RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
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Review
Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation.
Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE. ⋯ Hemoptyses are life threatening and require urgent diagnostic and therapy. Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE). BAE for the treatment of massive and recurrent hemoptysis is safe and effective. False embolization in spinal branches of BA are the most serious complication of a BAE. Repeatedly BAE refractory cases should undergo elective surgery.
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The following overview provides a summary of the state of the art and research as well as potential clinical applications of cardiovascular PET/MR imaging. PET/MRI systems have been clinically available for a few years, and their use in cardiac imaging has been successfully demonstrated. ⋯ On the other hand, PET/MRI has been used to demonstrate significant pathologies such as acute and chronic myocardial infarction, myocarditis or cardiac sarcoidosis; future applications in clinical routine or within studies appear to be possible. In coming years additional studies will have to be performed to prove diagnostic gain at a reasonable cost-benefit ratio before valid conclusions are possible regarding the clinical utility and future of cardiovascular PET/MR imaging.
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Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension (resting mean pulmonary arterial pressure of 25 mm Hg or more determined at right heart catheterization) with persistent pulmonary perfusion defects. It is a rare, but underdiagnosed disease with estimated incidences ranging from 0.5% to 3.8% of patients after an acute pulmonary embolism (PE), and in up to 10% of those with a history of recurrent PE. CTEPH is the only form of pulmonary hypertension that can be surgically treated leading to normalization of pulmonary hemodynamics and exercise capacity in the vast majority of patients. ⋯ MR imaging is the reference standard for the assessment of right heart function and lung perfusion, the latter delineating typical wedge-shaped perfusion defects in patients with CTEPH. New developments show that with MR techniques, an estimation of hemodynamic parameters like mean pulmonary arterial pressure and pulmonary vascular resistance will be possible. CT and MR imaging should be considered as complementary investigations providing comprehensive information in patients with CTEPH.
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Patellar dislocation is the lateral displacement of the patella from the femoral trochlea. Affected individuals typically have underlying anatomic risk factors of variable magnitude, which, in conjunction with leg rotation, cause the event. Magnetic resonance imaging (MRI) permits straightforward diagnosis of the typical features of recent patellar dislocation: contusion edema of the inferomedial patella and the lateral femoral condyle as well as rupture of the medial patellofemoral ligament. ⋯ The most relevant predisposing variants are trochlear dysplasia, patella alta, and an abnormal tibial tubercle to trochlear groove distance (TT-TG). The radiologist's report should give a quantitative estimate of both the injuries resulting from dislocation and the underlying anatomic risk factors. An accurate characterization of the individual pathomechanism is crucial for tailoring treatment.