White matter lesions of the central nervous system (CNS) are frequently encountered on magnetic resonance imaging (MRI) exams. If the morphologic findings, clinical symptoms and laboratory results are not typical for one of the more common inflammatory CNS diseases, the diagnosis may become challenging, which also means that interesting and sometime emotional discussions may arise. While frequent causes of inflammatory CNS diseases were already discussed in aprevious article, we now focus on more seldom forms and place attention on morphologic characteristics which may help to find the correct diagnosis.

Transarterial chemoembolization (TACE) is used as palliative and neoadjuvant treatment for patients with hepatocellular carcinoma (HCC). TACE should be offered as palliative treatment to patients with intermediate stage large or multinodular HCC if no curative treatment option is available by resection or thermoablation and if extrahepatic metastases and tumor infiltration of main portal and systemic veins has been excluded. TACE is possible only in patients with preserved liver function (Child-PughA-B, best up to 7points) and with good performance status (ECOG0). TACE can be used for bridging and for downstaging prior to liver transplantation with the intention to maintain or reach limited intrahepatic tumor load defined by Milan criteria. TACE should be adapted to the vascularization pattern of the HCC nodules and performed as selective as possible and repetetively if necessary with the goal of complete devascularization of the tumor tissue. Conventional TACE (cytotoxic drugs, iodized oil and embolic particles) and drug-eluting TACE (anthracycline preloaded in microspheres) can be used in acomparable way. During drug-eluting TACE, peripheral concentration of cytotoxic drugs is lower. Using conventional TACE in apalliative setting, survival benefit for patients was 8-11months compared to best supportive care; however, this requires that all known contraindications and other criteria in terms of tumor and liver disease, respectively, associated with negative prognosis be taken into consideration. Better local response is achieved by drug-eluting TACE; however, no related survival benefit was shown compared to conventional TACE so far. Response to neoadjuvant local treatment is associated with improved prognosis after liver transplantation.

The S3guideline on hepatocellular carcinoma has been expanded to include malignant biliary carcinoma (synonym cholangiocarcinoma [CCA]). Magnetic resonance imaging (MRI) with additional magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice to evaluate local findings. Use of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-based contrast agent increases its diagnostic value. Histologic confirmation is always required when diagnosing intrahepatic CCA (iCCA) because using imaging alone there is arisk of confusion with HCC subtypes.

Many pathologies of the mediastinum can be diagnosed using standard radiographs. Correlation of radiographic findings with computed tomography (CT) is instructive for abetter understanding and can help improve detection rates of mediastinal lesions. To identify the most common mediastinal lesions and to correlate their features in chest radiographs and CT. The International Thymic Malignancy Interest Group (ITMIG) classification in the anterior, middle, and posterior mediastinum is based on anatomic landmarks. Used as atool to characterize mediastinal lesions this classification is applied in this article. The most common lesions include mediastinal goiter, germ cell and thymic neoplasms in the anterior mediastinum, lymphadenopathy in the middle mediastinum, and neurogenic neoplasms in the posterior mediastinum. Other lesions of neoplastic or non-neoplastic origin can be distinguished in the three compartments and should be considered in the differential diagnosis. Knowledge of the most common pathologies in the three mediastinal compartments can accelerate differential diagnosis. Understanding the normal mediastinal lines is key in anatomic localization and detection of many lesions in chest radiographs.

HintergrundDas konventionelle Röntgenbild zählt zu den am häufigsten durchgeführten radiologischen Untersuchungen. Seine Interpretation gehört zu den Grundkenntnissen jedes Radiologen.FragestellungZiel dieses Artikels ist es, häufige Zeichen und Muster der Pneumonie sowie Merkmale von Pseudoläsionen im konventionellen Röntgenbild zu erkennen und einen diagnostischen Leitfaden für junge Radiologen zu schaffen.MethodenAnalyse aktueller Studien und Daten sowie eine Übersicht der häufigsten Zeichen und Muster im konventionellen Röntgenbild.ErgebnisseDie Kenntnis über häufige Zeichen und Muster im Röntgenbild bietet eine Hilfestellung in der Diagnostik und kann hinweisend für die Ursache einer Infektion sein. Häufig sind diese Zeichen jedoch unspezifisch und sollten daher immer in klinische Korrelation gesetzt werden. In der Detektion und Beurteilung von pulmonalen Rundherden gewinnt die Computertomographie (CT) durch ihre deutlich höhere Sensitivität in der Primärdiagnostik immer mehr an Bedeutung.SchlussfolgerungDas konventionelle Röntgenbild bildet weiterhin eine führende Rolle in der Primärdiagnostik; der Radiologe sollte jedoch die Limitationen des konventionellen Bildes kennen.

Instabilität und Impingement stellen die Hauptpathomechanismen dar, die bereits bei jungen Patienten durch erhöhten mechanischen Stress zu chondrolabralen Schäden, schmerzhafter Bewegungseinschränkung und frühzeitiger Coxarthrose führen können. Ziele der gelenkerhaltenden Chirurgie an der Hüfte sind die Korrektur der knöchernen Deformitäten und chondrolabraler Schäden sowie die Wiederherstellung der Gelenkfunktion. Voraussetzung dafür ist die Identifikation der ursächlichen Pathologien an der Hüfte, welche zudem in Kombination auftreten können. Die dezidierte Röntgen- und Magnetresonanzbildgebung der knöchernen Morphologie und der degenerativen Gelenkbinnenläsionen liefern einen essenziellen Beitrag für die Behandlungsindikation und die Behandlungsplanung. Der vorliegende Artikel soll einen kurzen Überblick über die Hüftdeformitäten mit deren Prävalenz, Pathomechanismus und indizierter Therapie sowie detaillierte Empfehlungen über die spezifische radiologische Abklärung geben.

Multiple myeloma can affect the complete skeleton, which makes whole-body imaging necessary. With the current assessment of these complex datasets by radiologists, only asmall part of the accessible information is assessed and reported. Depending on the question and availability, computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) is performed and the results are then visually examined by radiologists. Acombination of automatic skeletal segmentation using artificial intelligence and subsequent radiomics analysis of each individual bone have the potential to provide automatic, comprehensive, and objective skeletal analyses. Afew automatic skeletal segmentation algorithms for CT already show promising results. In addition, first studies indicate correlations between radiomics features of bone and bone marrow with established disease markers and therapy response. Artificial intelligence (AI) and radiomics algorithms for automatic skeletal analysis from whole-body imaging are currently in an early phase of development.

Introduction and application of structured reporting in radiology private practice. Ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), digital x‑ray (DR), mammography (MG). Structuring and predefinition of entire reports and report parts. Structured reporting in radiology presumably allows for higher report quality, reproducibility and easier access to data mining. Also the communication with the referring physicians can be improved. Although these advantages are well acknowledged, structured reporting does not prevail in private radiology practices. This article sheds light on the current situation of structured reporting in radiology private practice and provides information for the faltering implementation as well as perspective for individual potential solutions to overcome this situation. Structured reporting is not yet standard. Growing acceptance of structured reporting can be expected. The application of structured reporting can improve report quality. The use of structured reporting should be considered for common examinations.