8 %) had more than two fractures. When assessing the 405 CRs, we detected 69 (17 %) fractures while the corresponding RS of the same patients revealed 87 (21.5 %) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1 % received medical therapy, while 64.5 % of those patients without a radiologically documented fracture also received therapy (p = 0.25). CONCLUSION: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated by CR to exclude fracture-associated complications such as hemo- and pneumothorax.

Single-phase percutaneous recanalization of malignant bile duct obstructions with a covered stent graft.

PURPOSE: The aim of this study was to evaluate the benefit of a percutaneous transhepatic biliary drainage (PTCD) endoprothesis in the case of patients with malignant occlusion of the common bile duct (CBD). MATERIALS AND METHODS: 32 patients (mean age 72 ±â€Š13 years) were treated with an endoprosthesis (VIABIL; M. L. GORE & ASSOCIATES, INC., USA) due to failed attempts of endoscopic retrograde cholangiopancreatography (ERCP) in the case of malignant occlusion of the CBD. RESULTS: The technical success rate was 96.9 %. In one patient the probing of an intrahepatic bile duct was impossible. Two major complications (bleeding, liver abscess) were successfully treated with appropriate measures. The bilirubin level did not significantly decrease immediately after intervention (13.2 ±â€Š6.5 mg/dl; p > 0.05). However, the follow-up displayed a highly significant decrease of bilirubin to 6.0 ±â€Š7.4 mg/dl; p < 0.05). The endoprosthesis was extended with bare metal NITINOL stents in 9 patients. The mean survival time of the patient group was 64 ±â€Š28 days (range 2 - 250  days). CONCLUSION: The implantation of an endoprosthesis proved to be an option with high technical success, a low complication rate and good benefit in our patients with malignant bile duct obstruction in palliative therapy situations. KEY POINTS: • The primary objective in the case of malignant bile duct obstruction is the treatment of jaundice.• After failed endoscopic recanalization of the bile ducts, transhepatic biliary drainage is desirable.• An ePTFE-FEP covered endoprothesis is a good treatment option in palliative situations.• A single-stage procedure shortens hospitalization time.

Transarterial chemoembolization - status quo in Germany.

PURPOSE: Against the background of the current preparation of the national disease management guideline for the diagnosis and treatment of hepatocellular carcinoma (HCC), the German Society for Interventional Radiology (DEGIR) launched a statewide survey in order to evaluate the current status of transarterial chemoembolization (TACE) in Germany. MATERIALS AND METHODS: In April 2012 an e-mail questionnaire relating to TACE practices in patients with intermediate-stage HCC was sent to all chief physicians of interventional radiology departments in Germany that were members of DEGIR. RESULTS: 96 questionnaires were completed and evaluated statistically. The most frequent combinations of embolic agents and cytotoxic drugs are drug-eluting beads combined with doxorubicin or epirubicin as well as lipiodol plus doxorubicin, epirubicin or cisplatin. 60 % of the interventionalists prefer superselective chemoembolization. In most cases more than one chemoembolization per patient is performed (95.5 %). The most common (77 %) time interval between two interventions ranges between one and two months. CONCLUSION: The results of this survey show the often stated criticism in Germany regarding the substantial differences in TACE protocols and highlight the importance of standards of practice for TACE in patients with HCC.