[Spinal ozone therapy]. / Spinale Ozontherapie.

CLINICAL/METHODOLOGICAL PROBLEM: Technical advances in the field of spinal interventional neuroradiology allow the application of a wide range of targeted, minimally invasive treatment options including targeted spinal ozone therapy for back pain. This article provides an overview of the biochemical, molecular, immunologic, and pharmaceutical mechanisms and delivery techniques of targeted ozone therapy. STANDARD RADIOLOGICAL METHODS: Computed tomography (CT), conventional X­ray (fluoroscopy). PERFORMANCE: Computed tomography-guided interventions (epidural, periradicular, facet joint, and intradiscal) have the highest place value and have historically prevailed. Fluoroscopy-guided procedures may also be used. PRACTICAL RECOMMENDATIONS: Ozone therapy provides promising results. The article is intended to provide information on the basics of the technique(s).

[Spondylodiscitis and epidural abscesses]. / Spondylodiszitis und epiduraler Abszess.

CLINICAL/METHODOLOGICAL PROBLEM: Spondylodiscitis is an inflammation of the intervertebral disc, which in adults is generally associated with spondylitis of the adjacent vertebrae. It often presents clinically with nonspecific symptoms such as back or neck pain. It may be caused by various pathogens, especially bacteria. One or more vertebral segments can be affected. The infection can spread to surrounding compartments and can lead to epidural abscesses. Radiology, in particular magnetic resonance imaging (MRI), plays an important role in the diagnostic work-up and in the follow-up to monitor response to therapy. Treatment consists of conservative (antibiotics) and invasive approaches, including surgery. Interventional puncture and drainage is a promising alternative to surgery, especially in early stages of abscess formation. STANDARD RADIOLOGICAL METHODS: Magnetic resonance imaging (MRI), computed tomography (CT), nuclear medical procedures, conventional x­ray. PERFORMANCE: MRI has the highest value. CT and nuclear medical procedures can be used as a supplement to MRI and in patients with contraindications for MRI. PRACTICAL RECOMMENDATIONS: With adequate diagnosis and therapy, spondylodiscitis has a good prognosis. In addition to targeted or calculated drug therapy, invasive treatment is the main focus, especially for epidural abscesses. Interventional radiological drainage can represent a less invasive alternative to surgical treatment.

[Malignant tumors of the oral cavity]. / Tumoren der Mundhöhle.

CLINICAL/METHODICAL ISSUE: Oral cavity malignancies are the most common tumors in the field of ear, nose and throat medicine or otorhinolaryngology worldwide. It comprises a heterogeneous group of tumors, the knowledge of which is necessary to meet the different requirements of diagnostics and therapy. STANDARD RADIOLOGICAL METHODS: Computed tomography (CT), magnetic resonance imaging (MRI), sonography (US), nuclear medical procedures (NUK). PERFORMANCE: The above-mentioned diagnostics are used in a complementary manner. ACHIEVEMENTS: Early diagnosis of the tumor improves staging and thus the patient's therapy and prognosis. PRACTICAL RECOMMENDATIONS: The radiologist plays an important role in the interdisciplinary treatment of malignant tumors of the oral cavity. Despite great progress in radiotherapy, oncology and immunotherapy, surgery still plays an important role in the treatment of malignant diseases of the oral cavity.

CT follow-up in patients with neuroendocrine tumors (NETs): combined radiation and contrast dose reduction.

Background Frequent computed tomography (CT) follow-ups involve significant radiation related risks for patients with low-grade neuroendocrine tumors (NETs). Contrast agent (CA) application is essential for diagnostic evidence and has additional risks especially in patients with limited renal function. Purpose To investigate if a combination of dose and contrast agent (CA) reduction affects image quality and diagnostic evidence in neuroendocrine tumor (NET) patients. Material and Methods A total of 51 NET patients were enrolled in the study and 153 CT scans were analyzed. Patients underwent a baseline CT scan (A = 120 kVp, filtered back projection [FBP]) and two follow-up CTs (B = 120 kVp, adaptive statistical iterative reconstruction [ASIR] 40%; C1 = 100 kVp, ASIR 40%; C2 = 100 kVp, ASIR 60%; the latter two protocols were applied with a 30% reduction in CA volume). We evaluated image quality and applied dose. Results In C1/2, the combination of low kV (100 kVp) with ASIR 40%/60% reduced the mean applied dose significantly by 28% compared to B and by 57% compared to A. Signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR) of tumor to liver/muscle were significantly increased by using C1/2 compared to B and A. With respect to subjective image quality, a slight loss of diagnostic confidence in C1 could be counterbalanced by the higher ASIR blending in C2. Conclusion Combined dose reduction techniques can be used to reduce radiation dose and CA volume without sacrificing image quality and diagnostic confidence in staging CT of NET patients.

Maniobras quirurgicas en el tratamiento del trauma hepatico. Interrupcion temporal y/o definitiva de la circulacion hepatica. / Surgical procedures in the treatment of hepatic trauma. Temporary or definitive interruption of hepatic circulation.

Se presenta la aplicacion de conceptos de cirugia vascular, en el manejo de la s lesiones traumaticas del higado, en particular en los casos en que los procedimientos habituales (sutura primaria diseccion y sutura, etc.), son insuficientes para controlar la hemorragia. Se recomienda el uso de la maniobra de Pringle durante un minimo de 30 minutos con objeto de identificar los elementos del pediculo hepatico; y la aplicacion del torniquete de Bardic como otra maniobra util, antes de proceder a la interrupcion completa del flujo arterial con la ligadura de la arteria hepatica.